Altruistic Donation Research Articles

Financial aspects of organ procurement from deceased donors in the USA-Relevance to xenotransplantation.

When clinical xenotransplantation is introduced, the costs associated with acquisition of a genetically engineered pig organ are as yet unknown. How will these costs compare with those currently associated with the acquisition of deceased human organs? An understanding of the financial aspects of deceased organ and tissue procurement in the USA is therefore worthwhile. We have therefore attempted to review certain economic aspects of non-profit and for-profit organizations that provide cadaveric organs and/or tissues for purposes of transplantation into patients with end-stage organ failure, cellular deficiencies, or in need of reconstructive procedures. We briefly consider the laws, organizations, and business practices that govern the acquisition, processing, and/or distribution of cadaveric organs and tissues, and the economic implications of industry practices. In particular, we explore and highlight what we perceive as a lack of transparency and oversight with regard to financial practices, and we question whether donor families would be entirely happy with the business environment that has developed from their altruistic donations. Until xenotransplantation becomes established clinically, which will negate the need for any system of organ procurement and allocation, we suggest that those involved in organ and cell transplantation, as well as those who participate in reconstructive surgery, should take responsibility to ensure that the financial practices associated with procurement are transparent, and overseen/regulated by a responsible authority. We suggest the major transplant societies should take a lead in this respect. The ability to acquire a genetically engineered pig organ whenever required through a simple commercial transaction (as in the acquisition of a life-saving drug) will be greatly to the patient's benefit.

Give and let live

Would you sacrifice one of your kidneys to save the life of someone you've never met? Clare Wilson goes in search of the altruistic organ donors

Altruistic and Selfish Motivations of Charitable Giving: Case of the Hometown Tax Donation System

In Japan’s hometown tax donation system, people can donate to municipalities where they are not resident and in return receive reciprocal gifts from the local governments of those municipalities. A large part of the donated amount can be deducted from their income and residence taxes. This study examined altruistic and selfish motivations in donating money to municipalities where people are not resident through that donation system; we did so using panel data of local governments for 2008–2015. We made the following key findings: (1) The Great East Japan earthquake increased the amount of money donated through that system for local governments with disaster victims. We considered that motivation altruistic. (2) A 1% increase in expenditure for gifts to donors led to a 0.61% increase in donations. We considered that motivation selfish. (3) Compared with donors not receiving gifts, providing gifts to donors led to a reduction in altruistic donations by almost 300%.

