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Marcus K, Berner D, Hadaya K, Hurst S. Anonymity in Kidney Paired Donation: A Systematic Review of Reasons. Transpl Int 2023; 36:10913. [PMID: 36819123 PMCID: PMC9931741 DOI: 10.3389/ti.2023.10913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023]
Abstract
The objective of this study was to investigate reasons for or against anonymity that are pertinent to kidney paired donations (KPD). We conducted a systematic review of reasons using PubMed and Google Scholar until May 2022 and through snowballing. Inclusion criteria were publications that: 1) discussed organ donation anonymity; 2) was peer-reviewed; 3) presented at least one reason on anonymity. Exclusion criteria: 1) not published in a scientific journal; 2) grey literature and dissertations. Four researchers independently reviewed and selected papers based on the criteria, extracted text passages and coded them into narrow and broad reason types, selected reasons that were valid for kidney paired donations. 50 articles were included, 62 narrow reasons (n = 24 for; n = 38 against) and 13 broad reasons were coded. Broad reasons were: protection against harm, general benefits, gratitude, curiosity, unrealistic to implement, fundamental rights, respect people's wishes, professional neutrality, timing is important, information disclosure, altruism, reciprocity and donation pool. We did not find reasons that justify legal prohibition of donor-recipient interactions for KPD, if they consented to meet. Professional counselling, follow-up and careful evaluations to prevent potential harm.
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Affiliation(s)
- Kailing Marcus
- Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Delphine Berner
- Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Karine Hadaya
- Service of Nephrology and Hypertension, Geneva University Hospitals and Clinique des Grangettes-Hirslanden, Geneva, Switzerland
| | - Samia Hurst
- Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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2
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Moropa M, Mokwena J, Makgahlela M, Sodi T. Older black rural South African adults’ perceptions on organ donation: An exploratory study. JOURNAL OF PSYCHOLOGY IN AFRICA 2022. [DOI: 10.1080/14330237.2021.2017597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Monareng Moropa
- Department of Psychology, University of Limpopo, Sovenga, South Africa
| | - Jabu Mokwena
- Department of Psychology, University of Limpopo, Sovenga, South Africa
| | | | - Tholene Sodi
- Department of Psychology, University of Limpopo, Sovenga, South Africa
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Herbst LR, Zeiser LB, Mitchell J, Nijhar K, Perincherry V, López JI, Segev DL, Massie AB, King E, Cameron AM. Examination of Racial and Socioeconomic Disparity in Use of Nondirected Kidney Donation in the US. J Am Coll Surg 2022; 234:615-623. [PMID: 35290281 DOI: 10.1097/xcs.0000000000000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nondirected donor (NDD) kidney transplant (NDDKT) continues to improve organ access for waitlisted candidates. Although NDDs are becoming increasingly common, there has been no contemporary evaluation of NDD allograft use, and it is vital to understand sociodemographic, as well as center-level, use across the US. STUDY DESIGN Using national data from the Scientific Registry for Transplant Recipients, this study characterized NDDs, NDDKT recipients, and center-level distribution of NDDKT. Directed donor and NDD characteristics were compared using Fisher's exact and Wilcoxon rank-sum tests for categorical and continuous variables, respectively. Multivariable logistic regression was used to identify characteristics associated with receiving NDDKT, and center distribution of NDDKT was assessed using the Gini coefficient. RESULTS NDDKT increased from 1.4% (n = 154) of all living donor kidney transplants in 2010 to 6.5% (n = 338) in 2020. Compared with directed living donors, NDDs were older (median [IQR], 44 [33 to 54] vs 43 [33 to 52], p < 0.01), more often male (40.2% vs 36.7%, p < 0.001), and White (91.4% vs 69.5%, p < 0.001). White adult candidates were more likely to receive NDDKT compared with Black (adjusted odds ratio [aOR], 0.300.340.39, p < 0.001), Hispanic/Latino (aOR, 0.360.420.48, p < 0.001), and Other (aOR, 0.410.470.55, p < 0.001) candidates. Black pediatric candidates had lower odds of receiving NDDKT (aOR, 0.090.220.54, p = 0.02). The proportion of centers performing NDDKT has increased from 2010 to 2020 (Gini = 0.77 vs 0.68). CONCLUSIONS Although more centers are performing NDDKT, racial disparities persist among NDDs and NDDKT recipients. Continued effort is needed to recruit living kidney donors and improve access to living donation for minority groups in the US. (J Am Coll Surg 2022;234:000-00. © 2022 by the American College of Surgeons).
