Donor-recipient Relationships Research Articles

Experiential aspects of tourism gift consumption

This article addresses how consumers make use of fantasy, feelings, and fun when deciding, giving, and consuming gifts of tourism and leisure. Despite little industry awareness, consumers are engaging with such behaviour because tourism gifts offer considerable scope for the creative expression of donor–recipient relationships. This UK-based interpretive qualitative study captured data from donors, recipients, and tourism and leisure providers. The feelings (emotions), fantasies (imagination and dreaming), and fun (playfulness) were interrogated through the behavioural phases of gift decision making, gift exchange, post-exchange, and gift consumption. A range of emotions were displayed by donors and recipients at different stages in the gift-giving process; donor decision making in groups for created gifts was particularly charged. Fantasies were evident both for donors planning gifts and for recipients. As an intangible gift, means of exchange allowed for creative mechanisms beyond the classic wrapping strategies associated with physical gifts. The ‘decoy’ strategy stimulated the recipient’s imagination to conjure fantastical scenarios. Fun or playfulness was built into many of the gifts and often related to an element of ‘surprise’, an attribute of the perfect gift (e.g. Belk, 1996) in Western societies.

Infrared Fluorescence Imaging of Lymphatic Regeneration in Nonhuman Primate Facial Vascularized Composite Allografts

Clinical vascularized composite allografts (VCA), although performed with good success, have been characterized by rejection episodes and postoperative graft edema. We investigated lymphatic donor-recipient reconstitution and lymphatic regeneration in a nonhuman primate facial VCA model. Heterotopic partial face (n = 9) VCAs were performed in cynomolgus macaques. Grafts were monitored for rejection episodes and response to immunosuppressive therapies as previously described. Donor and recipient lymphatic channels were evaluated using a near-infrared handheld dual-channel light-emitting diode camera system capable of detecting fluorescence from indocyanine green injections. Graft lymphatic channels were serially evaluated from postoperative day 0 to 364. Preoperative imaging demonstrated superficial lymphatic anatomy similar to human anatomy. Initial resolution of facial allograft swelling coincided with superficial donor-recipient lymphatic channel reconstitution. Reconstitution occurred despite early acute rejection episodes in 2 animals. However, lymphatic channels demonstrated persistent functional and anatomic pathology, and graft edema never fully resolved. No differences in lymphatic channels were noted between grafts that developed transplant vasculopathy (n = 3) and those that did not (n = 6). Dynamic changes in patterns of lymphatic drainage were noted in 4 animals following withdrawal of immunosuppression. Donor-recipient lymphatic channel regeneration following VCA did not result in resolution of edema. Technical causes of graft edema may be overcome with alternative surgical techniques, allowing for direct investigation of the immunologic relationship between VCA graft edema and rejection responses. Mechanisms and timing of dynamic donor-recipient lymphatic channel relationships can be evaluated using fluorescent imaging systems to better define the immunologic role of lymphatic channels in VCA engraftment and rejection responses, which may have direct clinical implications.

Donor quality of life in living-donor lobar lung transplantation

Living-donor lobar lung transplantation has been established as a life-saving option for end-stage pulmonary diseases. However, factors associated with quality of life (QOL) of living lung donors have not been fully investigated. A cross-sectional study was performed at Okayama University using the version 2 questionnaire of the 36-item Short Form (SF-36) Health Survey. Linear regression analysis was used to estimate the relationship of donor factors and recipient outcomes using the SF-36 component summary scores. Of 65 donors, 42 (65%) agreed to participate in this study; the mean age was 42 ± 1 (range 25 to 59) years. Mean time from the operation to questionnaire was 39 ± 4 (range 1 to 78) months. Donor-recipient relationships were as follows: sibling (18 cases); spouse (9 cases); parent (11 cases); and child (4 cases). Thirty-four of 42 donors were paired with those who donated their organ to the same recipient. Both physical and mental health scores in donors were higher than those in the general Japanese population. Lower mental health scores were seen in those who donated to their child or parent. There was a significant correlation in mental health scores between the paired donors. In the univariate analysis, donor age (r = -0.35, p = 0.02), donor-recipient relationship (r = 0.38, p = 0.01) and recipient death (r = -0.42, p = 0.006) were factors significantly associated with donor mental health scores. The average QOL in the living lung donors was better than that of the general population. However, a fatal outcome in the recipient significantly impacted donor mental health QOL. Ensuring that donor candidates consider both the risks/benefits of donation, and the potential recipient outcomes may be critical in the informed consent process.