MP30-10 GLOBAL KIDNEY EXCHANGE: STRIVING FOR TRIFECTA OUTCOMES IN MANAGEMENT OF KIDNEY FAILURE

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II1 Apr 2017MP30-10 GLOBAL KIDNEY EXCHANGE: STRIVING FOR TRIFECTA OUTCOMES IN MANAGEMENT OF KIDNEY FAILURE Obi Ekwenna, Ty Dunn, Susan Rees, Jeffrey Rogers, Christian Kuhr, Alvin Roth, Laurie Reece, Kimberly Krawiec, Samay Jain, David Fumo, Christian Marsh, Alejandro Cicero, Jonathan Kopke, Miguel Tan, Puneet Sindhwani, Siegfredo Paloyo, and Michael Rees Obi EkwennaObi Ekwenna More articles by this author , Ty DunnTy Dunn More articles by this author , Susan ReesSusan Rees More articles by this author , Jeffrey RogersJeffrey Rogers More articles by this author , Christian KuhrChristian Kuhr More articles by this author , Alvin RothAlvin Roth More articles by this author , Laurie ReeceLaurie Reece More articles by this author , Kimberly KrawiecKimberly Krawiec More articles by this author , Samay JainSamay Jain More articles by this author , David FumoDavid Fumo More articles by this author , Christian MarshChristian Marsh More articles by this author , Alejandro CiceroAlejandro Cicero More articles by this author , Jonathan KopkeJonathan Kopke More articles by this author , Miguel TanMiguel Tan More articles by this author , Puneet SindhwaniPuneet Sindhwani More articles by this author , Siegfredo PaloyoSiegfredo Paloyo More articles by this author , and Michael ReesMichael Rees More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.943AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While organ shortage is the major limitation to kidney transplantation in the developed world, in resource poor countries, financial barriers prevent kidney transplantation much more often—even when willing living kidney donors are available. Global Kidney Exchange (GKE) is a unique approach that allows mutual benefit between patients-donor pairs in rich and poor nations who face barriers to transplantation. METHODS We propose that the cost difference between dialysis and transplantation in some countries would allow the exchange of kidneys between developed world patient/donor pairs with immunological barriers and developing-world patient/donor pairs with financial barriers to transplantation. RESULTS Through the GKE 3 BT-O donors (2 from the Philippines and 1 from Mexico) were identified. Three Non-simultaneous extended altruistic donors (NEAD) chain were identified with each US BT-A non-directed donor (NDD) with no match in a regional kidney paired donation (KPD) pool. A US NDD or bridge donor donated to a foreign recipient creating a chain of kidney transplants. So far a total of 27 kidney transplants have been generated, with each chain producing 12, 9 and 6 transplants respectively. The blood type of the 27 GKE recipients were BT-0 in 14, BT-A in 9, and BT-B in 4. Of the 27 GKE recipients, 10 had a PRA of 0-20%, 11 had a PRA of 21-79%, and 6 had a PRA of >80%. Two of the chains remain open at this time with bridge donors awaiting donation, with the potential to extend the number of total transplants. The transplant cost for each foreign recipient was paid for by Philanthropy. An additional, $50,000 was reserved for subsequent immunosuppression for follow-up of the foreign donor/recipient pair. The cost saving from transplanting 24 U.S patients compared with the cost of dialysis will exceed $7.3 million over a 5 year period. At most recent follow-up all patients have excellent renal function. CONCLUSIONS GKE is an innovative approach that achieves the trifecta (cost reduction, quality of life improvement, and assess to kidney transplant) in the management of all patients with End-stage renal disease by providing increased opportunities for transplantation for all blood types and levels of sensitization © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e393 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Obi Ekwenna More articles by this author Ty Dunn More articles by this author Susan Rees More articles by this author Jeffrey Rogers More articles by this author Christian Kuhr More articles by this author Alvin Roth More articles by this author Laurie Reece More articles by this author Kimberly Krawiec More articles by this author Samay Jain More articles by this author David Fumo More articles by this author Christian Marsh More articles by this author Alejandro Cicero More articles by this author Jonathan Kopke More articles by this author Miguel Tan More articles by this author Puneet Sindhwani More articles by this author Siegfredo Paloyo More articles by this author Michael Rees More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Mobile Health in Solid Organ Transplant: The Time Is Now.

Despite being in existence for >40 years, the application of telemedicine has lagged significantly in comparison to its generated interest. Detractors include the immobile design of most historic telemedicine interventions and the relative lack of smartphones among the general populace. Recently, the exponential increase in smartphone ownership and familiarity have provided the potential for the development of mobile health (mHealth) interventions that can be mirrored realistically in clinical applications. Existing studies have demonstrated some potential clinical benefits of mHealth in the various phases of solid organ transplantation (SOT). Furthermore, studies in nontransplant chronic diseases may be used to guide future studies in SOT. Nevertheless, substantially more must be accomplished before mHealth becomes mainstream. Further evidence of clinical benefits and a critical need for cost-effectiveness analysis must prove its utility to patients, clinicians, hospitals, insurers, and the federal government. The SOT population is an ideal one in which to demonstrate the benefits of mHealth. In this review, the current evidence and status of mHealth in SOT is discussed, and a general path forward is presented that will allow buy-in from the health care community, insurers, and the federal government to move mHealth from research to standard care.

Feasibility of an altruistic sperm donation program in Canada: results from a population-based model

BackgroundStringent donor-screening criteria and legislation prohibiting payment for donor gametes have contributed to the radical decline of donor insemination (DI) using sperm provided by Canadian men. Thus, many individuals rely on imported sperm. This paper examines the feasibility of an altruistic sperm donation (ASD) program to meet the needs of Canadians.MethodsUsing Canadian census data, published literature and expert opinions, two population-based, top-down mathematical models were developed to estimate the supply and demand for donor sperm and the feasibility of an ASD program.ResultsIt was estimated that 63 donors would pass Canadian screening criteria, which would provide 1,575 donations. The demand for DI by women was 7,866 samples (4,319 same sex couples, 1,287 single women and 2,260 heterosexual couples).ConclusionConsiderable effort would be necessary to create the required increase in awareness of the program and change in societal behaviour towards sperm donation for an ASD program to be feasible in Canada.