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Affiliation(s)
- Leyla R Herbst
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Herbst, Zeiser, Mitchell, Nijhar, López, Segev, Massie, King, Cameron)
| | - Laura Bowles Zeiser
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Herbst, Zeiser, Mitchell, Nijhar, López, Segev, Massie, King, Cameron)
| | - Jonathan Mitchell
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Herbst, Zeiser, Mitchell, Nijhar, López, Segev, Massie, King, Cameron)
- the Department of Surgery, Howard University Hospital, Washington, DC (Mitchell)
| | - Kieranjeet Nijhar
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Herbst, Zeiser, Mitchell, Nijhar, López, Segev, Massie, King, Cameron)
| | | | - Julia I López
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Herbst, Zeiser, Mitchell, Nijhar, López, Segev, Massie, King, Cameron)
| | - Dorry L Segev
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Herbst, Zeiser, Mitchell, Nijhar, López, Segev, Massie, King, Cameron)
| | - Allan B Massie
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Herbst, Zeiser, Mitchell, Nijhar, López, Segev, Massie, King, Cameron)
- the Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD (Massie)
| | - Elizabeth King
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Herbst, Zeiser, Mitchell, Nijhar, López, Segev, Massie, King, Cameron)
| | - Andrew M Cameron
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Herbst, Zeiser, Mitchell, Nijhar, López, Segev, Massie, King, Cameron)
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Abstract
BACKGROUND Living donor liver transplants (LDLTs) including those from nondirected donors (NDDs) have increased during the past decade, and center-level variations in LDLTs have not yet been described. We sought to quantify changes in the volume of NDD transplants over time and variation in NDD volume between transplant centers. We further examined characteristics of living liver donors and identified factors potentially associated with receiving an NDD liver transplant. METHODS Using Scientific Registry of Transplant Recipients data between March 01, 2002, and December 31, 2020, we compared 173 NDDs with 5704 DLDs and 167 NDD recipients with 1153 waitlist candidates. RESULTS NDDs increased from 1 (0.4% of LDLTs) in 2002 to 58 (12% of LDLTs) in 2020. Of 150 transplant centers, 35 performed at least 1 NDD transplant. Compared with waitlist candidates, adult NDD recipients were less frequently males (39% versus 62%, P < 0.001), had a lower model for end-stage liver disease (16 versus 18, P = 0.01), and spent fewer days on the waitlist (173 versus 246, P = 0.02). Compared with waitlist candidates, pediatric NDD recipients were younger (50% versus 12% age <2 y, P < 0.001) and more often diagnosed with biliary atresia (66% versus 41%, P < 0.001). Compared with DLDs, NDDs were older (40 versus 35 y, P < 0.001), college educated (83% versus 64%, P < 0.001), White (92% versus 78%, P < 0.001), and more frequently donated left-lateral segment grafts (32.0% versus 14%, P < 0.001). CONCLUSIONS Liver NDD transplants continue to expand but remain concentrated at a few centers. Graft distribution favors female adults and pediatric patients with biliary atresia. Racial inequities in adult or pediatric center-level NDD graft distribution were not observed.
