Living Organ Donation Research Articles

Mapping French Laypeople's Views Regarding Living Organ Donation

BackgroundFrench laypeople's views on living organ donation (LOD) were examined. MethodsFrom 2010 to 2014, 327 adults (including 21 nurses) judged the acceptability of LOD in 60 realistic scenarios composed of all combinations of 5 factors: 1. type of organ; 2. whether it could have been obtained from a cadaver; 3. donor-recipient relationship; 4. donor's level of autonomy; 5. financial compensation; and 6. patients' level of responsibility for their illness. In all scenarios, the patients were in need of a kidney or liver transplantation. The ratings were subjected to cluster analysis and analyses of variance. ResultsFive qualitatively different positions were found that were termed Free Market (22%), Pragmatism (15%), Altruism (48%), Always Acceptable (7%), and Undetermined (8%). Nurses comprised the majority (90%) of the members of the altruism cluster. Younger and more-educated people were, more frequently than older and less-educated people, members either of the pragmatism or of the free market cluster. ConclusionsHalf of French adults support the altruism model of LOD. A substantial minority, however, mostly young and more educated people, support alternative models allowing the introduction of financial incentives.

Living-Donor Organ Donation: Impact of Expansion of Genetic Relationship.

In Jordan, the history of organ transplantation started in 1972 with a kidney transplant from a deceased donor. At present, Jordan is in a good position with regard to organ transplantation among developing countries. It remains important to follow through with some decisions and enact laws that would increase the percentage of legal organ donations and transplant procedures. This has involved the expansion of relative degree donation. Until 2013, most relative degree donations involved 1st-degree and 2nd-degree relatives. The degree of genetical and legal relatives in living organ donation was then expanded to allow 4th- and 5th-degree relatives. This expansion to a 5th-degree relative came about when it was realized that the percentage of organ transplants in 2nd-degree relatives was high. Therefore, the idea of organ donation in these degrees may be beneficial, as it can lead to significantly higher numbers of organ donations.

Living Organ Donation Near and at the End of Life: Drawing and Re-Drawing the Boundaries Around Permissible Practices in Organ Donation

Living Organ Donation Near and at the End of Life: Drawing and Re-Drawing the Boundaries Around Permissible Practices in Organ Donation

Прижизненное органное донорство: тенденции развития

Прижизненное органное донорство: тенденции развития

Report of Donors of Living Donor Liver Transplantation at Dr. Cipto Mangunkusumo Hospital Jakarta: an Emerging Liver Transplant Center

Introduction: LDLT has developed over the years, despite limited donation rate. Evaluation of living donor is important because there are many risks arise in operating such patients. Thorough evaluation is needed to assess the risks and safety outcomes of the donor and graft adequacy for the recipient. Setting up the liver transplantation program in a developing country like ours was challenging Method: We retrospectively reviewed our living donor patients between 2011-2019. Result: As an emerging liver transplant center, Cipto Mangunkusumo is the first hospital able to routinely perform LDLT successfully in Indonesia. Until 2019, we have successfully performed 53 LDLT; seven were adults and 46 were pediatrics. Main indications for liver transplantation in our institution were biliary atresia and HCC. Mean donor age was 31 years old, the majority of the donor was female. Only one person was an acquaintance donor, others were biologically related. ABO-incompatibility occurred in 1 adult and 2 pediatric patients. Mean of BMI was 22,5 kg/m2. Mild fatty liver was found in 24 donors.. We ran CT-volumetry and biliary tree evaluation using MRCP preoperatively. Mean actual GRWR was 2.5%. We performed right lobe hepatectomy in four patients, the rest were left segmentectomy Length of donor surgery was 393 minutes with 326 cc of mean intra-operative hemorrhage. Two donors have 2 portal veins,1 donor has 3 hepatic arteries and 11 donors have 2 bile ducts. The Average length of stay (ALOS) in the ICU was 2.4 days with total ALOS was 8.3 days. There is no donor mortality. Conclusion: LDLT is a major step forward in our hospital. We hope to raise the awareness of live organ donation to increase the number of adult LDLT in Indonesia. Further improvements are needed to establish a set of criteria for living donor liver transplantation that will ensure donor safety.