Past, present and future of kidney paired donation transplantation in India.

One third of healthy willing living kidney donors are rejected due to ABO blood group incompatibility and donor specific antibody. This increases pre-transplant dialysis duration leading to increased morbidity and mortality on the kidney transplantation waiting list. Over the last decade kidney paired donation is most rapidly increased source of living kidney donors. In a kidney transplantation program dominated by living donor kidney transplantation, kidney paired donation is a legal and valid alternative strategy to increase living donor kidney transplantation. This is more useful in countries with limited resources where ABO incompatible kidney transplantation or desensitization protocol is not feasible because of costs/infectious complications and deceased donor kidney transplantation is in initial stages. The matching allocation, ABO blood type imbalance, reciprocity, simultaneity, geography were the limitation for the expansion of kidney paired donation. Here we describe different successful ways to increase living donor kidney transplantation through kidney paired donation. Compatible pairs, domino chain, combination of kidney paired donation with desensitization or ABO incompatible transplantation, international kidney paired donation, non-simultaneous, extended, altruistic donor chain and list exchange are different ways to expand the donor pool. In absence of national kidney paired donation program, a dedicated kidney paired donation team will increase access to living donor kidney transplantation in individual centres with team work. Use of social networking sites to expand donor pool, HLA based national kidney paired donation program will increase quality and quantity of kidney paired donation transplantation. Transplant centres should remove the barriers to a broader implementation of multicentre, national kidney paired donation program to further optimize potential of kidney paired donation to increase transplantation of O group and sensitized patients. This review assists in the development of similar programs in other developing countries.

Anonymous Altruistic Living Kidney Donation in the US: Reality and Practice

Living kidney donors have emerged as the best option to overcome the severe shortage of transplantable kidneys. A growing number of these living donor kidneys come from anonymous altruistic donors who are not related to the recipients according to UNOS data. This study examines the process of anonymous altruistic kidney donation and identifies barriers and variance in transplant center practices. Using a mock patient caller, 73 transplant centers were contacted and asked about the process of altruistic anonymous kidney donation and then scored using objective and subjective metrics. We use SRTR data to measure the relationship between altruistic donation and transplant volume, competition, and quality and scored responses as subjective (how nice and responsive the person was) and objective (follow up, etc). Sixty-seven of the 73 transplant centers contacted perform anonymous altruistic donations. The mean subjective score was 53.60, and the mean objective score was 53.88. A majority of centers were willing or highly willing to answer questions (56.8%), but more than half (56.8%) answered them inadequately or used jargon. Models including a center's characteristics (competition, waitlist and transplant volume and quality measures) were capable of significantly predicting which programs would have higher objective (C-stat 0.846) and subjective scores (C-stat 0.749). The process for anonymous altruistic donation is highly variable by center. These inconsistencies in practice can potentially lead to confusion, public misperception and discourage motivated individuals from donation.

Debt Relief for Poor Countries: Conditionality and Effectiveness

This paper studies the effectiveness of debt relief to stimulate economic growth in the most heavily indebted poor countries. We develop a neoclassical framework with a conflict of interest between the altruistic donor and the recipient government, and model conditionality as an imperfectly enforceable dynamic contract. In contrast to the recent practice of fully cancelling debt, optimal incentive‐compatible conditionality is accompanied by a concessionality level that implies a combination of subsidized loans and outright grants. The optimal concessionality level depends on the recipient's access to international financial markets and on the strength of the conflict of interest. Incentive‐compatible transfers with optimal concessionality levels generate substantial welfare gains. If the donor does not implement the optimal concessionality level and provides subsidized loans only, then the effectiveness of transfers decreases in the long run with severe welfare implications. In contrast, transfers are less effective in the short run if the donor offers outright grants only.

Donor insemination: Israel as a representative case of a competitive market examining the possibility of policy reform.

