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.

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.

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 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.

Questioning the Premise

2021 ◽  
pp. 369-378
Author(s):  
Lainie Friedman ◽  
J. Richard Thistlethwaite, Jr
Keyword(s):  
Organ Donation ◽  
Organ Procurement ◽  
Solid Organ ◽  
Social Scientists ◽  
Primary Position ◽  
Demand And Supply ◽  
The Social ◽  
Patient Concerns ◽  
Dying Patient ◽  
Moral Limits

Given the gap between demand and supply, living donation is not going away any time soon. This chapter explores the book’s initial premise 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. Concerns regarding the appropriate moral limits to living solid organ donation by both eminent transplant physicians (Joseph Murray, Felix Rapaport) and the social scientists (Renée Fox, Judith Swazey) embedded in evaluating the practice are explored. This chapter reiterates the book’s primary position: only if living organ donors are regarded as patients in their own right can the moral limits of living solid organ donation be realized and living donors be given the full respect that they deserve.

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.

Living Organ Donation Role of Ethics for Improved Clinical Practice

2018 ◽  
pp. 242-259
Author(s):  
Pierpaolo Di Cocco
Keyword(s):  
Organ Donation ◽  
Organ Transplantation ◽  
Financial Incentives ◽  
Ethical Issues ◽  
Supply And Demand ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Live Donor ◽  
Live Donation

Solid organ transplantation represents one of the most important achievements in history of medicine. Over the last decades, the increasing number of transplants has not been of the same extent of the number of patients in the waiting lists. Live donation has been implemented in order to reduce the gap between supply and demand. From an ethical standpoint, the donation process from a live donor seems to violate the traditional first rule of medicine—primum non nocere because inevitably exposes healthy persons to a risk in order to benefit another person. In the chapter will be presented the crucial role of ethics and specific ethical issues in the different forms of live donation, such as financial incentives for living donation, reimbursement in unrelated live donation, minor sibling-to-sibling organ donation. The ethical aspects of live donor organ transplantation are continuously evolving; in order to make this strategy more beneficial and lifesaving, everyone involved in the process should make every possible effort with in mind the best interests of the patients.

scholarly journals Randomised sham-controlled double-blind trial evaluating remote ischaemic preconditioning in solid organ transplantation: a study protocol for the RIPTRANS trial

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038340
Author(s):  
Aki Uutela ◽  
Ilkka Helanterä ◽  
Karl Lemström ◽  
Arie Passov ◽  
Simo Syrjälä ◽  
...  
Keyword(s):  
Organ Transplantation ◽  
Study Protocol ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Organ Donors ◽  
Ischaemic Preconditioning ◽  
Study Results ◽  
Remote Ischaemic Preconditioning ◽  
Brain Dead ◽  
Transplanted Organs

IntroductionRemote ischaemic preconditioning (RIPC) using a non-invasive pneumatic tourniquet is a potential method for reducing ischaemia-reperfusion injury. RIPC has been extensively studied in animal models and cardiac surgery, but scarcely in solid organ transplantation. RIPC could be an inexpensive and simple method to improve function of transplanted organs. Accordingly, we aim to study whether RIPC performed in brain-dead organ donors improves function and longevity of transplanted organs.Methods and analysesRIPTRANS is a multicentre, sham-controlled, parallel group, randomised superiority trial comparing RIPC intervention versus sham-intervention in brain-dead organ donors scheduled to donate at least one kidney. Recipients of the organs (kidney, liver, pancreas, heart, lungs) from a randomised donor will be included provided that they give written informed consent. The RIPC intervention is performed by inflating a thigh tourniquet to 300 mm Hg 4 times for 5 min. The intervention is done two times: first right after the declaration of brain death and second immediately before transferring the donor to the operating theatre. The sham group receives the tourniquet, but it is not inflated. The primary endpoint is delayed graft function (DGF) in kidney allografts. Secondary endpoints include short-term functional outcomes of transplanted organs, rejections and graft survival in various time points up to 20 years. We aim to show that RIPC reduces the incidence of DGF from 25% to 15%. According to this, the sample size is set to 500 kidney transplant recipients.Ethics and disseminationThis study has been approved by Helsinki University Hospital Ethics Committee and Helsinki University Hospital’s Institutional Review Board. The study protocol was be presented at the European Society of Organ Transplantation congress in Copenhagen 14−15 September 2019. The study results will be submitted to an international peer-reviewed scientific journal for publication.Trial registration numberNCT03855722.