Should All Living Kidney Donors Receive Donor Health Insurance? - Ethical Guidance for Evaluating Policies and Actions that Provide Financial Benefits to Living Organ Donors

This review article provides ethical guidance for determining which kinds of financial benefits provided to living organ donors are ethically appropriate. It does so by way of ethical analysis of a policy case study: the National Kidney Registry (NKR) has implemented a donor insurance program to all its living donors. Is such a policy ethically supportable, or is it an unethical practice? The article proceeds as follows. First, a framework for grounding the ethical commitments of transplant programs is defended. It is argued that this framework can be accepted by all who work in transplant medicine, regardless of differences in ethical theory preference or background. Second, from this framework two ethical principles are formulated. (1) Living donors should, as far as possible, not be worse off for donating. (2) Disincentives towards donation should be removed as much as possible. Third, issues with unethical incentives are explored: undue inducement, commodification of the body, potential decreased organ donation rates, and potential exploitation of vulnerable populations. Lastly, these ethical considerations are applied to the policy change at the NKR, showing that the NKR policy change appears to be ethically supportable. Financial benefits provided to donors are ethically sound if they are in keeping with principles (1) and (2), and do not cause undue inducement, commodification, decreased organ donation, or exploitation. It is ethically appropriate for transplant programs to institute as well as study such programs with the goal of serving the welfare and interests of patients, donors, and the general public.

Use of Twitter in communicating living solid organ donation information to the public: An exploratory study of living donors and transplant professionals.

As transplant centers start leveraging Twitter for information dissemination and public engagement, it is important to understand current living solid organ donation-related Twitter use. We identified public Twitter profiles available in 01/2017 that referenced living organ donation and analyzed the use of donation-related Twitter handles, names, or profile information. Tweets were manually abstracted and qualitatively analyzed for common themes. Social media influence of those tweeting about living donation was evaluated using Klout score. We identified 93 donors, 61 professionals, 12 hospitals, and 19 organizations that met eligibility criteria. Social media influence was similar across these groups (P=0.4). Donors (16%) and organizations (23%) were more likely than professionals (7%) or hospitals (0%) to include transplant-related educational information in their profiles (P=0.007). Living donation-related tweets were most commonly donation stories (33%), news reports (20%), reports about new transplant research (15%), and sharing transplant candidates' searches for donors (14%). This exploratory study of living donors and transplant professionals, hospitals, and organizations on Twitter provides insight into how the social media platform may be used to communicate about and disseminate information about living donation.

Acupuncture in living liver and kidney donors: a feasibility study

ObjectiveThe purpose of this study was to test the feasibility of integrating acupuncture into the routine care of living liver and kidney donors during the process of donation and recovery. MethodsThis is a pilot study on the feasibility of a brief acupuncture intervention for living liver and kidney donors. Participants received acupuncture immediately prior to organ donation surgery, every day as inpatients, while recovering from donation, and at a 2-week follow-up. Prior to surgery, questionnaires were completed on acupuncture outcome expectations and the State–Trait Anxiety Inventory. After participating, those who received acupuncture provided feedback. Following the active intervention, a retrospective chart review was conducted, using donors who did not receive acupuncture as a comparison cohort. ResultsForty donor candidates were approached and recruited, 32 consented and ultimately 25 donors participated in the acupuncture intervention (15 of kidney, 10 of liver), 68% female, and 88% Caucasian; only one had prior experience with acupuncture. Participants received an average of 4 sessions while inpatient (range 2–8). Those who expected acupuncture to be more helpful prior to the intervention reported lower inpatient pain scores (P = 0.04). Qualitative feedback from patients was predominantly positive, indicating acupuncture was helpful for relaxation and pain. However, a few patients reported feeling overburdened during postdonation recovery, and that the study was viewed as additional obligation. ConclusionPreliminary findings suggest it is feasible to integrate acupuncture into inpatient recovery for living organ donation. Tailoring interventions to the specific needs of patients is important to address ongoing concerns. Larger studies are needed to further ascertain benefits of peri-operative acupuncture.