To measure the private and social benefits of donor insemination (DI). An empirical model investigates the general public and DI clients' willingness to pay (WTP) for DI, and the willingness of potential donors to become altruistic or paid sperm donors. The general public and DI clients value DI and have a positive WTP for it, whereas willingness to donate, altruistically or for payment, is either low or very low. The general public's and DI clients' WTP for DI is in average above actual cost, so the government should consider funding or subsidizing DI. The government should encourage altruistic gamete donation through information and education of all parties involved directly and indirectly in the process of donation whose ultimate goal is the birth of a child.

“One man's trash is another man's treasure”: Nephrectomy patients as altruistic transplant donors

“One man's trash is another man's treasure”: Nephrectomy patients as altruistic transplant donors

A Signal of Altruistic Motivation for Foreign Aid

Abstract: We develop a stylized theoretical model showing that countercyclical transfers from a wealthy donor to a poorer recipient generate a signal of altruistic donor motivation. Applying the model to OECD foreign aid (ODA) data we find the signal present in approximately one-sixth of a large set of donor–recipient pairs. We then undertake two out-of-model exercises to validate the signal: a logit regression of signal determinants and the growth effects of ODA from signal-positive pairs are compared to non-signal bearers. The logit indicates our signal meaningfully distinguishes donor–recipient pairs by characteristics typically associated with altruism. The growth exercise shows ODA from signal bearers displays stronger reverse causation and more positive long-run effects. Beyond foreign aid, our signal of altruistic motivation may be applicable to a wide range of voluntary transfers.

Altruism or obligation? The motivations and experience of women who donate oocytes to known recipients in assisted conception treatment: an interpretative phenomenological analysis study

Introduction: This qualitative study was conducted to explore the motivations and experience of oocyte donors donating to women known to them.Methods: Three women who donated oocytes to a close relative were interviewed and data were analysed using an Interpretative Phenomenological Analysis approach.Results: The two key elements noted were “motivations for donation” and “coping with the consequences of oocyte donation”. The motivation for donation was influenced by the familial bond that was strengthened by the donation process in some cases. The concept of altruistic oocyte donation stemmed from the narratives of giving the gift of motherhood and gaining a positive self-image and respect from others. Coping with the consequences of oocyte donation tests the donor identity, their wishes for a positive outcome, concerns regarding disclosure of biological motherhood and detachment from the egg and potential child.Discussion: Motivation is influenced by a combination of factors including the rewards of altruistic behaviour, the existence and potential strengthening of the relationship between donor and recipient, but possibly also, a sense of obligation and societal expectations. Oocyte donation can be variously viewed by donors as a unique way of reproductive empowerment or an example of acceding to subtle coercion and thus disempowerment. The study also highlights the clinical as well as ethical importance of providing support services for oocyte donors and recipients.

A Look-Ahead Strategy for Non-Directed Donors in Kidney Paired Donation.

While there is a growing need for kidney transplants to treat end stage kidney disease, the supply of transplantable kidneys is in serious shortage. Kidney paired donation (KPD) programs serve as platforms for candidates with willing but incompatible donors to assess the possibility of exchanging donors, thus opening up new transplant opportunities for these candidates. In recent years, non-directed (or altruistic) donors (NDDs) have been incorporated into KPD programs beginning chains of transplants that benefit many candidates. In such programs, making optimal decisions in transplant exchange selection is of critical importance. With the aim of improving the selection of chains beginning with an NDD, this paper introduces a look-ahead multiple decision strategy to select chains, that are easy to extend in the future. Simulation studies are adopted to assess performance of this strategy. Taking into account the extensibility of chains increases the number of realized transplants.

Iranian kidney market in limbo: a commentary on “The ambiguous lessons of the Iranian model of paid living kidney donation”

Sigrid Fry-Revere's The Kidney Sellers: A Journey of Discovery in Iran, an allegedly first-hand examination of the Iranian paid kidney donation model, has been criticized by Koplin in an essay formerly published in the Monash Bioethics Review. Koplin especially challenges Fry-Revere's claim that financially compensating kidney vendors might facilitate altruistic kidney donation. The current situation in Iran, according to Koplin, suggests that the market model has undermined altruistic donation. On this point, this commentary tries to show that healthcare policymakers in Iran no longer see the Iranian paid kidney donation model as a sustainable and ethically justifiable status quo. Briefly touching on the criticisms that have been made even by some positive commentators of the Iranian model, this commentary aims to call attention to the fact that the current dynamic within healthcare policymaking in Iran seeks primarily to decrease its reliance on the organ market instead of revising and modifying it. This complicates the plausibility of any kind of extrapolation, replication or extracting empirical support from the Iranian model to create organ markets in other countries, for example, as Fry-Revere suggests to conduct a trial of a financially incentivized kidney donation scheme in the US. The conclusion is that the Iranian healthcare system should tackle the organ shortage through increasing altruistic living and postmortem kidney donations. This might also provide, finally, a space for conducting extensive and long-term follow-up studies on well-being, satisfaction and social integration of Iranian kidney vendors.