Donor–recipient relationships in African American vs. Caucasian live kidney donors

The purpose of the study was to characterize differences in donor and recipient relationships between African American (AA) and Caucasian living kidney donors. Data from all successful living kidney donors at a single institution between 1991 and 2009 were reviewed. Relationships between donor and recipient were categorized and between-group comparisons performed. The study sample consisted of 73 (18%) AA and 324 Caucasian living kidney donors. The distribution of donor-recipient relationships differed significantly between AA and Caucasians. AA donors were more likely to be related to the recipient (88% vs. 74%, p = 0.007) than Caucasians. AA donors were more likely to participate in child to parent donation and were less likely to participate in parent to child donation or to donate to unrelated individuals. Sibling and spousal donations were similar in both groups. Caucasian donors were more likely to be unrelated to the recipient than AA donors. Differences exist in donor-recipient relationships between AA and Caucasian living kidney donors. Future studies exploring cultural differences and family dynamics may provide targeted recruitment strategies for AA and Caucasian living kidney donors. Living unrelated kidney transplantation appears to be a potential growth area for living kidney donation in AA.

Global health: a positive addition to public health training?

Factors that influence health, both enduring and emergent, more than ever extend beyond national borders. Worldwide trade, migration, travel and communication technologies have all served to create a smaller world where notions of boundaries and nation states become less meaningful for health. No country is unaffected by the health threats posed by the global economic crisis, climate change, emerging novel diseases and increasing prevalence of chronic disease. The need to rebalance emphasis on disease-centred models and the search for technological health service-related solutions with social models of health that recognize the influence of wider determinants is evident. Those engaged in efforts to improve public health will need the knowledge and skills to deal with complex problems that bridge the gaps between biological, environmental and social sciences. Active participation in the development of innovative policies to tackle such problems will draw on explanations, methods and interventions from a range of disciplines. Effective communication of benefits, in terms of health outcomes and cost-effectiveness, to policy-makers will be required at local and global levels. Complex hierarchies created by multiple donor–recipient relationships are likely to be ineffective and inefficient. Global networks of partners collaborating on an increasingly equal basis require approaches that champion advocacy, equity, consensus and partnership underpinned by the best available evidence from research. Public Health will have to show its worth in this new environment demonstrating how a robust public health infrastructure and a trained public health workforce are paramount for economic growth and prosperity. Recognizing the growing demand for well-trained individuals to work within the field of global health many schools of public health and university faculties, including our own, have created new courses with modules covering areas such as global health politics, health diplomacy, global trade and health and global environmental change. These courses have in many cases also recognized the importance of continued exposure to established public health subjects including epidemiology, health economics, policy analysis and infectious disease control. Such courses should be considered complementary to more traditional courses on health problems that predominantly affect populations in low-income countries, which are designed to equip students with practical skills and conceptual understanding to improve health in such settings. Undertaking a postgraduate qualification is one route to acquisition of new competencies required, the experiences offered by international placements are another. Placements provide opportunities to become immersed in other cultures, to appreciate perspectives based on different value systems and to grasp the interdependencies and the possibilities for mutual learning. Experiences within complex, resource constrained healthcare settings or government structures with direct responsibility for providing care or implementing policies provide invaluable learning. The insights gained have the potential to promote a flexibility of approach needed to bring innovative solutions at whichever level the practitioner chooses to work in the future. As Nigel Crisp advocates in his book ‘Turning the World Upside Down’ such experiences have the potential to contribute to the development of public health infrastructure

Directed networks reveal genomic barriers and DNA repair bypasses to lateral gene transfer among prokaryotes

