The Living Organ Donor as Patient

2021 ◽  
Author(s):  
Lainie Friedman Ross ◽  
J. Richard Thistlethwaite, Jr.
Keyword(s):  
Organ Donation ◽  
Organ Transplantation ◽  
Living Donor ◽  
Organ Procurement ◽  
Well Being ◽  
Living Donors ◽  
Solid Organ ◽  
Organ Donors ◽  
Ethics Framework ◽  
Special Obligations

This is a book about living solid organ donors as patients in their own right. This book is premised on the supposition that the field of living donor organ transplantation is ethical, even if some specific applications are not, eg, pre-mortem organ procurement of an imminently dying patient. When Joseph Murray performed the first successful living kidney donor transplant in 1954, he thought this would be a temporary stopgap. Today, however, the goal of adequate organ supply without living donors remains elusive. If anything, the supply:demand ratio is worse. In this book, a five-principle living donor ethics framework is developed and used to examine the ethical issues raised by living donor selection demographics, innovative attempts to increase living organ donation, and living donor decision-making and risk thresholds. This ethics framework uses the three principles of the Belmont Report modified to organ transplantation (respect for persons, beneficence, and justice) supplemented by the principles of vulnerability and of special relationships creating special obligations. The approach requires that the transplant community fully embraces living organ donors (and prospective living organ donors) as patients to whom special obligations are owed. Only when living organ donors are regarded as patients in their own right and have a living donor advocate team dedicated to their well-being can the moral boundaries of living solid organ donation be determined and realized. This book provides theoretical arguments and practice guidelines, complemented by case studies, to ensure that living donors are given the full respect and care they deserve.

Introduction

2021 ◽  
pp. 3-21
Author(s):  
Lainie Friedman ◽  
J. Richard Thistlethwaite, Jr
Keyword(s):  
Organ Donation ◽  
Organ Transplantation ◽  
Living Donor ◽  
Organ Procurement ◽  
Solid Organ ◽  
Organ Donors ◽  
Ethics Framework ◽  
Do No Harm ◽  
Dying Patient ◽  
Donor Transplant

This is a book about living solid organ donors as patients in their own right. It is premised on the supposition that the field of living donor organ transplantation is ethical, even if some instantiations are not, eg, pre-mortem organ procurement of an imminently dying patient. In this chapter, the objection to living solid organ donation based on the obligation to do no harm is rejected because it ignores the fact that for many living donors, the benefits outweigh the harms. It is argued that the principle of respect for persons permits some living solid organ donation provided that both the donor and the recipient are treated as patients in their own right. This chapter then provides an outline for the rest of the book in which a five-principle living donor ethics framework is developed and applied to various living donor transplant proposals.

scholarly journals LO66: Solid organ donation from the emergency department: A death review

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S31-S32
Author(s):  
J. McCallum ◽  
R. Yip ◽  
S. Dhanani ◽  
I. Stiell
Keyword(s):  
Emergency Department ◽  
Organ Donation ◽  
Primary Outcome ◽  
Organ Procurement ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
Solid Organ ◽  
Organ Donors ◽  
Organ Procurement Organization

Introduction: A significant gap exists between the number of people waiting for an organ and donors. There are currently 1,628 people awaiting organ donation in Ontario alone. In 2018 to date, 310 donors have donated 858 organs. The purpose of this study was to determine whether there were missed donors in the Emergency Department (ED) and by what percent those missed donors would increase organ donation overall. Methods: This was a health records and organ donation database review of all patients who died in the ED at a large academic tertiary care center with 2 campuses and 160,000 visits per year. Patients were included from November 1, 2014 – October 31, 2017. We collected data on demographics, cause of death, and suitability for organ donation. Data was cross-referenced between hospital records and the provincial organ procurement organization called Trillium Gift of Life Network (TGLN) to determine whether patients were appropriately referred for consideration of donation in a timely manner. Potential missed donors were manually screened for suitability according to TGLN criteria. We calculated simple descriptive statistics for demographic data and the primary outcome. The primary outcome was percentage of potential organ donors missed in the Emergency Department (ED). Results: There were 606 deaths in the ED from November 1, 2014 – October 31, 2017. Patients were an average of 71 years old, 353 (58%) were male, and 75 (12%) died of a traumatic cause. TGLN was not contacted in 12 (2%) of cases. During this period there were two donors from the ED and 92 from the ICU. There were ten missed potential donors. They were an average of 67 years, 7 (70%) were male, and 2 (20%) died of a traumatic cause. In all ten cases, patients had withdrawal of life sustaining measures for medical futility prior to TGLN being contacted for consideration of donation. There could have been an addition seven liver, six pancreatic islet, four small bowel, and seven kidney donors. The ten missed ED donors could have increased total donors by 11%. Conclusion: The ED is a significant source of missed organ donors. In all cases of missed organ donation, patients had withdrawal of life sustaining measures prior to TGLN being called. In the future, it is essential that all patients have an organ procurement organization such as TGLN called prior to withdrawal of life sustaining measures to ensure that no opportunity for consideration of organ donation is missed.

