Altruistic Donation Research Articles

How altruistic organ donation may be (intrinsically) bad

It has traditionally been assumed that organ donation must be altruistic, though the necessity of altruistic motivations has recently been questioned. Few, however, have questioned whether altruism is always a...

The financial cost of status signaling: Expansive postural displays are associated with a reduction in the receipt of altruistic donations

Abstract Models of human altruism suggest that decisions to help are influenced by assessments of both potential recipients' need state and their competence, as high need increases the value of gifts received, and competent recipients can most effectively use and repay gifts. Need and competence are often inversely related, however, raising the question of how altruists weigh these competing sources of information. We examined the impact of a nonverbal display (expansive posture) that, by signaling high status, simultaneously cues both low need and high competence, on actual altruistic behaviors: donations of financial aid to needy individuals. Across three studies using ecologically valid data drawn from a micro-lending charity website, men who displayed expansive posture while requesting aid faced a substantial reduction in the amount of aid they received; this effect held controlling for a range of relevant covariates. These findings demonstrate that: (a) altruists bias their giving toward those in greater need rather those who may be more competent, and (b) subtle nonverbal cues of status influence altruistic decision-making.

What Matters for the Productivity of Kidney Exchange?

Kidney exchange platforms serve patients who need a kidney transplant and who have a willing, but incompatible, donor. These platforms match patients and donors to produce transplants. This paper documents operational details of the three largest platforms in the United States. It then uses the framework developed in Agarwal et al. (2017) to examine how practical details influence platform productivity. The results show that reducing frictions in accepting proposed matches, frequent matching, and encouraging altruistic donors are important ways in which a platform can increase its productivity.

Blood and Blood Components: From Similarities to Differences.

Blood transfusion is made possible because, in most countries and organizations, altruistic individuals voluntarily, anonymously, and generously donate (without compensation) either whole blood or separated components that are then processed and distributed by professionals, prior to being allocated to recipients in need. Being part of modern medicine, blood transfusion uses so-called standard blood components when relative to cellular fractions and fresh plasma. However, as will be discussed in this paper, strictly speaking, such so-called labile blood components are not completely standard. Furthermore, the prevalent system based on voluntary, non-remunerated blood donation is not yet universal and, despite claims by the World Health Organization that 100% of blood collection will be derived from altruistic donations by 2020 (postponed to 2025), many obstacles may hinder this ambition, especially when relative to the collection of the enormous amount of plasma destined for fractionation into plasma derivative or drugs. Finally, country organizations also vary due to the economy, sociology, politics, and epidemiology. This paper then, discusses the particulars (of which ethical considerations) of blood transfusion diversity and the consequences for donors, patients, and society.

Altruistic decisions following penetrating traumatic brain injury.

The cerebral correlates of altruistic decisions have increasingly attracted the interest of neuroscientists. To date, investigations on the neural underpinnings of altruistic decisions have primarily been conducted in healthy adults undergoing functional neuroimaging as they engaged in decisions to punish third parties. The chief purpose of the present study was to investigate altruistic decisions following focal brain damage with a novel altruistic decision task. In contrast to studies that have focused either on altruistic punishment or donation, the Altruistic Decision Task allows players to anonymously punish or donate to 30 charitable organizations involved with salient societal issues such as abortion, nuclear energy and civil rights. Ninety-four Vietnam War veterans with variable patterns of penetrating traumatic brain injury and 28 healthy veterans who also served in combat participated in the study as normal controls. Participants were asked to invest $1 to punish or reward real societal organizations, or keep the money for themselves. Associations between lesion distribution and performance on the task were analysed with multivariate support vector regression, which enables the assessment of the joint contribution of multiple regions in the determination of a given behaviour of interest. Our main findings were: (i) bilateral dorsomedial prefrontal lesions increased altruistic punishment, whereas lesions of the right perisylvian region and left temporo-insular cortex decreased punishment; (ii) altruistic donations were increased by bilateral lesions of the dorsomedial parietal cortex, whereas lesions of the right posterior superior temporal sulcus and middle temporal gyri decreased donations; (iii) altruistic punishment and donation were only weakly correlated, emphasizing their dissociable neuroanatomical associations; and (iv) altruistic decisions were not related to post-traumatic personality changes. These findings indicate that altruistic punishment and donation are determined by largely non-overlapping cerebral regions, which have previously been implicated in social cognition and moral experience such as evaluations of intentionality and intuitions of justice and morality.10.1093/brain/awy064_video1awy064media15758316955001.