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Yoeli D, Jackson WE, Adams MA, Wachs ME, Sundaram SS, Sater A, Cisek JR, Choudhury RA, Nydam TL, Pomposelli JJ, Conzen KD, Kriss MS, Burton JR, Pomfret EA. Challenging the Traditional Paradigm of Supply and Demand in Pediatric Liver Transplantation Through Nondirected Living Donation: A Case Series. Liver Transpl 2021; 27:1392-1400. [PMID: 34048131 DOI: 10.1002/lt.26108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/20/2021] [Accepted: 05/12/2021] [Indexed: 12/13/2022]
Abstract
A gap exists between the demand for pediatric liver transplantation and the supply of appropriate size-matched donors. We describe our center's experience with pediatric liver transplantation using anonymous nondirected living liver donors (ND-LLD). First-time pediatric liver transplant candidates listed at our center between January 2012 and June 2020 were retrospectively reviewed and categorized by donor graft type, and recipients of ND-LLD grafts were described. A total of 13 ND-LLD pediatric liver transplantations were performed, including 8 left lateral segments, 4 left lobes, and 1 right lobe. Of the ND-LLD recipients, 5 had no directed living donor evaluated, whereas the remaining 8 (62%) had all potential directed donors ruled out during the evaluation process. Recipient and graft survival were 100% during a median follow-up time of 445 (range, 70-986) days. Of ND-LLDs, 69% were previous living kidney donors, and 1 ND-LLD went on to donate a kidney after liver donation. Of the ND-LLDs, 46% were approved prior to the recipient being listed. Over time, the proportion of living donor transplants performed, specifically from ND-LLDs, increased, and the number of children on the waiting list decreased. The introduction of ND-LLDs to a pediatric liver transplant program can expand the benefit of living donor liver transplantation to children without a suitable directed living donor while achieving excellent outcomes for both the recipients and donors.
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Affiliation(s)
- Dor Yoeli
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO.,Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, CO
| | - Whitney E Jackson
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Megan A Adams
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO.,Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, CO
| | - Michael E Wachs
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO.,Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, CO
| | - Shikha S Sundaram
- Division of Gastroenterology, Hepatology and Nutrition, The Digestive Health Institute, Department of Pediatric Medicine, Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Anna Sater
- Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, CO
| | - Jaime R Cisek
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Rashikh A Choudhury
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Trevor L Nydam
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - James J Pomposelli
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Kendra D Conzen
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Michael S Kriss
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - James R Burton
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Elizabeth A Pomfret
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
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6
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Dunn S, Shah A. Anonymous Nondirected Living Liver Donation: Has the Time Come to Formalize the Process? Liver Transpl 2021; 27:1373-1374. [PMID: 34309166 DOI: 10.1002/lt.26237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/16/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Stephen Dunn
- Department of Surgery, Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Ashesh Shah
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
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7
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Jacobs C, Berglund DM, Wiseman JF, Garvey C, Larson DB, Voges M, Radecki Breitkopf C, Ibrahim HN, Matas AJ. Long-term psychosocial outcomes after nondirected donation: A single-center experience. Am J Transplant 2019; 19:1498-1506. [PMID: 30417522 DOI: 10.1111/ajt.15179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/19/2018] [Accepted: 11/01/2018] [Indexed: 01/25/2023]
Abstract
Short-term studies have demonstrated that nondirected donors (NDDs) have psychosocial outcomes that are similar to donors who donate directly, but long-term studies have not been done. NDDs at our center were surveyed regarding motivation; support during donation; stress related to donation; regret; financial resources used for donation; preferences about communication with the recipient; and cost reimbursement. Of 100 NDDs who donated at our center in the last 20 years, 95 remain in contact with us, and 77 responded to our survey (mean ± standard deviation [SD] 6.7 ± 4 years postdonation). The most common motivation for donation was the desire to help another (99%). Many NDDs received support from family, friends, and employers. NDDs voiced stress about the possibility of recipient kidney rejection, physical consequences to themselves, and financial burden. Only one donor expressed regret. Almost half wanted some recipient information at donation; 61% preferred routine recipient status updates; 56% believed meeting the recipient should occur at any mutually agreeable time; and 55% endorsed reimbursement for expenses. Stressors for NDDs are analogous to those of directed donors; NDDs prefer having some information about the recipient and prefer to be given a choice regarding the timing for communication with the recipient. NDDs supported donation being financially neutral.
