A proposed Saudi approach to the ethical utilization of living unrelated kidney donation (original) (raw)
Ethical issues in Kidney Transplantation and “An” Islamic perspective
Bangladesh Journal of Medical Science
Kidney transplantation (KT) is currently the most realistic treatment option for patients with end-stage renal disease (ESRD) as it enables them to live longer and provides better quality of life post-transplantation. Before the 1960s, all these patients would die as there was no treatment available. It is the commonest solid organ transplantation carried out in the world at the moment. Organs are harvested from living or cadaveric donors, with living kidney donor organs generally functioning better and for longer periods of time compared to the latter. Issues surrounding organ transplantation in general and kidney transplantation in particular, are fraught with ethical dilemmas due to the shortage of organs, the logistics behind the acquisition of organs, use of living donors including minors and the black market that has sprouted thereof. Entwined in this quagmire are the legal, social and psychological consequences for the individuals involved and the society at large. It is furt...
Background: Living donation presents a unique ethical dilemma. Risking the life of a healthy person to save or improve someone else's life generates lots of debate. Besides, patient's need for a kidney versus someone else's despairs for money has led to create a black market for trading human organs in many developing countries were the law is in loose. There are lots of controversies regarding the outcome of these donors and whether their quality of life has affected post surgery. Objectives: The aim of this study isto identify thephysical, psychological and financial outcome of live non-related kidney donors in Suliamani province, Kurdistan region/ Iraq. Methods: a retrospective study looked in to 71 live non-related kidney donors in Suliamani province-Kurdistan region/ Iraq all whom donated their kidney from April 2006 to April 2014. A questionnaire was made and all were interviewed either by phone calls or face to face. Results: Majority of living non-related donors had no major complication from the surgery. Most had no regular follow up since after the operation. Majority of them admitted selling their kidney for a variety of reasons. Almost half of them claimed their quality of life is worse than before the donation and about three quarters of them regrets selling their kidney. Conclusion: donating a kidney although seemed to be a safe procedure but didn't improve the quality of life of these donors. Many of them regret selling their kidneys and continued to remain under an economic deadlock due to continuous expenses needed for living.
Ethics and living donation in renal transplantation
2017
Nevertheless, the transplant community is dealing with organ scarcity in cadaveric transplantation, and potential receptors in Portugal spend an average of 5 years on the waiting list before receiving a kidney6. The following numbers illustrate this: in Portugal, in 2016, more than 7000 patients were on the waiting list for renal transplantation; only 513 patients were transplanted, 65 of whom received a kidney from a living donor7.
Ethical considerations related to organ transplantation and Islamic Law
International Journal of Surgery, 2006
With the increasing number of transplantable organs and tissues, as well as improvements in transplantation results, has come a severe shortage of organ donors. Organs for transplantation are usually obtained from living genetically related donors or from heart-beating cadavers. Unfortunately, these sources have so far been unable to keep up with demand. As a result, there is a large and steadily increasing number of potential recipients awaiting transplantation, some of who will die before an organ can be found. These trends have raised many ethical, moral, societal and in particular religious (Islamic Law) issues regarding supply, the methods of organ allocation, and use of living donors. Several ethical dilemmas regarding case selection, allocation within the law, medical problems, and economic sources have now to be confronted. Despite this, the legal framework regulating transplantation in Iran was recently enhanced in comparison to other Islamic countries.
Living kidney donation: outcomes, ethics, and uncertainty
The Lancet, 2015
Since the fi rst living-donor kidney transplantation in 1954, more than half a million living kidney donations have occurred and research has advanced knowledge about long-term donor outcomes. Donors in developed countries have a similar life expectancy and quality of life as healthy non-donors. Living kidney donation is associated with an increased risk of end-stage renal disease, although this outcome is uncommon (<0•5% increase in incidence at 15 years). Kidney donation seems to elevate the risks of gestational hypertension and pre-eclampsia. Many donors incur fi nancial expenses due to factors such as lost wages, need for sick days, and travel expenses. Yet, most donors have no regrets about donation. Living kidney donation is practised ethically when informed consent incorporates information about risks, uncertainty about outcomes is acknowledged when it exists, and a donor's risks are proportional to benefi ts for the donor and recipient. Future research should determine whether outcomes are similar for donors from developing countries and donors with pre-existing conditions such as obesity. Unequal access to living-donor kidney transplantation Unlike deceased-donor organs, living-donor organs are not usually treated as a public resource. Living kidney donation generally takes place as a directed gift between individuals after careful assessment by the transplant
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.
Transplantation, 2015
Deceased donor rates in Asia are among the lowest in the world. This has necessitated a reliance on living kidney donation, which has given rise to concerns about donor motivation and assessment in this region. We aimed to describe transplant professional perspectives on living kidney donor evaluation in Asia. Face-to-face, semistructured interviews were conducted with 53 transplant professionals (nephrologists [n = 21], surgeons/urologists [n = 17], coordinators [n = 7], social workers [n = 5], ethicists [n = 2], psychologist [n = 1]) from 20 centers in 10 countries. Transcripts were analyzed thematically to identify themes. The theme of traversing vulnerability overarched 4 themes. Vigilance against exploitation of the vulnerable meant mitigating the threat of commercial transplantation, combating disparities, and verifying volunteerism. Maintaining clarity of professional roles encompassed the perceived necessity of legal safeguards to determine legitimacy of relationships, ensur...