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

2018 ◽  
Vol 24 (3) ◽  
pp. 186-190 ◽  
Author(s):  
Lauren Lee
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Organ Donation ◽  
Health Care Providers ◽  
Consensus Statement ◽  
Organ Procurement ◽  
Well Being ◽  
Living Donors ◽  
Care Providers ◽  
Best Interest

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.

The History of Solid Organ Transplantation

2021 ◽  
pp. 22-52
Author(s):  
Lainie Friedman ◽  
J. Richard Thistlethwaite, Jr
Keyword(s):  
Organ Transplantation ◽  
Living Donor ◽  
Solid Organ Transplantation ◽  
Deceased Donor ◽  
Living Donors ◽  
Early Years ◽  
Solid Organ ◽  
Organ Transplants ◽  
History Of ◽  
Kidney Liver

This chapter provides a brief history of solid organ transplantation. Although the focus is on the living donor, the history of living donor solid organ transplantation is intertwined with the history of deceased donor solid organ transplantation. This is particularly true in the early years of solid organ transplantation when the earliest success for some solid organ transplants began with living donors, e.g. kidney, and began with deceased donors for other solid organ transplants, e.g. liver. The history of each solid organ in which living donors have supplied grafts (kidney, liver, lung, pancreas, intestines, and uterus) is described even though some are rarely if ever performed today, e.g. lung, intestine, pancreas. We also discuss the living domino donor—a candidate-recipient (most commonly the recipient of a deceased donor liver or heart) whose own organ is not discarded but is transplanted into another person.

scholarly journals Willingness to Become Deceased Organ Donors among Post-graduate Students in Selected Colleges in Kathmandu Valley, Nepal

2019 ◽  
Vol 3 (1) ◽  
pp. 47-58 ◽  
Author(s):  
Pragya Paneru ◽  
Samyog Uprety ◽  
Shyam S. Budhathoki ◽  
Birendra K. Yadav ◽  
Suman L. Bhandari
Keyword(s):  
Graduate Students ◽  
Organ Donation ◽  
Organ Transplantation ◽  
Mass Communication ◽  
Living Donor ◽  
Deceased Donor ◽  
World Health ◽  
Organ Donors ◽  
Post Graduate ◽  
Deceased Organ Donation

Introduction: Globally, there is a discrepancy between demand and availability of organs for transplantation. Transplantation is done from a living donor as well as a brain-dead/deceased donor. However, the World Health Organization (WHO) encourages deceased donor transplantation, since there is no risk to the donor. Although, the Transplant Act of Nepal 2016 opened the doors for deceased donor organ transplantation, the rate of transplantation from deceased donors is very low. Thus, this study assesses factors associated with willingness for deceased organ donation among post-graduate students of law, medicine, and mass communication streams. Methods: A total of 9 colleges, 3 from each specialty were selected via lottery method. The total sample size calculated was 440. Self- administered questionnaire was used to collect the data. 170, 140 and 130 forms were distributed in law, medicine and mass communication respectively via convenient sampling. Multivariate analysis among the variables that had p- value <0.05 in bivariate analysis was carried out to find out the strongest predictors of willingness to be deceased organ donors. Results: In all, 53.2% were willing to become deceased organ donors. Family permission in one's wish to donate organs, having someone in family with chronic disease, having attended any conference or general talk on organ donation, knowing a live organ donor and knowing that body will not be left disfigured after organ extraction were found to be the strongest predictors for willingness to be deceased organ donors; while lack of awareness was reported as the main barrier for the same reason. Conclusion: There is a need for extensive awareness programs and new strategies to motivate individuals and family members for organ donation. Key words: • Deceased Organ Donation • Willingness • Kathmandu • Nepal • Organ Transplantation • Living Donor • Deceased Donor   Copyright © 2019 Paneru et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction

2021 ◽  
pp. 1-10
Author(s):  
Martha Gershun ◽  
John D. Lantos
Keyword(s):  
Organ Donation ◽  
Organ Transplantation ◽  
Kidney Transplant ◽  
Living Donor ◽  
Organ Donors ◽  
Current State ◽  
Living Organ Donation ◽  
Professional Study ◽  
Psychological Risks