Empathy, social media, and directed altruistic living organ donation.

In this article we explore some of the ethical dimensions of using social media to increase the number of living kidney donors. Social media provides a platform for changing non‐identifiable ‘statistical victims’ into ‘real people’ with whom we can identify and feel empathy: the so‐called ‘identifiable victim effect’, which prompts charitable action. We examine three approaches to promoting kidney donation using social media which could take advantages of the identifiable victim effect: (a) institutionally organized campaigns based on historical cases aimed at promoting non‐directed altruistic donation; (b) personal case‐based campaigns organized by individuals aimed at promoting themselves/or someone with whom they are in a relationship as a recipient of directed donation; (c) institutionally organized personal case‐based campaigns aimed at promoting specific recipients for directed donation. We will highlight the key ethical issues raised by these approaches, and will argue that the third option, despite raising ethical concerns, is preferable to the other two.

The Social Stigma of Selling Kidneys in Iran as a Barrier to Entry: A Social Determinant of Health

Iran is the only country in the world currently with a legalized compensated kidney donation system, in which kidney sellers are matched with end‐stage renal disease patients through a regulated process. From a practical point of view, this model provides an abundance of kidneys for transplantation as opposed to the American model that relies on altruistic donation. The major concern about adopting the Iranian model is the possibility of exploitation. A large body of literature exists on this topic, but few have focused on its cultural aspects. This paper sheds light on the cultural implications of the Iranian model by providing empirical evidence on the social stigmas against kidney sale in Iran. We claim that these stigmas act as barriers to entry to the supply market of kidneys. Due to the conditions created by social stigmas, kidney sellers are forced to consider not only monetary rewards but also cultural factors. Thus, they tend to be more cautious and try to avoid impulsive decisions. Such social stigmas act as unofficial regulatory forces to keep kidney sale as the last resort for the poor, to diversify the supply market by age, and to stretch the decision‐making process in the absence of a mandatory waiting period for transplantation.

Valuing Sets of Potential Transplants in a Kidney Paired Donation Network.

In kidney paired donation (KPD), incompatible donor-candidate pairs and non-directed (also known as altruistic) donors are pooled together with the aim of maximizing the total utility of transplants realized via donor exchanges. We consider a setting in which disjoint sets of potential transplants are selected at regular intervals, with fallback options available within each proposed set in the case of individual donor, candidate or match failure. We develop methods for calculating the expected utility for such sets under a realistic probability model for the KPD. Exact expected utility calculations for these sets are compared to estimates based on Monte Carlo samples of the underlying network. Models and methods are extended to include transplant candidates who join KPD with more than one incompatible donor. Microsimulations demonstrate the superiority of accounting for failure probability and fallback options, as well as candidates joining with additional donors, in terms of realized transplants and waiting time for candidates.

Motivating Cord Blood Donation with Information and Behavioral Nudges

Umbilical cord blood is a source of hematopoietic stem cells essential to treat life-threatening diseases, such as leukemia and lymphoma. However, only a very small percentage of parents donate upon delivery. The decision to donate the cord blood occurs at a very specific time and when parents likely experience emotional, informational, and decisional overloads; these features of cord blood donation make it different from other pro-social activities. In collaboration with an OB-GYN clinic in Milan, Italy, we conducted the first randomized controlled trial that applies tools from behavioral science to foster cord blood donation, and quantified the gains that informational and behavioral “nudges” can achieve. We found that information and “soft” commitments increased donations; approaching expecting parents closer to the delivery date and providing them with multiple reminders, moreover, had the strongest impact. However, a significant portion of women who expressed consent to donate could not do so because of organizational constraints. We conclude that simple, non-invasive behavioral interventions that address information gaps and procrastination, and that increase the salience of the activity can substantially enhance altruistic donations of cord blood, especially when coupled with organizational support.

