Living Organ Donation Research Articles

The use of nondirected donor organs in living donor liver transplantation: Perspectives and guidance.

Interest in anonymous nondirected living organ donation is increasing in the United States and a small number of transplantation centers are accumulating an experience regarding nondirected donation in living donor liver transplantation. Herein, we review current transplant policy, discuss emerging data, draw parallels from nondirected kidney donation, and examine relevant considerations in nondirected living liver donation. We aim to provide a consensus guidance to ensure safe evaluation and selection of nondirected living liver donors and a schema for just allocation of nondirected grafts.

Living organ donation: the cultural perspective

Background: Despite the large number of transplant surgeries performed in Saudi Arabia, there remains a significant gap between the number of donors and the number of patients who need transplants. This study aimed at measuring the general Saudi public's knowledge and preparedness concerning organs and identify the barriers to becoming an organ donor. Methods: This descriptive cross-sectional study was conducted from December 2021 to March 2022 among 820 members of the general Saudi population. The data collection tool was a self-administered online questionnaire that gathered sociodemographic data and included questions about organ donation (OD). Results: A total of 820 participants were involved in this study. Although nearly all the participants were aware that they could donate organs while still alive, only 15% had a postmortem OD card. This low rate may be due to religious beliefs, as 43% of the participants believed that OD is prohibited in Islam. The most common factor that prevented the participants from agreeing to donate organs alive was fear of the associated operation and its complications. Yet, the participants' willingness to donate their organs to their parents (78.5%), partners (60.1%), and children (63.7%) were high, especially in life-threatening situations. Moreover, 42.1% agreed they would donate their organs after they died. Conclusion: The results showed a high level of knowledge regarding OD among the general Saudi population, especially younger people. However, the participant's attitudes toward living OD were unsatisfactory. These findings can help to guide the development of appropriate educational methods to increase the number of Saudis who donate the organ.

Transplant Programs: An Overview of the Scientific Registry of Transplant Recipients

The Scientific Registry of Transplant Recipients (SRTR) provides extensive data regarding the performance of various aspects of the national transplant system and a tier rating system that can aid patients in selecting their transplant center. The role of the SRTR is to provide clear, accurate, and timely information to regulatory agencies and transplant professionals, candidates, and recipients; live organ donors; donor families; and the general public. This overview provides basic information on the history and role of the SRTR, as well as changes made in response to the COVID-19 pandemic.

Differential Willingness to Pay for Kidney Transplantation From Living and Deceased Donors: Empirical Study Among End-Stage Kidney Disease (ESKD) Patients.

Kidney transplantation has developed to the stage where it is currently the most cost-effective treatment for patients suffering from end-stage kidney disease (ESKD) and, when available, offers them the highest quality of life. Yet, kidney transplantation is challenged by cultural and traditional beliefs; thus, this study sought to evaluate the willingness to pay for a kidney transplant in a culturally sensitive population. A self-administered survey was completed by 734 end-stage kidney disease (ESKD) patients. A quantitative method and survey design were chosen and employed descriptive, correlational, nonparametric, and multivariate statistical tests. Participants were willing to pay a mean amount of $40 751.36 for a living donor kidney transplant, whereas the mean is considerably lower, $18 350.51, for a deceased donor kidney. Significant predictors of the willingness to pay (WTP) for a kidney transplant from a living donor and a deceased donor were found, among them: religiosity and ethnicity. The participants' willingness to pay for a kidney transplant could attest to significant benefits in enhancing patient well-being. The willingness to pay differentially for a donation from a deceased or a living donor stems from the higher chances of success with a living-donor organ as well as from moral and religious motives. In Israel kidney transplantation is not tradable in the free market and is fully funded by the state. The average cost of kidney transplantation in Israel is $61 714.50. Since the cost exceeds the utility and since the economic literature suggests that the funding of healthcare interventions should be provided up to the point where the costs of that funding equal the benefits that society derives from it, crucial revisions in public health policy should be made. Education may have a significant impact on the approach to kidney donation and organ donation in general.