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Affiliation(s)
- Cheryl Jacobs
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | | | - Jennifer F Wiseman
- Department of Social Work, University of Minnesota Health, Minneapolis, Minnesota
| | - Catherine Garvey
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Dawn B Larson
- Department of Social Work, University of Minnesota Health, Minneapolis, Minnesota
| | - Margaret Voges
- University of Minnesota Health, Solid Organ Transplant, Minneapolis, Minnesota
| | | | - Hassan N Ibrahim
- Division of Nephrology, Houston Methodist Hospital, Houston, Texas
| | - Arthur J Matas
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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8
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Balliet W, Kazley AS, Johnson E, Holland-Carter L, Maurer S, Correll J, Marlow N, Chavin K, Baliga P. The non-directed living kidney donor: Why donate to strangers? J Ren Care 2019; 45:102-110. [PMID: 30868762 DOI: 10.1111/jorc.12267] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Kidney transplantation improves survival and quality of life for patients with end-stage kidney disease (ESKD). However, there is a shortage of donated organs, resulting in long wait times and the potential for death before a donor is found. Non-directed (also called altruistic) living kidney donation is a growing type of donation; however, few studies have examined the values and motivation of individuals evaluated to be a non-directed donor. OBJECTIVES This qualitative study explores the motivations and values of individuals evaluated for non-directed donation. DESIGN Focus groups were conducted with individuals who had been evaluated for non-directed living kidney donation. Grounded theory method guided the data analysis. PARTICIPANTS Participants (N = 11) were individuals who completed the evaluation for a non-directed living kidney donation. FINDINGS Qualitative analyses revealed eight major themes participants considered in making their decision to donate to a non-related person: (i) motivation to donate; (ii) minimise perceived risk; (iii) ideal selected recipient; (iv) change in lifestyle; (v) source of donation knowledge; (vi) history of altruistic acts; (vii) donation chain and (viii) others' response. CONCLUSIONS Results suggest that non-directed living kidney donors think deeply about their decision and have a resolve to help others that is aligned with their values. As organ availability remains at a critical shortage, unwillingness to consider non-directed living donors (NDD) due to beliefs of ill motivations appears unsupported. Future directions call for the need of standard practice of care in kidney donation evaluations across transplant centers.
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Affiliation(s)
- Wendy Balliet
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Abby S Kazley
- Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily Johnson
- Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lauren Holland-Carter
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stacey Maurer
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jennifer Correll
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicole Marlow
- Department of Health Services Research, Management, and Policy, University of Florida Health Science Center, Gainesville, Florida, USA
| | - Kenneth Chavin
- Department of Surgery-Transplant, UH Cleveland Medical Center, Cleveland, Ohio, USA
| | - Prabhakar Baliga
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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An ethical appraisal of living-anonymous kidney donation using Adam Smith's Theory of Moral Sentiments. Health Policy 2018; 122:1212-1221. [PMID: 30190087 DOI: 10.1016/j.healthpol.2018.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 08/13/2018] [Accepted: 08/24/2018] [Indexed: 12/11/2022]
Abstract
Ethical debates continue to shape organ transplant policies, particularly for kidneys. Facing organ shortages, governments have created incentives targeting prospective living-anonymous donors - socially and biologically unrelated to the recipient. However, these policies may transform altruistic exchanges of tissues into trades of commodities. We use Adam Smith's concept of sympathy to outline a new approach to transplantation ethics. This is accomplished using a case study analysis of six countries with established living-anonymous kidney donation practices - Iran, Israel, the Netherlands, Saudi Arabia, the United Kingdom, and the United States. An ethical test was also developed from ethnographies of donors and Smith's Theory of Moral Sentiments. The case study analysis considered the role of religious and historic norms, media campaigns, adherence to the 2008 Declaration of Istanbul guidelines for each case, and how each factor related to Smith's sympathy, categorizing the countries into four tiers of altruism. Iran occupied the least altruistic tier, followed by the Netherlands, the UK and the US, and Saudi Arabia and Israel. The ethical test identified a similar ranking. Our findings suggest that a highly-selected cohort of states with established living-anonymous kidney donation programs may already utilize a Smithian approach for recruiting donors, and that socially-valued government incentives can preserve altruism. The ethical test could become a useful instrument to assess the altruism of emerging incentive policies.