Living Kidney Donor Phenotype and Likelihood of Postdonation Follow-up

The Organ Procurement and Transplantation Network requires that United States transplant centers maintain follow-up with living donors for 2 years postdonation, but lack of donor follow-up is pervasive. Donor characteristics, including younger age, minority race, and lower education, have been associated with incomplete follow-up, but it is unknown whether altruistic donors, having no previous connection to their recipient, differ from traditional donors in their likelihood of follow-up. Using the Scientific Registry of Transplant Recipients data, we examined all adult living kidney donors from 2005 to 2015 (n = 63 592) classified as altruistic or traditional, and compared likelihood of 6-month medical follow-up using modified Poisson regression. Altruistic donors did not differ from traditional donors in likelihood of follow-up (adjusted relative risk [aRR], 1.02; 95% confidence interval [CI], 0.99-1.06). Among previously identified at-risk subgroups, however, altruistic donors were more likely to have follow-up than their traditional counterparts, including those who were younger (aRR, 1.04; 95% CI, 1.00-1.09), had less than college education (aRR, 1.05; 95% CI, 1.00-1.11), and were unmarried (aRR, 1.08; 95% CI, 1.04-1.12). Having medical follow-up at 6 months was significantly associated with having follow-up at 1 year (aRR, 1.84; 95% CI, 1.75-1.93) and 2 years (aRR, 1.63; 95% CI, 1.56-1.70) postdonation. These data provide additional granularity on living donor phenotypes associated with short-term (6 month) postdonation follow-up, which is important given its association with future likelihood of follow-up. These findings offer the opportunity to tailor and direct educational efforts to increase living donor follow-up, particularly among groups at higher risk of loss to follow-up.

Life After Giving Life.

Life After Giving Life Jeff Moyer I donated my right kidney to save a friend's daughter's life in June 2010. I dreaded the pain but knew that it would pass. My age at 61 and my gender proffered a hard recovery period; one renowned transplant center would have rejected me as a donor. Internet research disclosed nothing about chronic pain as a potential after-effect of the donation. My transplant center knew for three months that, due to vascular anomalies, I would require a difficult right side nephrectomy. I had inquired repeatedly about what they learned and, although it would not have changed my decision, I was not informed of this until three days before the donation. The surgeon peevishly told me that the operation would be far more difficult—for the surgeon. In the hospital, following the synthetic Morphine pain pump, I was prescribed Vicodin to take once a day. I have a high pain threshold, but I would find myself watching the clock until my self-assigned time at which I would take my medication and only one of two allotted tablets at that. I am a writer and I convinced my editor at NPR to permit me to do bookend commentaries pre and post donation. The first piece aired the Monday of surgery week. I spoke of my trepidation concerning the pain, but how my resolve stiffened once I had my first conversation with my fragile recipient and realized that I would have to marshal needed courage for both of us. After a month I recorded the second commentary, and I sounded road-worn and in pain. The Transplant Center refused to continue to prescribe me Vicodin after twelve weeks. Hand assisted laparoscopic is the standard surgical method for all transplant nephrectomies. With typical left-side nephrectomy, the surgeon reaches under the stomach muscles and bags the left kidney. In my case, four and half inches of stomach muscles were severed and the spleen, stomach, colon and liver were cut away from their supportive myofascial web and matter-of-factly moved to get to the right kidney. Once the kidney was removed, the resulting stitching of these organs to stabilize their position has caused adhesions and attendant pain. A recent surgical graduate of the transplant center's program described the surgery to me in shocking, mind-numbing detail. The surgeon said he had never known of a patient in pain after twelve weeks. His rebuke questioned my veracity. Although I was an "altruistic donor," my motives were impugned. I went from being seen as a noble and honorable man to a complainer and thrill seeker. My general practitioner skeptically and begrudgingly continued the Vicodin prescription—requiring visits every 90 days. Very fortunately, I became friends with another living kidney donor, a nurse and knowledgeable advocate, who taught me a lot about that woebe-gone and ignored world. Most importantly, she was affirming and wove me into the world of other donors. At a year post-surgery, I had a conversation with the head of the transplant center, during which he told me that there was no such thing as pain. He said pain was "an internal psychological perception and labeling of a neurological stimulus." I disagreed. I considered a third commentary on living with chronic pain, but in consultation with my "Morning Edition" editor, we widened the lens. She approached their Science Desk about doing a long Health Section piece on the plight of living kidney donors. The concept was accepted. A [End Page 211] reporter in my home town was assigned the story. I put a small group of highly knowledgeable kidney donors together, one of whom was also a wounded donor, who met at my house for the reporter's interviews. Other national experts were spoken with and the bleak plight of living kidney donors was laid bare in a nine-minute piece on "Morning Edition". There was (is?) no longitudinal research in the United States which followed us, although European studies disclose that over one third of living kidney donors live with chronic pain. I had been a volunteer musician at a hospice center prior to my surgery and upon my return...