Review article: Ethical issues in Kidney Transplantation and "An" Islamic perspective
Bangladesh Journal of Medical Science, 2021
Kidney transplantation (KT) is currently the most realistic treatment option for patients with end-stage renal disease (ESRD) as it enables them to live longer and provides better quality of life post-transplantation. Before the 1960s, all these patients would die as there was no treatment available. It is the commonest solid organ transplantation carried out in the world at the moment. Organs are harvested from living or cadaveric donors, with living kidney donor organs generally functioning better and for longer periods of time compared to the latter. Issues surrounding organ transplantation in general and kidney transplantation in particular, are fraught with ethical dilemmas due to the shortage of organs, the logistics behind the acquisition of organs, use of living donors including minors and the black market that has sprouted thereof. Entwined in this quagmire are the legal, social and psychological consequences for the individuals involved and the society at large. It is further compounded by religious concerns, which have a significant influence on the society's acceptance of the practice of organ donation. The practice of organ transplantation is generally accepted by most Islamic scholars as it is concordant to the objectives of Islamic Law (maqasid al Sharī'ah) which prioritize the preservation of human life. However, resistances do arise from some jurists and even physicians of the same Islamic faith despite a fatwas decreeing that organ and tissue transplantations are permissible in Islam under certain conditions. The take-up of organ-donation is still largely poor especially among Muslims. This article therefore hopes to explore the various moral and ethical issues surrounding KT as well as the Islamic viewpoints emanating from it. We hope that this knowledge and understanding will benefit both health-care personnel and the public in general.
Ethical Considerations on Kidney Transplantation From Living Donors
Transplantation Proceedings, 2005
our study population consisted of 402 Living Related Donors (LRD)of which 344 pairs shared I haplotype (Group A) and of 209 Living unrelated Donors (LURD) (Group B): | 75 between spouse pairs (Group C)'* t 32 from wife to husband (Group'C I) and 43 f;m husband to wife (croup C2) as well as 32 betwe€n relatives in law or emotionally related patients and 2 between members of clerg/ (Group D). 199 pairs showed 3-6 HLA A B Dr missmatches (MM) witi the donor and in i0 cases d-2 MM. Donor :nd recipient mean age was 49a 13.4 and 29t 10.3 in Group Aand resPectively 46a | 1.2 and 48:t9.6 in Group B. The post-transplant immunosuppression therapy was based on cyclosporin A (csA).12 test was usect to assess statistical significancy. Donor mortality was 096; perioperative morbidity was 15.
Commercial cadaveric renal transplant: an ethical rather than medical issue
Clinical Transplantation, 2006
Kidney transplantation is the treatment of choice for end-stage renal disease (ESRD) (1). A successful kidney transplant improves the quality of life and reduces the mortality for most patients, compared with maintenance dialysis (2-4). Most ESRD patients do not have a probability of receiving transplants in Taiwan, owing to the organ shortage. Shortage of donor kidneys is a universal problem. It is more serious in oriental countries owing to religious, traditional and ethical reasons. The widening gap between the demand and supply of donor kidneys has led to a call for expansion in the potential donor pools (5). In Western countries, many ESRD patients having no suitable living-related donors seek commercial living-unrelated donors (6). It has been reported that commercial living-unrelated transplantations in the third world have higher rates of serious posttransplantation complications, morbidity and mortality (7-10). Concerns over the ethical impact of this type of transplantations have been discussed for a long time (11-13). Transplantation communities all over the world, including ours, disagree with the unethical procedure. In response to the organ shortage, the cadaveric kidneys of the death-penalty outlaws in China are being used for kidney transplants (14). The international community has questioned this practice. However, the procedures still continue, regardless of the regulation. Commercial renal transplantation is prohibited by legislation in Taiwan. Although most of the transplant physicians did not advise the procedures, more and more Taiwanese ESRD patients have been receiving overseas commercial cadaveric renal transplantations in China in recent years. In a previous study, patient and graft survival of these patients was inferior to those who underwent cadaveric renal transplants in Taiwan in a three yr observation (15).
Ethics, Justice and the Sale of Kidneys for Transplantation Purposes
Potchefstroom Electronic Law Journal/Potchefstroomse Elektroniese Regsblad
Living kidney donor transplantations are complex; add to that financial compensation to the donor and one enters an ethical maze. Debates on whether the buying and selling of kidneys should be allowed are mainly between utilitarians, deontologists and virtue ethicists as legal transplants are more common in the Western world. The pros and cons of each theory in relation to the sale of human organs are analysed, after which the foundational principles for all bio-ethical judgments; beneficence, non-maleficence, autonomy and justice are also scrutinised in seeking to justify the sale of human kidneys for transplantation purposes in a country with a human rights culture.