scholarly journals P098: Solid organ donation from the emergency department - a systematic review

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S91-S91
Author(s):  
J. McCallum ◽  
B. Ellis ◽  
I. G. Stiell
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Organ Donation ◽  
Cardiopulmonary Arrest ◽  
Meta Analysis ◽  
Organ Transplant ◽  
Donation After Cardiac Death ◽  
Solid Organ ◽  
Organ Donors ◽  
Human Adults

Introduction: There is a significant gap between the number of organ donors and people awaiting an organ transplant; therefore it is essential that all potential donors are identified. Given the nature of Emergency Medicine it is a potential source of organ donors. The purpose of this study is to determine what percent of successful donors come from the Emergency Department (ED) and whether there are any missed potential donors. Methods: Electronic searches of EMBASE, MEDLINE, and CINAHL were performed July 7, 2017 using PRISMA guidelines. Primary literature in human adults were included if they described identification of patients in the ED who went on to become successful solid organ donors, or described missed potential donors in the ED. Data on the total population of actual or missed donors was required to allow calculation of a percentage. Studies describing non-solid organ donation, consent, ethics, survey of attitudes, teaching curricula, procurement techniques, donation outside the ED, and recipient factors were excluded. 2 authors independently screened articles for inclusion and discrepancies were resolved through consensus. Quality was assessed using STROBE for observational studies. Heterogeneity of patient populations precluded pooling of the data to conduct a meta-analysis. Results: 1058 articles were identified, 17 duplicates were removed, 800 articles were excluded based on title and abstract, and 217 full text articles were excluded, yielding 24 articles for the systematic review. For neurologic determination of death (NDD), ED patients comprised 4 44% of successful donors. ED death reviews revealed 0 84% of patients dying in the ED are missed as potential donors and hospital-wide death reviews revealed 13 80.9% of missed donors die in the ED. For donation after cardiac death (DCD), 4 20% of successful donors came from the ED and studies investigating potential donors suggest 2 36% of patients dying the in the ED could be potential DCD donors. The most common population of successful DCD organ donors was in traumatic cardiopulmonary arrest (TCPA), with 3.6 8.9% of TCPA patients presenting to the ED becoming successful donors. Conclusion: Patients dying in the Emergency Department are a significant source of both successful organ donors and missed potential donors. Emergency physicians should be familiar with their local organ donation protocol to ensure potential organ donors are not missed.

Join the Lone Kidney Club: incentivising live organ donation

2020 ◽  
pp. medethics-2019-105999
Author(s):  
Annet Glas
Keyword(s):  
Informed Consent ◽  
Organ Donation ◽  
Living Donor ◽  
Organ Procurement ◽  
Organ Transplant ◽  
Live Organ Donation ◽  
Regulatory Frameworks ◽  
Attractive Option ◽  
Patient Groups ◽  
Procurement System

Given the dramatic shortage of transplantable organs, demand cannot be met by established and envisioned organ procurement policies targeting postmortem donation. Live organ donation (LOD) is a medically attractive option, and ethically permissible if informed consent is given and donor beneficence balances recipient non-maleficence. Only a few legal and regulatory frameworks incentivise LOD, with the key exception of Israel’s Organ Transplant Law, which has produced significant improvements in organ donation rates. Therefore, I propose an organ procurement system that incentivises LOD by allocating additional priority points to the living donor on any transplant waiting list. I outline benefits and challenges for potential recipients, donors and society at large, and suggest measures to ensure medical protection of marginalised patient groups.

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