My Mom is Having Surgery (A Kidney Story) by B. E. Cortez

Cortez, Brenda E. My Mom is Having Surgery (A Kidney Story). Donate Life, 2015.
 Based on the true story of author Brenda E. Cortez’s kidney transplant, My Mom is Having Surgery (A Kidney Story) describes the process of donating a kidney and offers encouragement for others to take steps and donate. In targeting her book at young readers, those who are just beginning to read independently, Cortez offers an educational overview of the process in the hopes of normalizing lifesaving procedures such as living organ donation. From reassuring her children, to explaining in detail why donating a kidney is the right choice, to the process of surgery, recovery, and returning home, My Mom is Having Surgery (A Kidney Story) offers a realistic look at the many stages of this procedure.
 Aimed at audiences who are skilled and capable of reading independently, My Mom is Having Surgery is written in paragraph format with a medium sized font. By following the mother's surgery through the eyes of her daughter, the book engages with children and shows them how to be both encouraging and how to cope with the difficulties faced by a parent undergoing this procedure. Each page of the book is accompanied by colour images which represent the activities described in the text. These images are aesthetically pleasing and would help solidify the message of the book for young readers. As a tool designed to change attitudes in an engaging way, this book is a must read for young children. 
 Highly Recommended: 4 out of 4 starsReviewer: Madeline C. Crichton
 Madeline Crichton is a University of Alberta undergraduate student with a lifelong passion for reading. When she is not preoccupied with her studies, Madeline is busy volunteering in a variety of roles in her community.

Societal and Professional Obligation in the Care of the Living Organ Donor

Societal and Professional Obligation in the Care of the Living Organ Donor

Metal, magnet or transplant: options in primary sclerosing cholangitis with stricture.

Primary sclerosing cholangitis (PSC) is a chronic inflammatory disease of the biliary tree of unknown etiology leading to stricturing and dilation. There is currently no effective medical therapy for PSC and liver transplantation (LT) remains the ultimate treatment for severe disease defined as repeated episodes of cholangitis, decompensated biliary cirrhosis or in exceptional cases, cholangiocarcinoma (CCA). Patients often present with a "dominant" stricture and the therapeutic endoscopist plays an important role in management to improve biliary patency using a variety of techniques that involve sampling, balloon dilation and temporary stenting. Newer modalities such as self-expanding metal stents or magnetic compression anastomosis that have been used in other diseases may have a role to play in PSC but should remain investigational. Liver transplantation for PSC is curative in most cases but the optimal timing remains unclear. The lifetime risk of CCA is 10-15% in PSC patients and LT is often not possible at the time of diagnosis. Multiple studies have tried to identify risk factors and to diagnose CCA at an early stage when surgical resection may be possible or LT can be performed. However, deceased donor organs for LT remain in short supply throughout the world so even identifying PSC patients with CCA at an early stage may not be beneficial unless a live donor organ is available.

Message From the CRN Chair

Message From the CRN Chair

Lymphocyte depletion and risk of acute rejection in renal transplant recipients at increased risk for delayed graft function.

Delayed graft function (DGF) is a risk factor for acute rejection (AR) in renal transplant recipients, and KDIGO guidelines suggest use of lymphocyte-depletion induction when DGF is anticipated. We analyzed the United Network for Organ Sharing/Organ Procurement and Transplantation Network (UNOS/OPTN) database to assess the impact of induction immunosuppression on the risk of AR in deceased kidney recipients based on pretransplant risk of DGF using a validated model. Recipients were categorized into 4 groups based upon the induction immunosuppression: (1) Rabbit anti-thymocyte globulin (rATG); (2) Alemtuzumab (C1H); (3) IL2-receptor antagonists (IL2-RA; basiliximab or daclizumab), and (4) No antibody induction. The primary endpoint for analysis was a composite endpoint of treated AR or graft failure by 1-year posttransplantation. Compared to no antibody induction, rATG and C1H had consistently lower adjusted odds of the composite endpoint across all risk strata for DGF risk, whereas IL2-Ra was associated with increased adjusted odds of the composite endpoint with increasing DGF risk. When the induction agents were compared, rATG and C1H were associated with decreasing adjusted odds for the composite endpoint with increasing risk of DGF, especially at the higher risk spectrum of DGF. Consideration must be given to use of lymphocyte-depletion induction when the anticipated risk of DGF is increased.