Deceased-donor kidney transplantation in Iran: trends, barriers and opportunities
Indian journal of …, 2007
Having enjoyed considerable success in kidney transplantation in recent years, Iran has been named the most active country in the Middle East Society for Organ Transplantation region in providing equitable quick, and intermediary-free access to affordable kidney transplantation for everyone regardless of gender and economic circumstances. We are, however, of the opinion that the Iranian model can benefit further from improving deceased-donor kidney transplantation, especially after a fatwa (Islamic edict) in the early 1980s lifted many religious and legal barriers. Deceased-donor kidney transplantation in Iran should be bolstered by establishing a transplantation model, increasing government funds, and encouraging participation of the general public in the Iranian Network for Transplant Organ Procurement. We recommend that an intensive media campaign be launched to heighten public awareness and more transplantation centres be involved in cadaveric transplantation with streamlined sy...
Ethical Considerations for Participation of Nondirected Living Donors in Kidney Exchange Programs
American Journal of Transplantation, 2010
Kidneys from nondirected donors (NDDs) have historically been allocated directly to the deceased donor wait list (DDWL). Recently, however, NDDs have participated in kidney exchange (KE) procedures, including KE 'chains' , which have received considerable media attention. This increasing application of KE chains with NDD participation has occurred with limited ethical analysis and without ethical guidelines. This article aims to provide a rigorous ethical evaluation of NDDs and chain KEs. NDDs and bridge donors (BDs) (i.e. living donors who link KE procedures within KE chains) raise several ethical concerns including coercion, privacy, confidentiality, exploitation and commercialization. In addition, although NDD participation in KE procedures may increase transplant numbers, it may also reduce NDD kidney allocation to the DDWL, and disadvantage vulnerable populations, particularly O blood group candidates. Open KE chains (also termed 'neverending' chains) result in a permanent diversion of NDD kidneys from the DDWL. The concept of limited KE chains is discussed as an ethically preferable means for protecting NDDs and BDs from coercion and minimizing 'backing out' , whereas 'honor systems' are rejected because they are coercive and override autonomy. Recent occurrences of BDs backing out argue for adoption of ethically based protective measures for NDD participation in KE.
Contemporary debates over the acceptability of kidneys for donation
The virtual mentor : VM, 2012
For the last three decades, kidney transplantation has been the preferred approach to renal replacement therapy for the vast majority of patients. The virtue of transplantation lies in the expected conferral of a longer quantity and a better quality of life to recipients than they would have from chronic dialysis.
2015
Kidney transplantation has become the treatment of choice for patients with end-stage renal disease. Six decades of success in the field of transplantation have made it possible to save thousands of lives every year. Unfortunately, in recent years success has been overshadowed by an ever-growing shortage of organs. In the United States, there are currently more than 100 000 patients waiting for kidneys. However, the supply of kidneys (combined cadaveric and live donations) has stagnated around 17 000 per year. The ever-widening gap between demand and supply has resulted in an illegal black market and unethical transplant tourism of global proportions. While we believe there is much room to improve the Iranian model of regulated incentivized live kidney donation, with some significant revisions, the Iranian Model could serve as an example for how other countries could make significant strides to lessening their own organ shortage crises.
A review of the possibility of adopting financially driven live donor kidney transplantation
International braz j urol
Kidney transplantation for end-stage renal disease remains the preferred solution due to its survival advantage, enhanced quality of life and cost-effectiveness. The main obstacle worldwide with this modality of treatment is the scarcity of organs. The demand has always exceeded the supply resulting in different types of donations. Kidney donation includes pure living related donors, deceased donors, living unrelated donors (altruistic), paired kidney donation and more recently compensated kidney donation. Ethical considerations in live donor kidney transplantation have always created a debate especially when rewarding unrelated donors. In this paper, we examine the problems of financially driven kidney transplantation, the ethical legitimacy of this practice, and propose some innovative methods and policies that could be adopted to ensure a better practice with accepted ethical guidelines.
Organ donation and transplantation medicine: Ethical framework and solutions
2015
Advances in surgery and the introduction of drugs that suppress the immune system have paved the way for transplantation medicine. Today, the donation and transplantation of tissues and organs (including heart, kidney, liver, lung, pancreas, cornea, bone marrow, and face) are feasible. Transplantation medicine has created new areas of ethical and legal discussion. In these discussions, four principles generally accepted in medical ethics – beneficence, non-maleficence, autonomy, and justice – have featured in their different aspects. In particular, the principles of non-maleficence and autonomy can collide. The dramatic increase in the number of people waiting for an organ shows that any deadlock on this subject means the death of many; hence, it is important to find a solution appropriate to the values held in society. In this study discussing current transplantation methods throughout the world, basic ethical dilemmas are addressed and effective solutions sought in accordance with ethical perspectives.