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10
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Abstract
Unspecified kidney donation is an emerging resource to bridge the gap between supply and demand of kidneys for transplantation. However, uncertainty remains among both the transplantation community and lay public with regard to the intention, motivation, and legitimacy of such donors. Even within programs that use unspecified kidney donors, there is a lack of consensus regarding how to optimize the potential of the gifted kidney (and indirectly potentiate the altruistic benefit for the donor). Despite emerging guidance on how to work up unspecified donors, centers have adopted individualized unspecified donor pathways with regards to assessment, evaluation, and use. There are a variety of models for unspecified kidney donation, ranging from donation directly to deceased-donor waiting lists to benefit one recipient or chain transplantations occurring simultaneously (domino-paired donation) or nonsimultaneously (extended altruistic donor chains) to benefit many. After a brief exploration on the basis of altruism, this review will discuss the assessment, evaluation, and reported outcomes associated with unspecified kidney donation. It will also critique current utilization models and highlight some unresolved controversies. The aim is to highlight the principles, practice, and potential of unspecified kidney donation to bridge the current disparate international practice.
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11
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Clarke A, Mitchell A, Abraham C. Understanding donation experiences of unspecified (altruistic) kidney donors. Br J Health Psychol 2013; 19:393-408. [PMID: 23692296 DOI: 10.1111/bjhp.12048] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 03/27/2013] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Kidney donation from a living donor to an unknown recipient has been legal in the UK since 2006. Yet there is little research into the experiences of unspecified kidney donors (UKDs) in interaction with the health care systems. DESIGN This article explores the experiences of 14 UKDs recruited through four regional transplant co-ordinating centres in England. At interview, they were invited to share their donation stories and discuss the antecedents, social, and psychological processes involved. Interviews were audio-taped and transcribed. METHODS Transcripts were analysed using a grounded theory approach employing a constant comparison methodology. Themes emerging from the data were named to form categories organized around the central focus of the research, forming an analytical story of UKDs' experiences. RESULTS Two major categories emerged: 'connected to others' and 'uneasy negotiations with others'. 'Connected to others' encompasses the motivations and psychological and social consequences of UKD. 'Uneasy negotiations with others' refer to the concerns and conflicts that arose during the donation process. CONCLUSIONS This study highlights the importance of social relationships on the process and outcomes of UKD. These UKDs report both intra- and interpersonal benefits from donation. The donation process, however, also created interpersonal stress, and conflicting messages about the acceptability of their donation were experienced in UKDs' personal lives and in their interactions with health care services. Findings are discussed with reference to the wider literature on UKD and altruism and in relation to implications for clinical practice. STATEMENT OF CONTRIBUTION What is already known on this subject? Unspecified living kidney donation is an under-researched area with only three research papers published worldwide that report on the motivations and experiences of donors. These studies indicate that donors endorse pro-social values and receive positive interpersonal and intrapersonal benefits from donation. What does this study add? UKDs' experiences are made explicit and provide a framework for future research. Social connections (capital) are an important precursor to and outcome from donation. Assumptions of pathological motivations were encountered by donors in their personal life and within the NHS.
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Affiliation(s)
- Alexis Clarke
- Peninsula College of Medicine and Dentistry, University of Exeter, UK
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12
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Tong A, Craig JC, Wong G, Morton J, Armstrong S, Schollum J, Cross N. “It was just an unconditional gift.” Self reflections of non-directed living kidney donors. Clin Transplant 2012; 26:589-99. [DOI: 10.1111/j.1399-0012.2011.01578.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Neidich EM, Neidich AB, Cooper JT, Bramstedt KA. The ethical complexities of online organ solicitation via donor-patient websites: avoiding the "beauty contest". Am J Transplant 2012; 12:43-7. [PMID: 21951635 DOI: 10.1111/j.1600-6143.2011.03765.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The proliferation of the Internet has spurred the creation of websites dedicated to facilitating living directed organ donations. We argue that such sites potentially devolve into "beauty contests" where patients in need are evaluated on the basis of their personal appearance and biography-variables which should have no relevance to organ allocation. Altruism should be the guiding motivation for all donations, and when it does, there is no place for a beauty contest. The power of the Internet is optimally used when it facilitates Good Samaritan donations-donations to any stranger, rather than handpicked ones. Social networking sites which aim to match potential donors and patients should mask personal identifying information, allowing the ethical principles of altruism and justice to guide organ allocation.
