Expanding criteria for the use of living donors: what are the limits? (original) (raw)
Related papers
High-risk donors: expanding donor criteria
Transplantation Proceedings, 1999
IN THE CURRENT era of transplantation, the limitation of the cadaveric donor pool has necessitated a reevaluation of donor criteria to include organs that were previously considered high risk. The number of patients on the waiting list for all organs has since increased by 22% per year so that by the end of 1995, a total of 44,000 patients were registered (13,000 extrarenal and 31,000 renal).1 Concurrently, deaths on the waiting list have increased by 18% per year while the total number of transplantations has only increased by 8% per year. In 1996, 13,000 kidney transplants were performed in the United States and 934 in Canada. Simultaneously, the number of cadaveric organ donors has remained relatively static, with only a 4% increase per year from 1988 to 1994. Most of this incrementally small increase has been through the use of "expanded" donors, reflected by the fact that the use of donors older than 50 years old increased by 24% per year from 1988 to 1994, while those younger than 50 years increased by only 1.5% per year. In 1996, there were a total of 4,500 cadaveric donors in the United States and 450 in Canada, representing a donor rate of approximately 15 per million population, which has been static since 19872 , 3 despite estimates of potential organ donor rates of up to 50 per million population. A large study of the characterization of the potential renal organ donor pool in Pennsylvania concluded that the current ratio of organ donation could be increased by at least a factor of 2.4 To increase the potential donor supply, the implementation of presumed consent and financial incentives for donation have been proposed. In the United States, public attitude towards organ donation is such that presumed consent would probably not be acceptable. There has been resistance to financial incentives to the donor family because of the perceived danger of this escalating to the selling of organs as currently takes place in Southeast Asia and India. Efforts to expand the donor pool in this country are therefore limited to expanding the criteria for the use of "suboptimal" organs. This group would include kidneys from young (younger than 5 years old) pediatric donors, older donors, donors testing positive for hepatitis C antibody (HCV+), diabetic and hypertensive donors, and nonheartbeating donors (NHBD).
Living donor transplant: wider selection criteria
Transplantation Proceedings, 2004
The availability of cadaveric donor organs is insufficient for actual needs. The organ demand increases by 20% per year. Living donor transplant (LDT) may be a valid therapeutical alternative provided one uses proper criteria. LDT provides many advantages, like improved patient and organ survival, short waiting time, and the possibility to carefully plan the procedure. Potential risks include perioperative mortality and renal dysfunction in the kidney donor. At present, kidney LDTs in Italy represent 8% of the total, with an organ survival rate of 97% after 1 year (vs 93% for cadaveric transplants) and donors mortality rate of almost null. Most LDTs are performed from kinsmen. Presently, law no. 458, 26 June 1967, is in force in Italy for kidney LDT and law no. 453, 16 December 1999, for liver LDT. The foundations of LDT are, of course, the recipient's condition, the donor's motivation, and the altruism of the donation. It is desirable that in the future an increasing number of LDT be performed, supported by a careful, widespread health education regarding organ donation from living subjects and by the possibility to obtain insurance for the donor, which has been considered but never provided by actual laws.
Consensus statement on the live organ donor
2000
OBJECTIVE To recommend practice guidelines for transplant physicians, primary care providers, health care planners, and all those who are concerned about the well-being of the live organ donor. PARTICIPANTS An executive group representing the National Kidney Foundation, and the American Societies of Transplantation, Transplant Surgeons, and Nephrology formed a steering committee of 12 members to evaluate current practices of living donor transplantation of the kidney, pancreas, liver, intestine, and lung. The steering committee subsequently assembled more than 100 representatives of the transplant community (physicians, nurses, ethicists, psychologists, lawyers, scientists, social workers, transplant recipients, and living donors) at a national conference held June 1-2, 2000, in Kansas City, Mo. CONSENSUS PROCESS Attendees participated in 7 assigned work groups. Three were organ specific (lung, liver, and kidney) and 4 were focused on social and ethical concerns (informed consent, d...