Lateral gene transfer (LGT) plays a major role in prokaryote evolution with only a few genes that are resistant to it; yet the nature and magnitude of barriers to lateral transfer are still debated. Here, we implement directed networks to investigate donor-recipient events of recent lateral gene transfer among 657 sequenced prokaryote genomes. For 2,129,548 genes investigated, we detected 446,854 recent lateral gene transfer events through nucleotide pattern analysis. Among these, donor-recipient relationships could be specified through phylogenetic reconstruction for 7% of the pairs, yielding 32,028 polarized recent gene acquisition events, which constitute the edges of our directed networks. We find that the frequency of recent LGT is linearly correlated both with genome sequence similarity and with proteome similarity of donor-recipient pairs. Genome sequence similarity accounts for 25% of the variation in gene-transfer frequency, with proteome similarity adding only 1% to the variability explained. The range of donor-recipient GC content similarity within the network is extremely narrow, with 86% of the LGTs occurring between donor-recipient pairs having ≤5% difference in GC content. Hence, genome sequence similarity and GC content similarity are strong barriers to LGT in prokaryotes. But they are not insurmountable, as we detected 1530 recent transfers between distantly related genomes. The directed network revealed that recipient genomes of distant transfers encode proteins of nonhomologous end-joining (NHEJ; a DNA repair mechanism) far more frequently than the recipient lacking that mechanism. This implicates NHEJ in genes spread across distantly related prokaryotes through bypassing the donor-recipient sequence similarity barrier.

On the terms of the recipient? Norwegian sports development aid to Tanzania in the 1980s

This article discusses the donor–recipient1 relationship in a sports development aid context, and identifies potential dilemmas occurring when aiming to give aid on the recipient’s terms. Using the case of the Norwegian sports development aid project Sport for All, it is argued that the Norwegian Confederation of Sports was clearly in control of the project throughout its various phases, and thus a contradiction between the discourse of equality and the actual practice was evident. It is demonstrated in the article that donor–recipient relationships are power relationships that are complex and unclear to the involved parties, and shown that the Confederation’s role is shaped through a web of power relationships. The article questions the assumption that civil society organizations such as the Norwegian Confederation are more apt to provide aid on equal terms than government agencies.

Intravenous Compared to Oral Busulfan with Cyclophophamide for Allogeneic Hematopoietic Progenitor Cell Transplant Conditioning for AML and MDS.

AbstractAbstract 3475Busulfan (Bu) is commonly used with cyclophosphamide (Cy) as a conditioning regimen for allogeneic hematopoietic progenitor cell transplantation (HPCT). Recently, intravenous (IV) Bu has often replaced oral Bu for conditioning. We have previously reported that substituting IV for oral Bu was associated with a lower rate of relapse, and superior relapse-free and overall survivals for relapsed or refractory non-Hodgkin lymphoma patients undergoing autologous HPCT (Dean et al. Br J Haematol 2010 Jan;148(2):226-34). We retrospectively compared the outcomes of 135 consecutively treated AML and MDS patients who underwent allogeneic HPCT at our institution from 5/2001 through 10/2009 with BuCy using oral (n = 93) or IV (n = 42) Bu, without dose adjustment. The analysis included matched related (n=97) and 8/8 HLA matched unrelated donors (n=38). Oral Bu was administered as 1 mg/kg every 6 hours for 16 doses while IV Bu was administered as 0.8 mg/kg every 6 hours for 16 doses (days –8 through -4) followed by Cy 60 mg/kg/day × 2 (days –3 and –2). The IV Bu patients were older (median age 49 vs. 47 yrs, respectively, p=0.037), more commonly had unrelated donors and peripheral blood stem cells for their HPCT cell source than those treated with oral Bu. There were no significant differences between the groups with regards to patient gender, race, CIBMTR comorbidity index score, number of prior chemotherapy regimens, pre-transplant disease status (each group had 45% of patients in CR1 or CR2), donor-recipient gender relationships or nucleated cell dose infused. The IV Bu group had a higher median CD34+ cell dose infused than those who received oral Bu (3.34 vs. 2.19 ×106/kg, respectively, p=0.028). The IV Bu patients experienced a significantly lower incidence of mucositis (3% vs. 55%, p<0.001) and less severe mucositis (median OMAS scores 0 vs.0.08, respectively, p<0.001). However, there were no significant differences between the IV and oral Bu groups in days until neutrophil and platelet count engraftment, length of transplant hospitalization, incidence of acute or chronic GVHD, sinusoidal obstruction syndrome, and 100 day mortality. At this time 26 (62%) of the IV Bu patients and 33 (36%) of the oral Bu patients are alive, however, the median follow-up was substantially longer for the oral Bu group (50 vs. 13 months, p<0.001). Disease relapse was the most common cause of death for both the IV and oral Bu patients accounting for approximately 50% of deaths in each group. The 1 and 2 year transplant-related mortality for the IV Bu patients was 21% for both, while that for the oral Bu group was 23% and 29%, respectively. The 1 and 2 year relapse mortality for the IV Bu patients was 21% for both, while that for the oral Bu group was 24% and 29%, respectively. Substituting IV for oral Bu reduces variability in drug exposure and potentially improves safety as suggested from our finding of significantly less severe oral mucositis in the IV Bu group. Further follow-up of the IV Bu group is required to adequately assess for a survival benefit. Whether pharmacokinetic-based Bu dosing can improve outcomes after allogeneic HPCT in this setting is worthy of further study. Disclosures:Sobecks:Otsuka Pharm.: Research Funding.