Women take risks to help others to stay alive.

Evidence that women voluntarily expose themselves to some threats more than men do challenges the generalizability of the claim that women exceed men in self-protective responses. Examples include women's higher rates of living organ donation and rescuing Jews during the holocaust. In general, women's efforts to keep other people alive can take precedence over their efforts to protect themselves.

Stavovi o pravnim i etičkim aspektima doniranja organa među zdravstvenim radnicima i opštom populacijom u Crnoj Gori

Introduction: Medical and legal problems of organ transplantation are numerous. The donor must be fully and properly informed about all elements regarding the transplantation, and especially about the possible consequences resulting from the removal of tissues and organs, which is an essential ethical problem. Aim: The aim of this research was to determine the attitude of health professionals and the general population in Montenegro towards some of the legal and ethical aspects of organ donation. Material and methods: The research was conducted with the consent of the Ethics Committee of the Clinical Center of Montenegro, in Podgorica number 03 / 01-1504. The sample was formed by random selection and consisted of 400 adult citizens of the city of Podgorica. The research included 200 health workers employed at the Clinical Center of Montenegro in Podgorica and 200 adult citizens of the city of Podgorica. Results: The majority of health workers (84.6%) state that the donor should be the one who gives consent for organ donation for life. Similarly, the vast majority (76%) of the general population believe the same. The largest percentage of participants, more than a third, in both groups, believe that using organs for the wrong purposes is sometimes possible, while almost a quarter of respondents said they did not believe it could happen. The difference in the opinion of health workers and the general population on this issue was not statistically significant (p = 0.522). Conclusion: From our research it can be concluded that both groups of respondents generally believe that the guarantee that organs will be used for the right purposes is the most important factor in organ donation and that the donor is the one who will give consent for living organ donation. The proposed measures need to create a strategy to increase confidence that organ donation will be done only for the right purposes, both in the general population and among health professionals.

Knowledge and Beliefs about Organ Donation among Under-Graduate Medical Students at a Teaching Institute of New Delhi

Introduction: Organ shortage is a global issue. As future doctors, role of medical students becomes important in promoting organ donation. Objectives: 1. To study the knowledge of medical students regarding organ donation 2. To study the beliefs of medical students regarding various aspects of organ donation 3.To study their perceptions about the need to have a training on this topic. Method: The study design was cross sectional involving undergraduate medical students from a teaching institute of Delhi. Sample size of 296 was calculated and 60 students were randomly recruited from each year by using random number tables. Data collection was done by using a pre designed pre tested semi structured questionnaire. Data entry and analysis was done by using Microsoft Excel and SPSS version 20 software. Results: A large proportion of 95.3% (286) had heard of ‘organ donation’ but correct knowledge regarding ideal age for donation and brain dead people for donation was very poor. It was significantly poorer in males and those studying in earlier years of graduation (p<0.05). A very small proportion (14.7%) had actually pledged for donation. A large proportion of students were in favour of providing health insurance and financial compensation for live organ donors. Only 27% perceived to have adequate knowledge and 58% felt confident in counselling potential donors for organ donation. Females and senior students were significantly better in this aspect. (p< 0.05). Majority of them (90.3%) felt the need for training. Conclusion: Knowledge and some of the beliefs of medical students regarding organ donation were not found to be appropriate and training about it was desired by them.

Anonymous living liver donor perspectives on the role of family in their donation experience.

Anonymous living organ donation is an understudied but rapidly expanding sector in organ transplantation, in which donors choose to donate anonymously to a recipient in need. The family members and close support network of living donors often play a crucial role in the donation process, and their influence likely has a large impact on the decision to donate as well as the donor's physical and psychosocial state. However, there is limited data examining the impact donor families have on the anonymous donor, and in turn, the impact donation has on donors' families. To assess this, we analyzed a semi-structured qualitative interview on living donor experiences with 26 anonymous living liver donors for common themes concerning donor families. Responses surrounding donor families were grouped into three major categories: (1) family reactions to donation, ranging from (a) pride/support, (b) fear/worry, and (c) jealousy/anger; (2) the impact of donation on donor-family relationships, including (a) positive impacts, (b) negative impacts, (c) a positive ripple effect; (3) gaps in institutional support for donor families. This study provides unique information on anonymous living liver donor perceptions related to their families and will help improve existing programs to accommodate donor family needs and cater to donor relationships.