Mental health assessment of altruistic non-directed kidney donors: An EAPM consensus statement

The number of living kidney donations is increasing in many countries, in response to increasing demand, lengthening waiting lists for transplants from deceased donors, and, in some areas, cultural or religious resistance to deceased donation. In most such donations the donor and recipient are related genetically or emotionally, but there are various routes by which a donor may give a kidney to a recipient who is a stranger. The practice of paired, pooled or chained donation - in which a recipient receives an organ from a stranger, in return for which that recipient‘s emotionally or genetically related (but incompatible) donor gives a kidney to another stranger - is accepted and growing. In contrast, the selling of organs by donors is controversial and generally illegal, except in a few countries.

Altruistic nondirected kidney donation: attitudes, characteristics and ethical implications.

Altruistic nondirected kidney donation involves a person donating one of their kidneys to an unknown recipient. The donor's mental health and motives are frequently questioned. We want to highlight this topic and also encourage discussions about ethical implications. The main topics are the mental health of altruistic nondirected kidney donors and the general attitude towards the practice of this form of donation as well as the willingness of the public to donate this way. Soliciting organ donation via social networks or financial support is debated extensively in the media. There is a lack of studies on altruistic nondirected kidney donation. Most studies focus on related donors. Studies with larger samples should be performed on altruistic nondirected kidney donors to learn more about their motives and assess their mental health.

Kidney exchange simulation and optimization

One of the challenges in a kidney exchange program (KEP) is to choose policies that ensure an effective and fair management of all participating patients. In order to understand the implications of different policies of patient allocation and pool management, decision makers should be supported by a simulation tool capable of tackling realistic exchange pools and modeling their dynamic behavior. In this paper, we propose a KEP simulator that takes into consideration the wide typology of actors found in practice (incompatible pairs, altruistic donors, and compatible pairs) and handles different matching policies. Additionally, it includes the possibility of evaluating the impact of positive crossmatch of a selected transplant, and of dropouts, in a dynamic environment. Results are compared to those obtained with a complete information model, with knowledge of future events, which provides an upper bound to the objective values. Final results show that shorter time intervals between matches lead to higher number of effective transplants and to shorter waiting times for patients. Furthermore, the inclusion of compatible pairs is essential to match pairs of specific patient–donor blood type. In particular, O-blood type patients benefit greatly from this inclusion.

A Ten-Year Retrospective Analysis of Consent for the Donation of Residual Human Tissue in a Singapore Healthcare Institution: Reflections on Governance

A 10-year (2002 to 2011) retrospective analysis of consent documentation for the donation of leftover or residual human tissue from surgical interventions at a major academic healthcare institution in Singapore was conducted. Findings suggest that demographics like gender, religious belief and socioeconomic status could be indicators of the willingness of a patient to donate residual tissue to a tissue repository or biobank for future research use. Patients in general did not decide to donate based on specific details that were provided to them. Instead, those who donated were of a background that engendered a level of security or confidence that harm would not befall them. It is argued that willingness to donate depended more on this sense or perception of security that arose from systemic trustworthiness than from the rigour of consent-taking. In 2015, changes to the regulation of tissue banking and related activities in Singapore include legislative requirement for a prescribed list of information to be provided to a prospective tissue donor in consent-taking. While this and other legislative changes are important to ensure that tissue donation for research remains informed and voluntary, it is argued that trust and trustworthiness remain an unfinished project. Tissue repositories or biobanks more broadly must be constituted as moral institutions that safeguard the interests and rights of altruistic tissue donors. More critically, they must advance security and trustworthiness through good stewardship that is directed at promoting the common good through accountability, transparency and control.

Multi-Organ Exchange

Kidney exchange, where candidates with organ failure trade incompatible but willing donors, is a life-saving alternative to the deceased donor waitlist, which has inadequate supply to meet demand. While fielded kidney exchanges see huge benefit from altruistic kidney donors (who give an organ without a paired needy candidate), a significantly higher medical risk to the donor deters similar altruism with livers. In this paper, we begin by exploring the idea of large-scale liver exchange, and show on demographically accurate data that vetted kidney exchange algorithms can be adapted to clear such an exchange at the nationwide level. We then propose cross-organ donation where kidneys and livers can be bartered for each other. We show theoretically that this multi-organ exchange provides linearly more transplants than running separate kidney and liver exchanges. This linear gain is a product of altruistic kidney donors creating chains that thread through the liver pool; it exists even when only a small but constant portion of the donors on the kidney side of the pool are willing to donate a liver lobe. We support this result experimentally on demographically accurate multi-organ exchanges. We conclude with thoughts regarding the fielding of a nationwide liver or joint liver-kidney exchange from a legal and computational point of view.

