Introduction

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.

Living Organ Donor Perspectives and Sources of Hesitancy about COVID-19 Vaccines

Background: Living organ donation declined substantially in the United States during the COVID-19 pandemic due to concerns about donor and transplant candidate safety. COVID-19 vaccines might increase confidence in the safety of living organ donation during the pandemic. We assessed informational preferences and perspectives about COVID-19 vaccines among US living organ donors and prospective donors. Methods: We conducted a national survey study of organ donors and prospective donors on social media platforms between 12/28/2020-2/23/2021. Survey items included multiple choice, visual analog scale, and open-ended responses. We examined associations between information preferences, history of COVID-19 infection, influenza vaccination history and COVID-19 vaccine acceptance using multivariable logistic regression and performed a thematic analysis of open-ended responses. Results: Among 342 respondents from 47 US states and the District of Columbia, 35% were between 51-70 years old, 90% were non-Hispanic white, 87% were women; 82% were living donors (94% kidney) and 18% in evaluation to donate (75% kidney). The majority planned to or had received COVID-19 vaccination (77%), whereas 11% did not plan to receive a vaccine, and 12% were unsure. Adjusting for demographics and donor characteristics, respondents who receive yearly influenza vaccinations had higher COVID-19 vaccine acceptance than those who do not (adjusted Odds Ratio [aOR] 5.06, 95% Confidence Interval [CI] 2.68-9.53). Compared to respondents who prioritized medical information sources (e.g., personal physicians and transplant providers), those who prioritized news and social media had lower COVID-19 vaccine acceptance (aOR 0.34, 95% CI 0.15-0.73). Low perceived personal benefit from vaccination and uncertainty about long-term safety were common themes among those declining COVID-19 vaccines. Conclusions: Donor informational source preferences were strongly associated with the likelihood of accepting a COVID-19 vaccine. Vaccine guidance for organ donors who are unsure about COVID-19 vaccines could incorporate messaging about safety and benefits of vaccination for healthy people.