INTERTEMPORAL COMPETITION AND AID

We study donor–recipient relationships in which the donor finances aid programs from which recipients want to divert funds in order to meet their own objectives. We analyze two economies. In the first one, the donor commits to a program budget for each period. In the second economy, the donor commits to a program budget for two periods. This introduces intertemporal competition among recipient officials. We show that intertemporal competition may weaken recipients' incentives to divert funds from aid programs. Furthermore, we show that this may occur even in the presence of regional competition among recipients.

Risk Factors for Recurrence of Primary Sclerosing Cholangitis After Living Donor Liver Transplantation: A Single Center Experience

We retrospectively reviewed our 10-year experience with living donor liver transplantation (LDLT) in 30 consecutive patients with end-stage primary sclerosing cholangitis (PSC) to determine long-term patient and graft survival and risk factors for recurrence of PSC. For strict diagnosis of recurrence, patients with hepatic artery thrombosis (n = 2), ABO blood type incompatible transplantation (n = 3), and postoperative survival shorter than 1 year (n = 5) were excluded from the study, leaving 20 patients for analysis. Recurrence was diagnosed in 11 patients 26-71 months after transplantation. Multivariate analysis showed that cytomegalovirus diseases within 3 months after transplantation and related donors were independent risk factors for recurrence. When the effects on recurrence were compared among donor-recipient relationships, there were significant differences, especially between nonrelated donors and parents. Multivariate analysis showed that age was an independent risk factor for time to graft loss. Cytomegalovirus prophylaxis and avoidance of related donors are important in reducing PSC recurrence, although this is a preliminary report with limitations due to the small number of patients. LDLT for young patients with PSC using grafts from their parents might have to be avoided where deceased donor liver transplantation is available.

Gift exchange and organ donation: Donor and recipient experiences of live related kidney transplantation

Background Live transplantation presents many stressors for donors and recipients, yet a holistic understanding of the process, from both perspectives, is limited. Gift exchange is a theory governed by the principles of giving, receiving and reciprocating and has many similarities with the process of organ transplantation. It may therefore provide a framework for understanding donor and recipient experiences of live kidney transplantation. However, the relevance of this theory to live kidney transplantation has not previously been properly explored. Objectives To gain a theoretical understanding of the live transplantation experience from the perspectives of donors and recipients. Design A phenomenological, longitudinal study. Participants All donors and their recipients undergoing live kidney transplantation in a regional renal transplant centre in South-West England (between July 2003 and February 2004) were invited to participate in this study. Of this cohort, 11 families ( n = 55%) volunteered to participate. Methods Data were collected through a series of 3 recorded, semi-structured interviews with donors and recipients. Interviews were conducted pre transplant and at 3 and 10 months post transplant. Data were analysed using a process of thematic content analysis. Findings were also considered within a theoretical framework of gift exchange. Results All donors initially made an instantaneous, voluntary decision to donate and found the decision relatively easy to make. In contrast, recipients found accepting the donors’ offer arduous, because of concern for their wellbeing. They were only able to accept the transplant after discussing the matter with their donor and establishing that it was something that they wanted to do. Recipients’ lives were transformed by a successful transplant and they were subsequently very grateful to the donors for donating. Donors derived immense personal satisfaction from this outcome and it helped to confirm to them that what they had done had been worthwhile. The transplant did not have a detrimental effect on donor–recipient relationships. Conclusions The concept of gift exchange provides a logical explanation of donor and recipients experiences in this study, particularly in relation to factors that influence giving, receiving and reciprocating. This understanding should help health professionals assist donors, recipients and their families throughout this process.