Equity or Equality? Which Approach Brings More Satisfaction in a Kidney-Exchange Chain?

In United States (U.S.), government-funded organizations, such as NLDAC, reimburse travel and subsistence expenses incurred during living-organ donation process. However, in Iran, there is a non-governmental organization called Iranian Kidney Foundation (IKF) that funds the direct and indirect costs of donors through charitable donations and contributions from participants in the exchange program. In this article, for countries outside the U.S. that currently use an equality approach, we propose a potential new compensation-apportionment approach (equitable approach) for kidney-exchange chains and compare it with the currently available system (equality approach) in terms of the apportionment of compensation in a kidney-exchange chain to cover the expenses incurred by the initiating living donor of the chain in the act of donation. To this end, we propose a mechanism to apportion compensation among all participating pairs based on the equity approach by utilizing a prediction model to calculate the probability of graft survival in each transplant operation. These probabilities are then used to define the utility of any transplantation, considering the quality of each pair’s donated and received kidney in the chain. Afterward, the corresponding cost is apportioned by a mechanism based on the normalized differences between the utility of donated and received kidneys for each incompatible pair of the chain. In summary, we demonstrate that by utilizing the equitable approach, there is more fairness and equity in the allocation of resources in organ-procurement systems, which results in more satisfaction among incompatible pairs. Additional future prospective studies are needed to assess this proposed equitable approach for kidney-exchange chains in countries outside the U.S., such as Iran, that currently use an equality approach.

Value-Based Care in Nephrology: The Kidney Care Choices Model and Other Reforms.

The Advancing American Kidney Health (AAKH) initiative has reinvigorated the focus on improving the care of patients with advanced CKD. Multiple interventions have been planned, focusing on education campaigns for both clinicians and patients, delaying the progression of kidney disease and improving utilization of home dialysis modalities and kidney transplantation. Value-based care models for patients with advanced kidney disease are being rolled out, with the ESKD treatment choices model starting in January 2021, and the Kidney Care Choices model planned to start in January 2022. There is increasing emphasis on the role of the nephrologist as the "captain of the ship," leading efforts in care coordination as physician leaders. The transplant reforms have focused on changes to organ procurement organizations aiming to increase availability of organs, and transplants performed, both deceased and living donor, and removing financial disincentives from live organ donation. The American Society of Nephrology (ASN) and the National Kidney Foundation (NKF) are partnering with the Department of Health and Human Services to develop educational material for clinicians and patients. In this review, we discuss these reforms, potential challenges that have arisen, and potential solutions, with emphasis on the Kidney Care Choices model.

Assessment of Safety and Applicability of Laparoscopic vs Open Non Anatomical Resection of Hepatocellular Carcinoma in Cirrhotic Patients

Abstract Background Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Liver surgery was one of the last frontiers reached by minimally invasive surgery. Surgical technique and equipment evolved to overcome technical limitations, making laparoscopic liver resections (LLR) safe and feasible. Surgeons developed skills in a stepwise approach, beginning with low complexity operations for benign diseases and reaching high-complexity surgeries for malignant cases and living donor organ harvesting. Objective s: The aim of the study is to compare short term results of laparoscopic versus open hepatectomy regarding to intra operative details and post-operative management and complications for achieving a safe hepatic resection for treatment of HCC in cirrhotic patients. Patients and Methods In this prospective study, a comparison between laparoscopic resection and open resection was done to compare short-term results between laparoscopic and open liver resection. This study was conducted on 30 patients with hepatocellular carcinoma. 15 patients (50%) were treated by laparoscopic liver resection (Group A) while the other 15 patients (50%) were treated by open liver resection (Group B). Results Regarding the demographic data, the presence of past history of medical condition and the preoperative laboratory results, no statistical significance was found. The mean operative time has statistically significant difference between the 2 groups, with decreased operative time in the laparoscopic group (P < 0.001). The mean blood loss has no statistically significant difference relations between the 2 groups, (P = 0.866) with conversion rate of (13.3%) happened in two cases. Conclusion Laparoscopic liver resection is a safe and feasible treatment option for HCC in cirrhotic patient needing minor resection at laparoscopic segments (II, III, IVa,V,VI). Laparoscopic liver resection for HCC has superior short- term and comparable oncological outcomes to open liver resection. LLR should be performed for carefully selected patients and by an expert surgical team.

