Ethical Issues Surrounding High-Risk Kidney Recipients: Implications for the Living Donor

2007 ◽  
Vol 17 (3) ◽  
pp. 180-182 ◽  
Author(s):  
Jerome F. O'Hara ◽  
Katrina Bramstedt ◽  
Stewart Flechner ◽  
David Goldfarb
Keyword(s):  
Informed Consent ◽  
High Risk ◽  
Ethical Issues ◽  
Family Members ◽  
Transplant Recipients ◽  
Kidney Donor ◽  
Living Kidney Donor ◽  
Kidney Recipients ◽  
Medical Issues ◽  
Donor Transplant

Evaulating patients for living kidney donor transplantation involving a recipient with significant medical issues can create an ethical debate about whether to proceed with surgery. Donors must be informed of the surgical risk to proceed with donating a kidney and their decision must be a voluntary one. A detailed informed consent should be obtained from high-risk living kidney donor transplant recipients as well as donors and family members after the high perioperative risk potential has been explained to them. In addition, family members need to be informed of and acknowledge that a living kidney donor transplant recipient with pretransplant extrarenal morbidity has a higher risk of a serious adverse outcome event such as graft failure or recipient death. We review 2 cases involving living kidney donor transplant recipients with significant comorbidity and discuss ethical considerations, donor risk, and the need for an extended informed consent.

Challenging (Organ and Global) Boundaries

2021 ◽  
pp. 285-305
Author(s):  
Lainie Friedman ◽  
J. Richard Thistlethwaite, Jr
Keyword(s):  
Case Report ◽  
Informed Consent ◽  
Ethical Issues ◽  
Middle Income Country ◽  
Income Country ◽  
Kidney Donor ◽  
Living Kidney Donor ◽  
Middle Income ◽  
Kidney Recipient ◽  
Selection Of

The original living kidney paired exchanges (KPE) involved two donors who were ABO- or crossmatch incompatible with their intended recipients but were compatible with the other’s recipient such that they could “swap” kidneys. This chapter examines the ethical issues raised by two novel expansions of KPE: bi-organ (also known as trans-organ) exchange involving a living liver donor (donor-L)-kidney recipient (recipient-K) and a living kidney donor (donor-K)-liver recipient (recipient-L), and global kidney exchange (GKE) between a living kidney donor-recipient pair from a low to middle income country and living kidney donor-recipient pair(s) from a high income country. Although this chapter describes a case report of an ethical bi-organ exchange, bi-organ exchanges and GKE are usually unjust because they challenge the fair selection of donors. Bi-organ exchanges and GKE also raise significant deferential and infrastructural vulnerability challenges that threaten the donor’s ability (autonomy) to provide a voluntary and informed consent.

scholarly journals Differential Microvasculature Dysfunction in Living Kidney Donor Transplant Recipients: Nondialyzed versus Dialyzed Chronic Kidney Disease Patients

2010 ◽  
Vol 47 (2) ◽  
pp. 128-138 ◽  
Author(s):  
Ada W.Y. Chung ◽  
H.H. Clarice Yang ◽  
Mhairi K. Sigrist ◽  
Elliott Chum ◽  
Anthony D. Booth ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Transplant Recipients ◽  
Kidney Donor ◽  
Living Kidney Donor ◽  
Donor Transplant

scholarly journals Ethical issues in genomics research on neurodevelopmental disorders: a critical interpretive review

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
S. Mezinska ◽  
L. Gallagher ◽  
M. Verbrugge ◽  
E.M. Bunnik
Keyword(s):  
Informed Consent ◽  
Neurodevelopmental Disorders ◽  
Cognitive Abilities ◽  
Social Impact ◽  
Mental Health Problems ◽  
Ethical Issues ◽  
Family Members ◽  
Genetic Diagnosis ◽  
Research Participation ◽  
Genomic Research