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Affiliation(s)
- E M Neidich
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
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14
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Abstract
In the literature, varying terminology for living organ donation can be found. However, there seems to be a need for a new classification to avoid confusion. Therefore, we assessed existing terminology in the light of current living organ donation practices and suggest a more straightforward classification. We propose to concentrate on the degree of specificity with which donors identify intended recipients and to subsequently verify whether the donation to these recipients occurs directly or indirectly. According to this approach, one could distinguish between "specified" and "unspecified" donation. Within specified donation, a distinction can be made between "direct" and "indirect" donation.
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Altruistic kidney donation to a stranger: psychosocial and functional outcomes at two US transplant centers. Transplantation 2011; 91:772-8. [PMID: 21285916 DOI: 10.1097/tp.0b013e31820dd2bd] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The number of living kidney donors with no preexisting relationship to the recipient has increased sharply. This study compared the psychosocial and functional outcomes of these altruistic donors to a stranger (ADs) with donors with a longstanding relationship with the recipient (traditional donors [TDs]). METHODS ADs (n=39) and TDs (n=52), who were similar on age, sex, and year of donation, were recruited from two transplant programs in the United States. Participants completed validated measures of psychosocial and functional outcomes a median of 5 years after donation (range, 1-12 years). RESULTS ADs and TDs did not differ significantly in the total number of donation motives. Both were motivated by a desire to help, the benefits to the recipient outweighing the risks to the donor, a sense of moral duty, and imagining oneself in the position of the recipient. Psychological benefits were endorsed equally by both types of donors, although TDs reported higher Quid Pro Quo scores relative to ADs (P=0.04). ADs and TDs did not differ significantly on any of the Short Form-36, Version 2 scales (P values ranged from 0.19 to 0.85). Few donors (3 ADs and 1 TD) regretted their donation decision. CONCLUSION Overall, findings indicate that carefully screened ADs experience psychosocial and functional outcomes comparable with those of TDs and should not be systematically excluded from the opportunity to donate.
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Live donor kidney transplantation: attitudes of patients and health care professionals concerning the pre-surgical pathway and post-surgical follow-up. Int Urol Nephrol 2011; 44:157-65. [PMID: 21614509 DOI: 10.1007/s11255-011-9987-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 04/29/2011] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We surveyed the following groups of individuals concerning their attitudes towards the pathway leading up to live donor kidney transplantation (LDKT) and post-operative follow-up: kidney transplant (deceased and live donor) recipients, live kidney donors and medical and nursing staff caring for end-stage renal disease and dialysis patients. MATERIALS AND METHODS Participants were recruited within a tertiary renal and transplant centre and invited to complete anonymized questionnaires, be involved in focus groups and undertake structured interviews. RESULTS A total of 464 participants completed the questionnaire (36% health care professionals and 64% patients). Most perceived donor risk as small or very small (62%), and 49% stated that a potential donor should be given up to 3 months to reconsider the decision to donate. Participants were almost equally divided as to whether consensus of the donor's family is necessary (46%) or not (44%) in LDKT. Seventy-one percentage of the participants suggested that patients have a greater appreciation of a LDKT if they have been on dialysis; 58% of participants thought that donor and recipient should recuperate beside each other after surgery; 45% thought that the post-operative follow-up for the donor should last up to a year; and 83% thought that donor follow-up should include medical status and quality of life. In the interviews, participants expressed several interesting views. CONCLUSIONS Participants believed that LDKT is safe for the donor, and the pathway to surgery and post-operative follow-up should be performed in a way that ensures lack of coercion and includes family support and an extensive post-operative follow-up.