Sex Disparities in Organ Donation: Finding an Equitable Donor Pool.

BackgroundThe majority of living organ donors are women, but few are deceased organ donors, which increases risks associated with sex mismatched organs. We sought to identify reasons for sex disparities in organ donation and strategies for equity.Methods and ResultsUsing Amazon's Mechanical Turk, we examined US adults' perceptions regarding donation in a mixed‐methods survey study. Results were compared by sex with Fisher's exact test and T‐tests for quantitative results and qualitative descriptive analyses for write‐in responses. Among 667 participants (55% women), the majority of men (64.8%) and women (63.4%) self‐identified as registered donors. Women's willingness to donate their own organs to family members (P=0.03) or strangers (P=0.03) was significantly higher than men. Donors from both sexes were guided by: desire to help, personal experience, and believing organs would be useless to deceased donors. Non‐donors from both sexes were guided by: no reason, medical mistrust, contemplating donation. When considering whether to donate organs of a deceased family member, women were equally guided by a family member's wishes and believing the family member had no further use for organs. Men had similar themes but valued the family member's wishes more. Among non‐donors, both sexes would consider donation if more information was provided.ConclusionsIn a national survey, both sexes had similar reasons for becoming and not becoming an organ donor. However, compared with men, women were more willing to donate their organs to family members and strangers. Improving education and communicating wishes regarding organ donation with direct relatives may increase sex equity in deceased organ donation.

Evaluating early maladaptive schemas and depression levels in living kidney and liver donors

ABSTRACT Living organ donation is a stressful process, both in terms of physical and mental consequences after the operation. Studies have found that cumulative depression prevalence in 5-year follow-up after the organ donation is 4.2% in 1 year and 11.5% in 5 years. The aim of the present study was to find out early maladaptive schemas (EMS) and depression levels of living kidney and liver donors. Ninety-three patients who have become living kidney or liver donors in Baskent University Hospital between 2015 and 2019 and accepted to participate in the study are included. Interviews were conducted via telephone or face-to-face and socio-demographic information form, Young Schema Questionnaire Short Form-3 and Beck Depression Inventory were given to the participants. The first three schemas with the highest average scores in living donors were self-sacrifice, punitiveness and approval seeking. The Sschema domain with the highest score is ‘other directedness’ among living donors. The donors who had depression revealed higher scores in the schema domains of ‘abandonment and rejection’ and ‘impaired autonomy’ when compared to those who did not have depression. As the donors had higher scores in the ‘other directedness’ schema domain and ‘self-sacrifice’ and ‘approval seeking’ schemas, overthinking and acting accordingly for the others with the expectation of being praised is thought to be the underlying pattern (motivation) of being a living donor. Culture could have an important impact in this particular way of thinking and acting. There is a cultural and religious impact as well in the high scores of ‘punitiveness’ schema of the donors. Being adequately informed pre-operatively, feeling safe and independent during the decision process and getting enough social support post-operatively seem to be the important factors of tackling depression for living organ donors.

Hepatic Vein and Inferior Vena Cava Reconstruction during Hepatic Surgery Resection for Cancer

Invasion of tumor in the liver requires surgical interventions that may reduce the effects or may eliminate the tumor-affected cells. The renewal of the hepatic vein and inferior vena cava has enabled most specialized oncologists and medical specialists to use advanced diagnostic methods in the treatment of the liver tumors. Liver resection has prolonged the lives of many patients and the invention of live donor organ transplants has effectively enabled the use of liver resection in most cancer centers across the world. By reviewing data from 10 articles, 21 surgical analyses were investigated and analyzed for the risks involved in the applications of reconstructions of hepatic vein and inferior vena cava in the surgical liver resection. The postoperative complications and the indications of reconstructions were mentioned. The results indicated that with these surgical procedures, complications are still involved but may be successful for particular patients.

