Ethical Analysis of Living Organ Donation

In 2003, the first 3-way living kidney donor-swap was performed at Johns Hopkins Hospital in Baltimore, Md. Three new donor protocols including paired donation now allow unrelated individuals to serve as donors. Some ethicists have suggested that emotionally unrelated individuals not be permitted to donate because they will not experience the same satisfaction that a family member who is a donor experiences. Others who frame living donation as an autonomous choice do not see emotionally unrelated or even nondirected donation as ethically problematic. This article uses an ethical framework of principlism to examine living donation. Principles salient to living donation include autonomy, beneficence, and nonmaleficence. The following criteria are used to evaluate autonomous decision making by living donors, including choices made (1) with understanding, (2) without influence that controls and determines their action, and (3) with intentionality. Empirical work in these areas is encouraged to inform the ethical analysis of the new living donor protocols.

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Physician Attitudes Toward Living Kidney Donation

Progress in Transplantation ◽

10.1177/1526924818817063 ◽

2018 ◽

Vol 29 (1) ◽

pp. 78-83 ◽

Cited By ~ 1

Author(s):

Howard Trachtman ◽

Brendan Parent ◽

Ari Kirshenbaum ◽

Arthur Caplan

Keyword(s):

Internal Medicine ◽

Careful Consideration ◽

Physician Attitudes ◽

Kidney Donation ◽

Living Donation ◽

Living Kidney Donation ◽

Kidney Donor ◽

Living Kidney Donor ◽

Kidney Donors ◽

Living Kidney Donors

Background: Compared to dialysis, living kidney donation has a greater chance of restoring health and is associated with better outcomes than deceased kidney donation. Although physicians advocate for this treatment, it is uncertain how they would act as potential living kidney donors or recipients. Methods: We surveyed 104 physicians, pediatric, and internal medicine nephrologists, to ascertain their attitudes toward living donation. Results: Among surveyed nephrologists, there was nearly universal support for living kidney donation as a viable medical option, and nearly all of them would support a healthy and medically cleared patient who wishes to participate. Although support was still strong, nephrologists were significantly less likely to support their friends and relatives participating in living kidney donation, and their support declined further for friends and relatives donating to nonrelatives. Conclusion: Our findings suggest the need to more deeply examine physician-perceived risks involved in serving as a living kidney donor. Based on differences in surveyed nephrologist attitudes regarding donation to and from loved ones versus nonrelatives, we suggest that physicians should give careful consideration to how they describe the risks of living donation to potential donors.

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Evaluation of the Medically Complex Living Kidney Donor

Journal of Transplantation ◽

10.1155/2012/450471 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Yasar Caliskan ◽

Alaattin Yildiz

Keyword(s):

Living Donor ◽

Viral Infections ◽

Evaluation Process ◽

Living Donors ◽

Stone Disease ◽

Organ Shortage ◽

Kidney Donor ◽

Living Kidney Donor ◽

Living Donor Transplantation ◽

History Of

Due to organ shortage and difficulties for availability of cadaveric donors, living donor transplantation is an important choice for having allograft. Live donor surgery is elective and easier to organize prior to starting dialysis thereby permitting preemptive transplantation as compared to cadaveric transplantation. Because of superior results with living kidney transplantation, efforts including the usage of “Medically complex living donors” are made to increase the availability of organs for donation. The term “Complex living donor” is probably preferred for all suboptimal donors where decision-making is a problem due to lack of sound medical data or consensus guidelines. Donors with advanced age, obesity, asymptomatic microhematuria, proteinuria, hypertension, renal stone disease, history of malignancy and with chronic viral infections consist of this complex living donors. This medical complex living donors requires careful evaluation for future renal risk. In this review we would like to present the major issues in the evaluation process of medically complex living kidney donor.

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Trapianto renale da donatore vivente

Giornale di Clinica Nefrologica e Dialisi ◽

10.33393/gcnd.2021.2250 ◽

2021 ◽

Vol 33 ◽

pp. 34-38

Author(s):

Aris Tsalouchos ◽

Maurizio Salvadori

Keyword(s):

Kidney Failure ◽

Living Donor ◽

Atypical Hemolytic Uremic Syndrome ◽

Primary Hyperoxaluria ◽

Kidney Donor ◽

Living Kidney Donor ◽

Uremic Syndrome ◽

End Stage ◽

Cadaveric Donors ◽

Donor Transplant

Kidney transplant is the best therapy to manage end-stage kidney failure. The main barriers limiting this therapy are scarcity of cadaveric donors and the comorbidities of the patients with end-stage kidney failure, which prevent the transplant. Living kidney donor transplant makes it possible to obviate the problem of scarcity of cadaveric donor organs and also presents better results than those of cadaveric transplant. The principal indication of living kidney donor transplant is preemptive transplant. This allows the patient to avoid the complications of dialysis and it has also been demonstrated that it has better results than the transplant done after dialysis has been initiated. Priority indications of living donor transplant are also twins and HLA identical siblings. We also have very favorable conditions when the donor is young and male. On the contrary, the living donor transplant will have worse results if the donors are over 60-65 years and the recipients are young, and this can be a relative contraindication. There is an absolute contraindication for the living donation when the recipient has diseases with high risk of aggressive relapse in the grafts: focal and segmental hyalinosis that had early relapse in the first transplant; atypical hemolytic uremic syndrome due to deficit or malfunction of the complement regulatory proteins; early development of glomerulonephritis due to anti-glomerular basement membrane antibody in patients with Alport syndrome; primary hyperoxaluria. Extreme caution should also be taken in the evaluation of the kidney donors. The risks of developing renal failure or other complications are low if an adequate pre-donation evaluation has been made according to the international guidelines.