Altruistic Kidney Donation – International perspectives on motives and attitudes: A systematic review

Altruistic Kidney Donation – International perspectives on motives and attitudes: A systematic review

Utilization of Deceased Donor Kidneys to Initiate Living Donor Chains.

We propose that some deceased donor (DD) kidneys be allocated to initiate nonsimultaneous extended altruistic donor chains of living donor (LD) kidney transplants to address, in part, the huge disparity between patients on the DD kidney waitlist and available donors. The use of DD kidneys for this purpose would benefit waitlisted candidates in that most patients enrolled in kidney paired donation (KPD) systems are also waitlisted for a DD kidney transplant, and receiving a kidney through the mechanism of KPD will decrease pressure on the DD pool. In addition, a LD kidney usually provides survival potential equal or superior to that of DD kidneys. If KPD chains that are initiated by a DD can end in a donation of an LD kidney to a candidate on the DD waitlist, the quality of the kidney allocated to a waitlisted patient is likely to be improved. We hypothesize that a pilot program would show a positive impact on patients of all ethnicities and blood types.

BARTERING FOR A COMPATIBLE KIDNEY USING YOUR INCOMPATIBLE, LIVE KIDNEY DONOR: LEGAL AND ETHICAL ISSUES RELATED TO KIDNEY CHAINS.

Kidney chains are a recent and novel method of increasing the number of available kidneys for transplantation and have the potential to save thousands of lives. However, because they are novel, kidney chains do not fit neatly within existing legal and ethicalframeworks, raising potential barriers to their full implementation. Kidney chains are an extension of paired kidney donation, which began in the United States in 2000. Paired kidney donations allow kidney patients with willing, but incompatible, donors to swap donors to increase the number of donor/recipient pairs and consequently, the number of transplants. More recently, transplant centers have been using non-simultaneous, extended, altruistic donor ("NEAD") kidney chains--which consist of a sequence of donations by incompatible donors--to further expand the number of donations. This Article fully explains paired kidney donation and kidney chains and focuses on whether NEAD chains are more coercive than traditional kidney donation to a family member or close friend and whether NEAD chains violate the National Organ Transplant Act's prohibition on the transfer of organs for valuable consideration.

Demographic Characteristics of Non-directed Altruistic Kidney Donors in the United States

Demographic Characteristics of Non-directed Altruistic Kidney Donors in the United States

Assessment of Potential Live Kidney Donors and Computed Tomographic Renal Angiograms at Christchurch Hospital.

Aims. To examine the outcome of potential live kidney donors (PLKD) assessment program at Christchurch Hospital and, also, to review findings of Computed Tomographic (CT) renal angiograms that led to exclusion in the surgical assessment. Methods. Clinical data was obtained from the database of kidney transplants, Proton. Radiological investigations were reviewed using the hospital database, Éclair. The transplant coordinator was interviewed to clarify information about PLKD who did not proceed to surgery, and a consultant radiologist was interviewed to explain unfavorable findings on CT renal angiograms. Results. 162 PLKD were identified during the period January 04–June 08. Of those, 65 (40%) proceeded to have nephrectomy, 15 were accepted and planned to proceed to surgery, 13 were awaiting further assessment, and 69 (42.5%) did not proceed to nephrectomy. Of the 162 PLKD, 142 (88%) were directed donors. The proportion of altruistic PLKD who opted out was significantly higher than that of directed PLKD (45% versus 7%, P = 0.00004). Conclusions. This audit demonstrated a positive experience of live kidney donation at Christchurch Hospital. CT renal angiogram can potentially detect incidental or controversial pathologies in the kidney and the surrounding structures. Altruistic donation remains controversial with higher rates of opting out.