Differences in tolerance for health risk to the living donor among potential donors, recipients, and transplant professionals

In organ donation, the donor, recipient, and transplant team must all accept potential health risks to the donor and any uncertainties. To gauge these risks, we surveyed general altruism and risk-taking behaviors in 112 potential donors, 111 potential recipients, and 51 transplant professionals. Next, participants indicated their risk thresholds for long-term donor hypertension, cardiovascular disease, and kidney failure that would stop them from pursuing living donation and their willingness to proceed when risks were uncertain. The three groups had similar general altruism and risk-taking behaviors. Potential donors were significantly more willing to accept greater long-term donor risks than potential recipients and transplant professionals. Moreover, these potential donors were significantly more likely to agree that living donation was acceptable when long-term donor risks were uncertain. Potential kidney donors readily accept high long-term risks, whereas potential recipients were the most averse to donor risk. Our study shows that transplant professionals facilitate the best decisions by appreciating the willingness of their patients to accept donor health risks along with their own risk tolerance.

Internet Solicitation: What Donor–Recipient Relationships Are Acceptable?

Internet Solicitation: What Donor–Recipient Relationships Are Acceptable?

Evaluating Living Kidney Donors: Relationship Types, Psychosocial Criteria, and Consent Processes at US Transplant Programs

We conducted a survey of 132 US kidney transplant programs to examine how they evaluate and select potential living kidney donors, focusing on donor-recipient relationships, psychosocial criteria, and consent processes. There is heterogeneity in donor-recipient relationships that are considered acceptable, although most programs (70%) will not consider publicly solicited donors. Most programs (75%) require a psychosocial evaluation for all potential living donors. Most programs agree that knowledge of financial reward (90%), active substance abuse (86%), and active mental health problems (76%) are absolute contraindications to donation. However, there is greater variability in how other psychosocial issues are considered in the selection process. Consent processes are highly variable across programs: donor and recipient consent for the donor evaluation is presumed in 57% and 76% of programs, respectively. The use of 13 different informed consent elements varied from 65% (alternative donation procedures) to 86% (description of evaluation, surgery and recuperative period) of programs. Forty-three percent use a 'cooling off' period. Findings demonstrate high variability in current practice regarding acceptable donor-recipient relationships, psychosocial criteria, and consent processes. Whether greater consensus should be reached on these donor evaluation practices, especially in the context of more expansive use of living donor kidney transplantation, is discussed.

In Defense of Transplantation: A Reply to Nancy Scheper-Hughes

The recent Scheper-Hughes essay on the “sacrificial violence in living donor transplants” is at odds with conventional understanding of transplantation and donor-recipient relationships.

Choosing to be Harmed: Autonomy and its Limits in Living Organ Donor Transplantation

The field organ transplantation has experienced rapid and dramatic advances and increases in the use of living organ donors during the past twenty years. During this time, important questions have emerged about the acceptability of their use, including the extent to which these donors can and should be understood as acting autonomously with regard to the decision to donate. I argue that the standard model of ethical decision-making currently being applied in the context of living organ donor transplantation distorts the philosophical requirements of the bioethical principles of beneficence/nonmaleficence, respect for persons, and justice. I argue that this model relies on a simplistic accounting of the concept of beneficence that reduces the goal of medicine to the promotion of the narrowly-defined health-based self-interests of individual patients and so cannot accommodate the various goods and harms that are legitimately given weight in risk/benefit calculations made by donors. I suggest a broader understanding of the requirements of beneficence that can be adopted to accommodate individual donor's conceptions of the good. Related to this, I argue that the picture of agency being applied in living organ donor decision-making relies on a superficial view of choice that equates freedom with independence from moral and emotional connections to other people and so cannot accommodate the complex choices embedded within many of the donor-recipient relationships that are often brought to bear in the context of living organ donor transplantation. I suggest that a different understanding of the role of emotion in donor decision-making - one that includes recognition that emotions have a positive role to play in decision-making - is needed in the context of living organ donor transplantation. I further argue that proponents of paying for organs rely on a conceptual mistake related to the picture of agency being applied in this area that conflates the philosophical requirements of the bioethical principle of respect for persons with those of justice. I suggest that a different conception of the requirements of these bioethical principles is needed in the context of living organ donor transplantation in order to adequately account for how potential living organ donors' values, goals, and moral connections to other people might complexly and legitimately influence their decisions, particularly the decision to donate. Though consideration of various paradigmatic cases, I demonstrate the essential practical importance of gaining a clear understanding of the requirements of these bioethical principles for informing practices and policies that effectively address some of the ethical complexities and challenges in this area.