Understanding barriers and outcomes of unspecified (non-directed altruistic) kidney donation from both professional’s and patient’s perspectives: research protocol for a national multicentre mixed-methods prospective cohort study

IntroductionLiving donation accounts for over one-third of all kidney transplants taking place in the UK.1 The concept of anonymously donating a kidney to a stranger (non-directed altruistic or unspecified kidney...

Banking on Living Kidney Donors-A New Way to Facilitate Donation without Compromising on Ethical Values.

Public surveys conducted in many countries report widespread willingness of individuals to donate a kidney while alive to a family member or close friend, yet thousands suffer and many die each year while waiting for a kidney transplant. Advocates of financial incentive programs or "regulated markets" in kidneys present the problem of the kidney shortage as one of insufficient public motivation to donate, arguing that incentives will increase the number of donors. Others believe the solutions lie-at least in part-in facilitating so-called "altruistic donation;" harnessing the willingness of relatives and friends to donate by addressing the many barriers which serve as disincentives to living donation. Strategies designed to minimize financial barriers to donation and the use of paired kidney exchange programs are increasingly enabling donation, and now, an innovative program designed to address what has been termed "chronologically incompatible donation" is being piloted at the University of California, Los Angeles, and elsewhere in the United States. In this program, a person whose kidney is not currently required for transplantation in a specific recipient may instead donate to the paired exchange program; in return, a commitment is made to the specified recipient that priority access for a living-donor transplant in a paired exchange program will be offered when or if the need arises in the future. We address here potential ethical concerns related to this form of organ "banking" from living donors, and argue that it offers significant benefits without undermining the well-established ethical principles and values currently underpinning living donation programs.

Reformulation-Linearization Technique Approach for Kidney Exchange Program IT Healthcare Platforms

Kidney exchange allows a potential living donor whose kidney is incompatible with his intended recipient to donate a kidney to another patient so that the donor’s intended recipient can receive a compatible kidney from another donor. These exchanges can include cycles of longer than two donor–patient pairs and chains produced by altruistic donors. Kidney exchange programs (KEPs) can be modeled as a maximum-weight cycle-packing problem in a directed graph. This paper develops a new integer programming model for KEPs by applying the reformulation-linearization technique (RLT) to enhance a lower bound obtained by its linear programming (LP) relaxation. Given the results obtained from the proposed model, the model is expected to be utilized in the integrated KEP IT (Information Technology) healthcare platform to obtain plans for optimized kidney exchanges.

Banking on Living Kidney Donors – a New Way to Provide and Preserve Opportunities for Donation

Introduction A new program of advanced donation is being piloted in the US to address a barrier to living kidney donation in the form of “chronological incompatibility” between potential donors and their intended beneficiaries. In this program, a person whose kidney is not currently required for transplantation in a specific recipient may instead donate to the paired exchange program: in return, a commitment is made to the specified recipient that priority access for a living donor transplant in a paired exchange program will be offered when or if the need arises in the future. This commitment has been symbolically described as a “voucher”. Methods We evaluated the current model of advanced donation to identify ethical risks and potential benefits of the program. Results The program enables advanced donors to help their intended beneficiaries obtain a transplant in the future, while helping to meet public needs for transplantation in the present. However, conditions imposed in the current program unduly limit the potential benefits of the program, particularly the prohibition of transfer of “vouchers” during the lifetime of the donor. If a person close to the donor unexpectedly develops the need for transplantation but is unable to take advantage of the voucher, the donor may experience significant decisional regret, especially if they would have been eligible to donate at this time in the absence of advanced donation. Conclusion Advanced donation enables a form of public virtual banking of kidneys obtained through living donation by providing opportunities for donation to the common pool of organs for public allocation, while preserving the future opportunity for donors to benefit a designated individual. If advanced donation vouchers were transferable, this program might greatly increase non-directed donation by those who are chronologically incompatible with their intended transplant recipient, and those who are willing to make an altruistic donation but concerned about potential future transplant needs of loved ones.