This chapter presents two very different perspectives on living organ donation — one very specific and personal and one shaped by a lifetime of professional study and experience. The chapter aims to better understand the evolution and current state of organ transplantation, as well as consideration of practices and policies that could increase the willingness and ability of more people to donate. It tells the story of one kidney transplant from a living donor. The donor was unrelated to the recipient and, when she volunteered to donate, she did not even know the recipient. The chapter examines the importance of the story for two reasons: first, it might inspire some people to follow the donor's path and donate, the second reason is that it might goad transplant programs into rethinking their processes for cultivating, evaluating, and then stewarding organ donors. Ultimately, the chapter discusses why the criteria for who could donate expanded. With each expansion, new ethical questions arose about the motivations of donors, the prerogatives of surgeons, and the acceptable levels of physical and psychological risks for donors.

Minors as Living Organ Donors

2021 ◽  
pp. 108-123
Author(s):  
Lainie Friedman ◽  
J. Richard Thistlethwaite, Jr
Keyword(s):  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Living Donor ◽  
Living Donors ◽  
Identical Twin ◽  
Living Donation ◽  
Solid Organ ◽  
Organ Donors ◽  
The World ◽  
A Minor

In 1957, three years after the first successful kidney transplant between identical twin brothers, the Supreme Judicial Court in Massachusetts authorized kidney transplantation between three sets of identical twin minors and approved another two dozen living donor transplants involving minor donors over the next twenty years. Today, minors rarely serve as living solid organ donors, and donation by minors is prohibited in much of the world. In this chapter arguments are made to restrict children from serving as living donors except as a last resort. It is also argued that if one embraces the concept of the living donor as patient, then one would not make an exception for living donation by a minor to his or her identical twin sibling.

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

2018 ◽  
pp. e13447 ◽  
Author(s):  
Jessica M. Ruck ◽  
Macey L. Henderson ◽  
Ann K. Eno ◽  
Sarah E. Van Pilsum Rasmussen ◽  
Sandra R. DiBrito ◽  
...  
Keyword(s):  
Organ Donation ◽  
Exploratory Study ◽  
Living Donors ◽  
Solid Organ ◽  
The Public

scholarly journals Coupling and Deviating of Altruism-Voluntariness Relationship in Organ Transplantation

2021 ◽  
Author(s):  
Mesut Güvenbaş ◽  
Omur Sayligil
Keyword(s):  
Organ Transplantation ◽  
Living Donor ◽  
Living Donors ◽  
Indirect Utility ◽  
Universal Principle ◽  
Right To Life ◽  
Human Right ◽  
Real Situation ◽  
New Approach ◽  
The Right

Organ transplantation is an issue that concerns two people (donor and recipient) at the same time in terms of the right to life, which is the most basic human right. The direct utility arising from organ transplantation involves the patient to whom the organ is transplanted, and the indirect utility relates to the donor. Today, the decision to obtain an organ from a living donor is based on the idea of doing something good by those who sacrifice themselves for their relatives. The person who donates an organ treats their body as an instrument and uses their willpower on it. If the statement “I will care about the health of others” is accepted as a universal principle, it will be very important to establish a balance between the duty of caring for the health of others and protecting one’s own health. If we want to introduce a new approach to be adopted in the assessment of living donors in society, we must look at the real situation in terms of utility, altruism, and volunteering. This Chapter thus evaluates organ transplantation from living donors in terms of utility, altruism, and volunteering.

scholarly journals Retrospective screening of solid organ donors in Italy, 2009, reveals unpredicted circulation of West Nile virus

2010 ◽  
Vol 15 (34) ◽  
Author(s):  
M R Capobianchi ◽  
V Sambri ◽  
C Castilletti ◽  
A M Pierro ◽  
G Rossini ◽  
...  
Keyword(s):  
Risk Assessment ◽  
West Nile Virus ◽  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Organ Donors ◽  
West Nile ◽  
Retrospective Survey ◽  
Italian Regions ◽  
Potential Risks

Since the occurrence of West Nile virus (WNV) infection in humans in 2008 in Italy, concerns have been raised about the potential risks associated with solid organ transplantation (SOT). A nationwide retrospective survey showed that 1.2% of SOT donors in 2009 were WNV-seropositive and demonstrated that human WNV infection is distributed throughout several Italian regions. Transmission of WNV or other arboviruses through SOT is a possibility and risk assessment should be carried out before SOT to avoid infection through transplantation.

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