Crowd Sourcing for Organs: A Social Dilemma.

Crowd Sourcing for Organs: A Social Dilemma.

Living Donation of Vascularized Composite Allografts.

Living donation has become a medically and ethically accepted practice in solid organ transplantation. Published proceedings from the international kidney transplant community and from the Ethics Committee of The Transplantation Society articulated the general principles and specific recommendations for living donation, which remain the backbone of Centers for Medicare and Medicaid Services and Organ Procurement and Transplantation Network requirements and policies. Meanwhile, there have been major advancements in another revolutionary field of transplant medicine: vascularized composite allotransplantation. Recent interventions have demonstrated potential for superior functional and aesthetic outcomes in a single operation when compared to staged conventional reconstructions. In view of these successes, the indications for vascularized composite allotransplantation are expected to broaden to include less extensive types of transplants, which would introduce the possibility of using living vascularized composite allotransplantation donors. In this article, the authors discuss the feasibility and ethics associated with living donation of vascularized composite allografts. The authors explore the current guidelines and policies set by the Organ Procurement and Transplantation Network regarding living organ donation. In addition, the authors provide several clinical scenarios in which living donation of vascularized composite allotransplantation could be used to augment the reconstructive ladder currently used by reconstructive surgeons to guide their reconstructive strategies.

The Ethics of Organ Donation in Patients Who Lack the Capacity for Decision Making.

Free and informed consent is the legal and ethical basis for organ donation from living donors, and is a requirement for making an autonomous health decision. In clinical practice, health-care providers are required to respect four bioethical principles: respect for autonomy, beneficence, non-maleficence, and justice (Beauchamp & Childress, 2012), with the best interest of their patients in mind. Yet there are bioethical concerns behind organ procurement from living donors who have never attained capacity, do not yet have the capacity, or have permanently lost the capacity for decision making. A consensus statement by the Live Organ Donor Consensus Group (Abecassis et al., 2000) protects these donors' well-being and autonomy, but there still is a need to raise ethical awareness about the decision-making process regarding vulnerable potential donors. Health-care providers who are staff members in transplant clinics should be aware of the current consensus statement, commit to essential bioethical principles surrounding organ donation, and advocate for vulnerable living donors.

Euthanasia through living organ donation: Ethical, legal, and medical challenges

Euthanasia is categorically prohibited in almost all countries throughout the world. In Belgium and the Netherlands, combining euthanasia and subsequent organ donation in a so-called donation after circulatory-death (DCD) procedure is feasible on legal and medical grounds, and is increasingly gaining social and ethical acceptance. However, heart transplantation after DCD is currently not performed in Belgium and the Netherlands after euthanasia due to concerns surrounding the prolonged warm ischemia time associated with DCD and its effect on subsequent heart function. A number of patients who undergo euthanasia explicitly express their wish to donate their organs in a "living organ donation" procedure, which then causes death. Assuming that euthanasia is permitted, as expressed in Dutch and Belgian legislation, this exploratory article addresses whether it is legally and ethically sound to donate organs, especially the heart, as a living donor and to perform euthanasia in the same procedure in a patient who fulfills the due diligence requirements for euthanasia. Organ donation euthanasia (ODE) would then cause death by the associated surgical procedure, and in addition would improve the quality of the other donated organs, a procedure that would fully respect the patient's autonomy.

Renal cell cancer after kidney transplantation.

