Living donor transplant: wider selection criteria

Trends in Adult-to-Adult Living Donor Liver Transplant Organ Donation: The Johns Hopkins Experience

Adult-to-adult living donor liver transplantation is an increasingly important option for 17000 patients awaiting liver transplantation in the United States. However, adult-to-adult living donor liver transplantation volumes peaked in 2001 (N=518), and have gradually fallen in 2002 (N=362), 2003 (N=321), and 2004 (N=323). Recent concerns about donor safety and ethical considerations have made careful analysis of donor availability and selection criteria critically important. We conducted a retrospective review of our active liver transplant recipient registry (N=251) and compared it to our living donor registry (N=231), which included all potential living donors before the selection process. Fifteen percent of recipients accounted for the majority (53%) of donor evaluations, whereas 42% of recipients did not have even a single donor evaluation. Recipient diagnosis appears to have a significant impact on donor availability, with donors rarely evaluated for patients with alcoholic cirrhosis. Careful and stringent selection criteria rule out 67% of potential donors.

Living Donor Kidney Transplant: Medicolegal and Insurance Aspects

Kidney transplantation is quite a routine complex procedure, not without risks and consequences to the donor, the recipient, and the health care professionals. Kidney-related medical malpractice suits are growing rapidly, and for clinicians and surgeons, the risk of being sued can be only reduced by practicing high-quality medicine and by appropriately communicating with donors and recipients. Actually relevant guidelines are available including safety and quality assurance standards for procurements, preservation, processing, and distribution for organs to maximize their quality and thereby the rate of success of transplants and to minimize the risk of such a procedure. We also find it essential that practice of living donor kidney transplant is in line with the general rules of the Convention for the Protection of Human Rights and its Additional Protocol. In this article, financial incentives and insurance aspects related with living donors kidney transplants are also illustrated.