Successful Expansion of the Living Donor Pool by Alternative Living Donation Programs
American Journal of Transplantation, 2009
, 786 potential recipients and 1059 potential donors attended our pretransplant unit with the request for a living-donor renal transplant procedure. The recipients brought one potential donor in 77.2% and two or more donors in 22.8% of cases. In the regular living donor program, a compatible donor was found for 467 recipients. Without considering alternative donation, 579 donors would have been refused. Alternative living donation programs led to 114 compatible combinations: kidneyexchange program (35), ABO-incompatible donation (25), anonymous donation (37) and domino-paired anonymous donation (17). Together, the 114 alternative program donations and the 467 regular living donations led to 581 living donor transplantations (24.4% increase). Eventually for 54.9% (581/1059) of our donors, a compatible combination was found. Donor-recipient incompatibility comprised 19.4% (89/458) in the final refused population, which is 8.8% of the potential donor-recipient couples. Without considering alternative donation, 30.1% (174/579) of the refused donors would have been refused on incompatibility and 6.4% (37/579) because they were anonymous. This is 20% of the potential donor population (211/1059). The implementation of alternative living donation programs led to a significant increase in the number of transplantations, while transplantations via the direct donation program steadily increased.
Medicine, 2014
At the present time, increasing the use of living donors offers the best solution to the organ shortage problem. The clinical questions raised when the first living donor kidney transplant was performed, involving donor risk, informed consent, donor protection, and organ quality, have been largely answered. We strongly encourage a wider utilization of living donation and recommend that living donation, rather than deceased donation, become the first choice for kidney transplantation. We believe that it is ethically sound to have living kidney donation as the primary source for organs when the mortality and morbidity risks to the donor are known and kept extremely low, when the donor is properly informed and protected from coercion, and when accepted national and local guidelines for living donation are followed.
Controversies related to living kidney donors
Arab Journal of Urology, 2011
Background: Increasing the living-donor pool by accepting donors with an isolated medical abnormality (IMA) can significantly decrease the huge gap between limited supply and rising demand for organs. There is a wide range of variation among different centres in dealing with these categories of donors. We reviewed studies discussing living kidney donors with IMA, including greater age, obesity, hypertension, microscopic haematuria and nephrolithiasis, to highlight the effect of these abnormalities on both donor and recipient sides from medical and surgical perspectives.
Transplantation Proceedings, 2013
Background. The evaluation of a potential living kidney donor (LKD) leads to exclusion of at least 50% of candidates. The aim of this study was to analyze the reasons for exclusion of potential LKDs referred to our center. Methods. We retrospectively analyzed historic and clinical data of all potential LKDs who were evaluated over 7 years from January 2005 to March 2012. Data were obtained by review of an electronic database. Results. Among 79 (50 female, 29 male) candidates, 24 (30.3%) successfully donated, comprising 22 related and 2 unrelated donors. We excluded 45 (56.9%), and 10 (12.6%) are actively undergoing evaluation. Reasons for exclusion were medical (n ¼ 14; 31%), nonmedical (n ¼ 18; 40%), positive cross-match (n ¼ l7.7%), pregnancy (n ¼ 2; 4.4%), and other reasons (n ¼ 3; 6.6%). Of the 14 donors excluded for medical reasons, 75.8% were due to diabetes, cardiovascular disease, hypertension, or obesity and 21.5% to inadequate renal function, malignancy, or liver disease. Of the 18 (40%) excluded for nonmedical reasons, 6 (33.3%) were because the intended recipient received a deceased-donor transplantation before the evaluation could be completed, 5 (27.7%) because the recipient was no longer a candidate for transplantation, 5 (27.7%) because of donor withdrawal, and 2 (11.1%) for other reasons. Conclusions. Positive cross-match and deceased-donor transplantation during the evaluation process were the 2 most common reasons for LKD exclusion. Evaluation of potential LKDs is time consuming, requiring a remarkable amount of human and material resources. A dedicated pathway for the diagnostic work-up of LKDs may speed-the evaluation process and improve its efficiency, use of ABO-incompatible or paired-exchange donations may increase the yield of donor organs.