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Can Split Renal Volume Assessment by Computed Tomography Replace Nuclear Split Renal Function in Living Kidney Donor Evaluations? A Systematic Review and Meta-Analysis

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358119875459 ◽

2019 ◽

Vol 6 ◽

pp. 205435811987545

Author(s):

Steven Habbous ◽

Carlos Garcia-Ochoa ◽

Gary Brahm ◽

Chris Nguan ◽

Amit X. Garg

Keyword(s):

Computed Tomography ◽

Systematic Review ◽

Renal Function ◽

Random Effects ◽

Living Donor ◽

Meta Analysis ◽

Renal Volume ◽

Kidney Donor ◽

Living Kidney Donor ◽

Living Kidney Donors

Background: As part of their living kidney donor assessment, all living donor candidates complete a computed tomography (CT) angiogram, but some also receive a nuclear renogram for split renal function (SRF%). Objective: We considered whether split renal volume (SRV%) assessed by CT can predict SRF%. Design: Systematic review and meta-analysis. Setting: Living donor candidates undergoing evaluation as potential living kidney donors. Patients: Living donor candidates who received both a nuclear renogram for split function and CT for SRV as part of their living donor work-up. Measurements: Split renal volume from CT scans and SRF from nuclear renography. Methods: We performed a systematic review and meta-analysis of the literature, abstracting data and digitizing plots where possible. We searched Medline, EMBASE, and the Cochrane Library. We added data from donor candidates assessed in London, Ontario from 2013 to 2016. We used fixed and random-effects models to pool Fisher’s z-transformed Pearson’s correlation coefficient ( r). We conducted random-effects meta-regression on digitized and aggregate data. Studies were restricted to living kidney donors or living donor candidates. Results: After pooling 19 studies (n = 1479), we obtained a pooled correlation of r = 0.74 (95% confidence interval [CI] = 0.61-0.82). By linear regression using individual-level data, we observed a 0.76% (95% CI = 0.71-0.81) increase in SRF% for every 1% increase in SRV%. Split renal volume had a specificity of 88% for discriminating SRF at a threshold that could influence the decision of which kidney is to be removed (between-kidney difference ≥10%). Predonation SRV and SRF both moderately predicted kidney function 6 to 12 months after donation: r = 0.75 for SRV and r = 0.73 for SRF; Δ r = 0.05 (–0.02, 0.13). Limitations: Most studies were retrospective and measured SRV and SRF only on selected living donor candidates. Efficiency gains in removing the SRF from the evaluation will depend on the transplant program. Conclusion: Split renal volume has the potential to replace SRF for some candidates. However, it is uncertain whether it can do so reliably and routinely across different transplant centers. The impact on clinical decision-making needs to be assessed in well-designed prospective studies. Trial registration: The digitized data are registered with Mendeley Data (doi10.17632/dyn2bfgxxj.2).

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The influence of socio-demographic factors, treatment perceptions and attitudes to living donation on willingness to consider living kidney donor among kidney transplant candidates

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfl218 ◽

2006 ◽

Vol 21 (9) ◽

pp. 2569-2576 ◽

Cited By ~ 39

Author(s):

Deborah Zimmerman ◽

Shelley Albert ◽

Hilary Llewellyn-Thomas ◽

Gillian A. Hawker

Keyword(s):

Kidney Transplant ◽

Demographic Factors ◽

Living Donation ◽

Kidney Donor ◽

Living Kidney Donor ◽

Treatment Perceptions ◽

Perceptions And Attitudes ◽

Transplant Candidates ◽

Socio Demographic Factors

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Has the UK living kidney donor population changed over time? A cross-sectional descriptive analysis of the UK living donor registry between 2006 and 2017

BMJ Open ◽

10.1136/bmjopen-2019-033906 ◽

2020 ◽

Vol 10 (6) ◽

pp. e033906

Author(s):

Phillippa K Bailey ◽

Katie Wong ◽

Matthew Robb ◽

Lisa Burnapp ◽

Alistair Rogers ◽

...

Keyword(s):

Kidney Transplant ◽

Kidney Failure ◽

Living Donor ◽

Kidney Donor ◽

Living Kidney Donor ◽

Cross Sectional ◽

Kidney Donors ◽

Living Kidney Donors ◽

The Uk ◽

Over Time

BackgroundA living-donor kidney transplant is the best treatment for most people with kidney failure. Population cohort studies have shown that lifetime living kidney donor risk is modified by sex, age, ethnicity, body mass index (BMI), comorbidity and relationship to the recipient.ObjectivesWe investigated whether the UK population of living kidney donors has changed over time, investigating changes in donor demographics.DesignWe undertook a cross-sectional analysis of the UK living kidney donor registry between January 2006 to December 2017. Data were available on living donor sex, age, ethnicity, BMI, hypertension and relationship to recipient.SettingUK living donor registry.Participants11 651 consecutive living kidney donors from January 2006 to December 2017.Outcome measuresLiving kidney donor demographic characteristics (sex, age, ethnicity, BMI and relationship to the transplant recipient) were compared across years of donation activity. Donor characteristics were also compared across different ethnic groups.ResultsOver the study period, the mean age of donors increased (from 45.8 to 48.7 years, p<0.001), but this change appears to have been limited to the White population of donors. Black donors were younger than White donors, and a greater proportion were siblings of their intended recipient and male. The proportion of non-genetically related non-partner donations increased over the 12-year period of analysis (p value for linear trend=0.002).ConclusionsThe increasing age of white living kidney donors in the UK has implications for recipient and donor outcomes. Despite an increase in the number of black, Asian and minority ethnic individuals waitlisted for a kidney transplant, there has been no increase in the ethnic diversity of UK living kidney donors. Black donors in the UK may be at a much greater risk of developing kidney failure due to accumulated risks: whether these risks are being communicated needs to be investigated.

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