Cancer transmissions and non-transmissions from solid organ transplantation in an Australian cohort of deceased and living organ donors.

Evidence on cancer transmission from organ transplantation is poor. We sought to identify cases of cancer transmission or non-transmission from transplantation in an Australian cohort of donors and recipients. We included NSW solid organ deceased donors 2000-2012 and living donors 2004-2012 in a retrospective cohort using linked data from the NSW Biovigilance Register (SAFEBOD). Central Cancer Registry (CCR) data 1972-2013 provided a minimum one-year post-transplant follow-up. We identified cancers in donors and recipients. For each donor-recipient pair, the transmission was judged likely, possible, unlikely, or excluded using categorization from international guidelines. In our analysis, transmissions included those judged likely, while those judged possible, unlikely, or excluded were non-transmissions. In our cohort, there were 2502 recipients and 1431 donors (715 deceased, 716 living). There were 2544 transplant procedures, including 1828 (72%) deceased and 716 (28%) living donor transplants. Among 1431 donors, 38 (3%) had past or current cancer and they donated to 68 recipients (median 6.7-year follow-up). There were 64 (94%) non-transmissions, and 4 (6%) transmissions from two living and two deceased donors (all kidney cancers discovered during organ recovery). Donor transmitted cancers are rare, and selected donors with a past or current cancer may be safe for transplantation.

Disparities in living donation.

Living organ donation provides improved access to transplantation, thereby shortening transplant wait times and allowing for more deceased organ transplants. However, disparity in access to living donation has resulted in decreased rates of living donor transplants for some populations of patients. Though there have been marked improvements in deceased donor equity, there are still challenges as it relates to gender, racial/ethnic, and socio-economic disparity. Improvements in living donation rates in Hispanic and Asian populations are tempered by challenges in African American rates of organ donation. Socio-economic disparity may drive gender disparities in organ donation resulting in disproportionate female living donors. Tailored approaches relating to language-specific interventions as well as directed educational efforts have helped mitigate disparity. Additionally, the use of apolipoprotein1 testing and modifications of glomerular filtration rate calculators may improve rates of African American donation. This review will evaluate recent data in living donor disparity as well as highlight successes in mitigating disparity. Though there are still challenges in living donor disparity, many efforts at tailoring education and access as well as modifying living donor evaluation and identifying systemic policy changes may result in improvements in living donation rates.

Sustainability of Chronic Kidney Disease Care


 Strategies to contain the cost of chronic kidney disease (CKD) care and to improve patient outcomes were found across the continuum of care, from prevention and early disease management through later-stage interventions such as conservative management, dialysis, and transplantation. A variety of health system strategies, including funding reform, were identified to help support and enable sustainable CKD care.
 For those at risk of CKD or in early stages of the disease, public health interventions to support healthy behaviours and ensure access to primary health care seem crucial to preventing or delaying disease progression.
 For later-stage patients requiring renal replacement therapy, enhancing access to transplantation and home-based dialysis has the potential to reduce costs while improving outcomes and quality of life. Conservative management without dialysis is an option for those who may not be good candidates for renal replacement therapy or who wish to choose a less-invasive care option.
 From a health system policy perspective, funding reform may be warranted to enhance team-based CKD care with good continuity. Policy-makers should also consider the ways in which improving financial supports for caregivers, providing travel and expense reimbursement for home dialysis patients and living organ donors, and providing support for utility and ancillary costs of home dialysis could incentivize sustainable CKD care.

Living Organ Donor Perspectives and Sources of Hesitancy about COVID-19 Vaccines.