Internet Organ Solicitation, Explained

The growth of internet-based communications and the increasing demand for living organ donors are resulting in more use of Web sites for organ solicitation. Web resources have the capacity to improve public awareness about both organ donations and transplant outcomes. Rules for organ donation and fair allocation must follow legal principles regarding organ solicitation. Categories of internet recipient/donor matching services include "clearing house," "membership," and "individual" sites. All these raise ethical concerns related to the individual recipient/donor relationship and to the current system of organ allocation. However, a lack of rules and regulations regarding internet solicitation exists. Several pragmatic steps are proposed.

Exchange living-donor kidney transplantation: Diminution of donor organ shortage

Background To alleviate the organ shortage, the use of more living donors is strongly recommended world wide. A living donor exchange (swap) program was launched in Korea. After the success of a direct swap program between two families, we have developed the swap-around program to expand the donor pool by enrolling many kinds of unrelated donors. Herein, we report our results of a living donor exchange program. Methods This retrospectively review of 978 recipients of kidney transplants from living donors, included analysis of donor-recipient relationships, mode of donor recruitment, episodes of acute rejection, and 5-year patient/graft survivals. Results Transplantation was performed in 101 patients (10.3%) by way of the swap program. The proportion of swap patients among the number of unrelated donor renal transplants has been increasing from 4.2% to 46.6%. The incidence of acute rejection and 5-year patient/graft survival rates were comparable between the groups. Conclusions We have achieved some success in reducing the organ shortage with a swap program in addition to our current unrelated living donor programs without jeopardizing graft survival. Potentially exchangeable donors should undergo strict medical evaluation by physicians and social evaluation by social workers and coordinators as a pre-requisite for kidney transplantation. Expanding the swap around program to a regional or national pool could be an option to reduce the organ donor shortage in the future.

Caring at a distance: gift theory, aid chains and social movements

This paper takes as its starting point recent work on caring for distant others which is one expression of renewed interest in moral geographies. It examines relationships in aid chains connecting donors/carers in the First World or North and recipients/cared for in the Third World or South. Assuming predominance of relationships between strangers and of universalism as a basis for moral motivation I draw upon Gift Theory in order to characterize two basic forms of gift relationship. The first is purely altruistic, the other fully reciprocal and obligatory within the framework of institutions, values and social forces within specific relationships of politics and power. This conception problematizes donor–recipient relationships in the context of two modernist models of aid chains—the Resource Transfer and the Beyond Aid Paradigms. In the first, donor domination means low levels of reciprocity despite rhetoric about partnership and participation. The second identifies potential for greater reciprocity on the basis of combination between social movements and non‐governmental organizations at both national and trans‐national levels, although at the risk of marginalizing competencies of states. Finally, I evaluate post‐structural critiques which also problematize aid chain relationships. They do so both in terms of bases—such as universals and difference—upon which it might be constructed and the means—such as forms of positionality and mutuality—by which it might be achieved.

A Politico-Sociological Account of Donor Practice and Aid Effectiveness: Donor-Recipient Relationships in Bolivia

This discussion paper intends to stimulate debate on an often neglected subject: the socio-political aspects of donor practice and their relation to the effectiveness of development cooperation programs. It does so with reference to donor-recipient relationships in Bolivia - a country in which donors take an unusual interest since the structural reform era of the 1980s. After more than two decades of democracy and twenty years of structural reforms, Bolivia now stands at a crossroad of political and economic development. The last few years of economic and social crisis have further emphasized the fact that Bolivia - the model student of the World Bank's structural reform programs - has not achieved the level of economic growth and poverty alleviation that its governments, its civil society and its present donor community had hoped for.