This study aims to identify modifiable risk factors for de novo renal cell carcinoma (RCC) after kidney transplantation in a matched-pair approach matching for unmodifiable factors. One thousand six hundred fifty-five adults who underwent kidney transplantation in the period 1 January 2000 to 31 December 2012 were analyzed. Patients with RCC after kidney transplantation were matched in a 1:2 ratio with those without RCC using the indication for transplantation, age at transplantation (± 10years), recipient sex (male/female), number of received transplants, living organ donor transplantation (yes/no), and time of follow-up in days as matching criteria. The paired t test was used to compare continuous variables and the Cochran-Mantel-Haenszel test for categorical variables. Multivariable conditional logistic regression modeling was used to identify independent risk factors for RCC. In matched-pair analysis, a total number of 26 incident cases with RCC after kidney transplantation could be matched. Post-transplant RCC was significantly associated with longer durations of pre-transplant hemodialysis (p = 0.007) and post-transplant immunosuppression with cyclosporine (p = 0.029) and/or mycophenolate mofetil (p = 0.020) and with larger proportions of post-transplant time on mycophenolate mofetil (p = 0.046) and/or prednisolone medication (p = 0.042). Multivariable conditional logistic regression modeling revealed a significant risk increasing multiplicative factor interaction between the duration of pre-transplant dialysis (years) and the time of prednisolone usage (percent/100). Cyclosporine A usage and mycophenolate mofetil usage were also revealed as independent, significant risk factors for RCC development. Longer pre-transplant dialysis, cyclosporine-based protocols and/or intensified immunosuppression with additional mycophenolate mofetil, and larger proportions of time of prednisolone treatment during follow-up increase de novo RCC risk.

Attitudes Toward Living Organ Donation and Willingness to Be a Living Organ Donor Among Chinese Citizens in 3 Cities

ObjectiveThe level of awareness of living organ donation demonstrated by citizens may affect the rate of organ transplantation in their area of residence. The objective of this study was to assess the attitudes toward living organ donation and willingness to be a living organ donor among Chinese citizens. MethodsThe study population consisted of 2250 citizens in Beijing, Shanghai, and Wuhan. Data were collected using a questionnaire developed by the researchers based on the existing literature and expert opinions. The questionnaire included questions designed to assess demographics, attitudes, and willingness. The data were analyzed using SPSS 22.0 software. ResultsOverall, 2198 citizens completed the questionnaire, of whom 845 (38.4%) supported living organ donation; however, only 213 (9.6%) participants were supportive of their family members donating living organs. A total of 424 (19.3%) citizens were willing to be living organ donors. Of the respondents, 1173 (53.4%) were neutral toward living organ donation and 1463 (66.6%) were undecided about their willingness to donate. In addition, willingness was positively correlated with age, education level, income, marital status, and having descendants (P < .05). Those who had relatives or friends who had undergone organ transplantation were significantly more likely to be donors than those who did not (P < .05). ConclusionsThe results of our study suggest that Chinese citizens lack an understanding of living organ transplantation, indicating that more work needs to be done to inform the public about organ transplantation in China.

Liver transplantation and multivisceral transplantation in the management of patients with advanced neuroendocrine tumours.

Orthotopic liver transplantation (OLT) represents a generally accepted albeit somewhat controversially discussed therapeutic strategy in highly selected patients with non-resectable hepatic metastases from neuroendocrine tumours (NET). Whilst there are some exclusion criteria, these are not universally followed, and the optimal set of inclusion parameters for deeming patients eligible has not yet been elucidated. This is due to heterogeneity in the study populations, as well differing approaches employed and also divergences in selection criteria between centres. Recent data have suggested that OLT may represent the most efficacious approach in terms of overall and disease-free survival to the management of NET metastatic to the liver when conducted in accordance with the modified Milan criteria. Therefore, a consensus set of selection criteria requires definition to facilitate stringent and fair allocation of deceased-donor organs, as well as consideration for living-donor organs. In the context of classically non-resectable metastatic tumour bulk, multivisceral transplantation with or without the liver may also be indicated, yet experience is very limited. In this review, we discuss the diagnostic work-up of patients in whom the aforementioned transplantation approaches are being considered, critically analyse the published experience and also anticipate future developments in this field, including a discussion of immediate and longer-term research priorities.