Response to ‘When Disaster Strikes: Death of a Living Organ Donor’

Abstract

To the Editor: Drs. Ratner and Sandoval (1Ratner LE Sandoval PR When disaster strikes: Death of a living organ donor.Am J Transplant. 2010; 10: 2577-2581Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar) recently offered living donor safety recommendations relating to the national Organ Procurement and Transplantation Network (OPTN), operated under federal contract by United Network for Organ Sharing (UNOS). At its most recent meeting, the OPTN/UNOS Board of Directors endorsed five key priority goals for future policy development; one of these is to optimize the health and safety of living donors. This is a priority the entire field of transplantation must uphold. In 2006, the Health Resources and Services Administration of the US Department of Health and Human Services clarified the OPTN’s authority to develop policies to protect the health and safety of living donors. The OPTN has since established several key processes or initiatives. They include the following: •Specific requirements for OPTN designation of member living donor kidney and liver programs, including qualifications of key personnel and a requirement for an independent donor advocate;•Voluntary guidance to address procedures for living donor evaluation and informed consent;•A requirement for centers to report living donor deaths or organ failure within 72 h of becoming aware of the event; the OPTN then reviews these events for issues of policy compliance or threats to public health or safety;•A requirement for centers to submit living donor follow-up data for 2 years, as well as addition of data fields to assess living donor outcomes;•Site reviews of living donor programs and solicitation of living donor best practices. We agree more can (and must) be done to reduce living donor morbidity and mortality to the lowest possible level. We also agree the tragic occurrence of living donor deaths or major complications should engender greater sharing among all transplant programs of lessons learned, to further reduce risk for future donors. We support transparency regarding medical adverse events as the most effective means to improve medical safety. The recommendation to study donor ‘near miss’ events and share lessons with the transplant community is of particular interest. The OPTN/UNOS Operations and Safety Committee advocates a similar process for all living donor and transplant patient safety issues within the OPTN’s purview. As a model, we have studied national processes for aviation safety reporting. That system separates reporting and data analysis for voluntary process improvement versus enforcement of regulation. We are exploring the challenges to develop such a mechanism within the authority of the OPTN. Additional clinical or administrative practices that may guard against adverse living donor outcomes remain within the purview of transplant practitioners. The OPTN and UNOS have established a process to work with the American Society of Transplant Surgeons, the American Society of Transplantation and NATCO, the Organization for Transplant Professionals, to guide the development of OPTN initiatives as they affect clinical practice. We believe this is a key opportunity to leverage the expertise and commitment of the OPTN and the clinical practice community to improve outcomes for all who risk their own life and well-being for the benefit of others. The author of this manuscript has no conflicts of interest to disclose as described by the American Journal of Transplantation.