Abstract Background Genomic research on neurodevelopmental disorders (NDDs), particularly involving minors, combines and amplifies existing research ethics issues for biomedical research. We performed a review of the literature on the ethical issues associated with genomic research involving children affected by NDDs as an aid to researchers to better anticipate and address ethical concerns. Results Qualitative thematic analysis of the included articles revealed themes in three main areas: research design and ethics review, inclusion of research participants, and communication of research results. Ethical issues known to be associated with genomic research in general, such as privacy risks and informed consent/assent, seem especially pressing for NDD participants because of their potentially decreased cognitive abilities, increased vulnerability, and stigma associated with mental health problems. Additionally, there are informational risks: learning genetic information about NDD may have psychological and social impact, not only for the research participant but also for family members. However, there are potential benefits associated with research participation, too: by enrolling in research, the participants may access genetic testing and thus increase their chances of receiving a (genetic) diagnosis for their neurodevelopmental symptoms, prognostic or predictive information about disease progression or the risk of concurrent future disorders. Based on the results of our review, we developed an ethics checklist for genomic research involving children affected by NDDs. Conclusions In setting up and designing genomic research efforts in NDD, researchers should partner with communities of persons with NDDs. Particular attention should be paid to preventing disproportional burdens of research participation of children with NDDs and their siblings, parents and other family members. Researchers should carefully tailor the information and informed consent procedures to avoid therapeutic and diagnostic misconception in NDD research. To better anticipate and address ethical issues in specific NDD studies, we suggest researchers to use the ethics checklist for genomic research involving children affected by NDDs presented in this paper.

Metabolic Syndrome, a Real Barrier for Living Kidney Donor Transplant

2020 ◽  
Vol 52 (4) ◽  
pp. 1072-1076
Author(s):  
L.R. López y López ◽  
J. Martínez González ◽  
J. Bahena Méndez ◽  
D. Espinoza-Peralta ◽  
N.P. Campos Nolasco ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Kidney Donor ◽  
Living Kidney Donor ◽  
Donor Transplant

scholarly journals Becoming and being a biobank donor: The role of relationships and ethics

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242828
Author(s):  
Signe Mezinska ◽  
Jekaterina Kaleja ◽  
Ilze Mileiko
Keyword(s):  
Informed Consent ◽  
Ethical Issues ◽  
Family Members ◽  
Research Subjects ◽  
Structured Interviews ◽  
Research Results ◽  
General Data Protection Regulation ◽  
Related Data ◽  
Research Findings

Relational aspects, such as involvement of donor’s relatives or friends in the decision-making on participation in a research biobank, providing relatives’ health data to researchers, or sharing research findings with relatives should be considered when reflecting on ethical aspects of research biobanks. The aim of this paper is to explore what the role of donor’s relatives and friends is in the process of becoming and being a biobank donor and which ethical issues arise in this context. We performed qualitative analysis of 40 qualitative semi-structured interviews with biobank donors and researchers. The results show that relatedness to relatives or other types of close relationships played a significant role in the donors’ motivation to be involved in a biobank, risk-benefit assessment, and decisions on sharing information on research and its results. Interviewees mentioned ethical issues in the context of sharing relatives’ health-related data for research purposes and returning research findings that may affect their relatives. We conclude that the question of what information on family members may be shared with a biobank by research participants without informed consent of those relatives, and when family members become research subjects, lacks a clear answer and detailed guidelines, especially in the context of the introduction of the European Union’s (EU) General Data Protection Regulation. Researchers in Latvia and EU face ethical questions and dilemmas about returning research results and incidental findings to donors’ relatives, and donors need more information on sharing research results with relatives in the informed consent process.

scholarly journals Trapianto renale da donatore vivente

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.

Ethical issues surrounding high-risk kidney recipients: implications for the living donor

2007 ◽  
Vol 17 (3) ◽  
pp. 180-182 ◽  
Author(s):  
Jerome O'Hara ◽  
Katrina Bramstedt ◽  
Stewart Flechner ◽  
David Goldfarb
Keyword(s):  
High Risk ◽  
Living Donor ◽  
Ethical Issues ◽  
Kidney Recipients
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