Living organ donation declined substantially in the United States during the COVID-19 pandemic due to concerns about donor and transplant candidate safety. COVID-19 vaccines might increase confidence in the safety of living organ donation during the pandemic. We assessed informational preferences and perspectives about COVID-19 vaccines among US living organ donors and prospective donors. We conducted a national survey study of organ donors and prospective donors on social media platforms between 12/28/2020-2/23/2021. Survey items included multiple choice, visual analog scale, and open-ended responses. We examined associations between information preferences, history of COVID-19 infection, influenza vaccination history and COVID-19 vaccine acceptance using multivariable logistic regression and performed a thematic analysis of open-ended responses. Among 342 respondents from 47 US states and the District of Columbia, 35% were between 51-70 years old, 90% were non-Hispanic white, 87% were women; 82% were living donors (94% kidney) and 18% in evaluation to donate (75% kidney).The majority planned to or had received COVID-19 vaccination (76%), whereas 11% did not plan to be receive a vaccine, and 12% were unsure. Adjusting for demographics and donor characteristics, respondents who receive yearly influenza vaccinations had higher COVID-19 vaccine acceptance than those who do not (adjusted Odds Ratio [aOR] 5.06, 95% Confidence Interval [CI] 2.68-9.53). Compared to respondents who prioritized medical information sources (e.g., personal physicians and transplant providers), those who prioritized news and social media had lower COVID-19 vaccine acceptance (aOR 0.34, 95% CI 0.15-0.73). Low perceived personal benefit from vaccination and uncertainty about long-term safety were common themes among those declining COVID-19 vaccines. Donor informational source preferences were strongly associated with the likelihood of accepting a COVID-19 vaccine. Vaccine guidance for organ donors who are unsure about COVID-19 vaccines could incorporate messaging about safety and benefits of vaccination for healthy people.

Legal principles of Human Living Organ Donation: The Cross-over Donation –A Comparative Study

واجه التبرع التقليدي بالأعضاء البشرية بين الأحياء مشكلة جوهرية، تمثلت بعدم الملاءمة المناعية بين المتبرع والمتلقي، استحال معها إجراء عملية الزرع، لكن التبرع "التبادلي المتقاطع" شق طريقًا قانونيةً مستحدثةً وتغلب على ذلك وحقق فوائد أخرى عديدة، وقد أخذ به القانون الأمريكي والفرنسي والإماراتي والجزائري، وسكت عنه القانون اللبناني؛ سكوتًا مانعًا من الأخذ به. بينما منع سكوت القانون المصري والعراقي والفلسطيني من الأخذ ببعض مستوياته. في حين كان سكوت القانون القطري والعماني مقيدًا غير مانع له بكافة مستوياته. وبدى سكوت القانون الأردني والسوري والبحريني والكويتي والتونسي والمغربي مجردًا غير مانع له في وقت انتشرت فيه اتفاقيات "التبرع التبادلي الدولي" في أوروبا وأمريكا الشمالية؛ تمهيدًا للمستوى العالمي القادم من التبرع التبادلي المتقاطع.

Justifying the risks of COVID-19 challenge trials: The analogy with organ donation.

In the beginning of the COVID pandemic, researchers and bioethicists called for human challenge trials to hasten the development of a vaccine for COVID. However, the fact that we lacked a specific, highly effective treatment for COVID led many to argue that a COVID challenge trial would be unethical and we ought to pursue traditional phase III testing instead. These ethical objections to challenge trials may have slowed the progress of a COVID vaccine, so it is important to evaluate their merit. One common way of doing so is to make an analogy to other social practices that are relevantly similar and which we currently sanction. We submit that non‐directed live organ donation (NDLOD) is a promising analogy. After arguing that the risks to volunteers for each activity appear similar, we explore potential disanalogies that would undermine the comparison. We note that there are differences in both the kind and certainty of benefit secured by NDLOD compared to challenge trials. We conclude these differences are insufficient to make NDLOD permissible and challenge trials impermissible. Ultimately, if we think the risks associated with NDLOD are ethically permissible, then we should think the same of the risks associated with COVID challenge trials.