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Wallis CB, Samy KP, Roth AE, Rees MA. Kidney paired donation. Nephrol Dial Transplant 2011; 26:2091-9. [DOI: 10.1093/ndt/gfr155] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Abstract
The issue of directed donation of organs from deceased donors for transplantation has recently risen to the fore, given greater significance by the relatively stagnant rate of deceased donor donation in the UK. Although its status and legitimacy is explicitly recognized across the USA, elsewhere a more cautious, if not entirely negative, stance has been taken. In England, Wales and Northern Ireland, the Human Tissue Act 2004, and in Scotland the Human Tissue (Scotland) Act 2006, are both silent in this regard. Although so-called conditional donation, donation to (or perhaps withheld from) a specific class, has been outlawed as a product of guidance issued by the Secretary of State for Health issued in the wake of the controversial incident occurring in the North of England in 1998, its intended application to 'directed' donation is less certain.Directed and conditional donations challenge the traditional construct of altruistic donation and impartial (equitable) allocation in a very immediate and striking fashion. They implicitly raise important questions as to whether the body or parts of the body are capable of being owned, and by whom. This paper attempts to explore the notion of donor ownership of body parts and its implications for both directed and conditional donation.
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Affiliation(s)
- Antonia J Cronin
- Institute of Medicine Law and Bioethics and Institute of Science, Ethics and Innovation, School of Law, University of Manchester, Manchester, UK,
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Montgomery RA, Gentry SE, Marks WH, Warren DS, Hiller J, Houp J, Zachary AA, Melancon JK, Maley WR, Rabb H, Simpkins C, Segev DL. Domino paired kidney donation: a strategy to make best use of live non-directed donation. Lancet 2006; 368:419-21. [PMID: 16876670 DOI: 10.1016/s0140-6736(06)69115-0] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Robert A Montgomery
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Mark PJ, Baker K, Aguayo C, Sorensen JB. Experience with an organ procurement organization-based non-directed living kidney donation programme. Clin Transplant 2006; 20:427-37. [PMID: 16842517 DOI: 10.1111/j.1399-0012.2006.00501.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The organ procurement organization (OPO)-based non-directed living kidney donation programme was developed to decrease wait times for kidney transplants, and to meet the community's desire for altruistic living donation. Community awareness was encouraged through information about non-directed living kidney donation on the state donor registry Web site, and through the media. The OPO received all inquiries and responded with phone calls, e-mails, printed information, medical/social history questionnaires, interviews, and referrals to the transplant centres. Kidneys were allocated according to the United Network for Organ Sharing (UNOS) wait list for the evaluating transplant centre. Between March 2002 and 23 September 2005, there were 608 inquiries to the OPO about non-directed living kidney donation. In 41 months, 20 transplants occurred with kidneys from non-directed donors. The donor registry and OPO-sponsored publicity led to 578 of the 608 inquiries and 15 of the 20 transplants. OPO screening saved transplant centre resources by ruling out 523 inquiries, referring 76 to transplant centres for complete evaluations. Optional donor/recipient meetings appeared to be beneficial to those participating. OPO-based non-directed living donor programmes can be effective and efficient. Standardization of evaluation, allocation, and follow-up will allow for better data collection and more widespread implementation.
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Affiliation(s)
- Paula J Mark
- Intermountain Donor Services, Liver/Kidney/Pancreas Transplant, LDS Hospital, and Kidney Transplant Program, University of Utah Health Sciences Center, Salt Lake City, UT 84102, USA.
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Spital A. Increasing the pool of transplantable kidneys through unrelated living donors and living donor paired exchanges. Semin Dial 2006; 18:469-73. [PMID: 16398708 DOI: 10.1111/j.1525-139x.2005.00091.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Renal transplantation is the best therapy for eligible patients with end-stage renal disease (ESRD). Unfortunately the ability to perform this procedure is limited by a severe shortage of transplantable kidneys. One of the most successful approaches to this serious problem has been to expand the pool of living donors. This has been accomplished primarily by lifting restrictions on the use of genetically unrelated volunteers. As a result, acceptable living kidney donors now include individuals who are related to their recipients only through emotional bonds (e.g., spouses) and, at some centers, even people who are not related to their recipients at all. Living donor paired kidney exchanges provide a novel means for increasing further the number of kidneys available for transplantation. Each of these approaches will be reviewed.
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Affiliation(s)
- Aaron Spital
- New York Organ Donor Network, New York, New York 10001, USA.
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Morrissey PE, Dube C, Gohh R, Yango A, Gautam A, Monaco AP. Good samaritan kidney donation. Transplantation 2006; 80:1369-73. [PMID: 16340776 DOI: 10.1097/01.tp.0000179153.36227.2d] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Gilbert JC, Brigham L, Batty DS, Veatch RM. The nondirected living donor program: a model for cooperative donation, recovery and allocation of living donor kidneys. Am J Transplant 2005; 5:167-74. [PMID: 15636626 DOI: 10.1111/j.1600-6143.2004.00660.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We describe an altruistic nondirected (ND) and live donor/deceased donor list exchange (LE) donor program administered by an organ procurement organization (OPO) in the Washington, DC area. Screening eliminated 25 donors (17 NE; 8 LE) from the 97 donor applications (62 ND; 35 LE) completed. Twenty-one donors (16 ND; 5 LE) failed to follow through with the psychiatric evaluation, which eliminated 13 donors (9 ND; 4 LE). Two donors dropped out and 12 (9 ND; 3 LE) were medically unsuitable after final clinical evaluation. Twenty donor procedures were performed (10 ND; 10 LE) with four pending (2 ND; 2 LE). This resulted in a modest 3-5% increase in the OPO-procured kidney organ pool. The average cold ischemia time of the grafts not transported between transplant centers was 205 +/- 66 min compared with 243 +/- 48 min for transported grafts. With no documented adverse outcomes, donors had a hospital stay of length 2.9 days and at home recuperation of 12.3 days. Three- and 6-month creatinines were 1.44 +/- 1.36 and 1.68 +/- 0.61 for grafts not transported between transplant centers, and 1.6 +/- 0.27 and 1.6 +/- 0.44 for transported grafts. An OPO-administered altruistic donor program can serve as a model for cooperative donation, recovery and allocation of living donor kidneys.
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Affiliation(s)
- James C Gilbert
- Department of Pediatric Surgery, Children's National Medical Center, Washington, DC, USA.
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Steinberg D. An "opting in" paradigm for kidney transplantation. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2004; 4:4-14. [PMID: 16192186 DOI: 10.1080/15265160490518557] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Almost 60,000 people in the United States with end stage renal disease are waiting for a kidney transplant. Because of the scarcity of organs from deceased donors live kidney donors have become a critical source of organs; in 2001, for the first time in recent decades, the number of live kidney donors exceeded the number of deceased donors. The paradigm used to justify putting live kidney donors at risk includes the low risk to the donor, the favorable risk-benefit ratio, the psychological benefits to the donor, altruism, and autonomy coupled with informed consent; because each of these arguments is flawed we need to lessen our dependence on live kidney donors and increase the number of organs retrieved from deceased donors. An "opting in" paradigm would reward people who agree to donate their kidneys after they die with allocation preference should they need a kidney while they are alive. An "opting in" program should increase the number of kidneys available for transplantation and eliminate the morally troubling problem of"organ takers"who would accept a kidney if they needed one but have made no provision to be an organ donor themselves. People who "opt in" would preferentially get an organ should they need one at the minimal cost of donating their kidneys when they have no use for them; it is a form of organ insurance a rational person should find extremely attractive. An "opting in" paradigm would simulate the reciprocal altruism observed in nature that sociobiologists believe enhances group survival. Although the allocation of organs based on factors other than need might be morally troubling, an "opting in" paradigm compares favorably with other methods of obtaining more organs and accepting the status quo of extreme organ scarcity. Although an "opting in" policy would be based on enlightened self-interest, by demonstrating the utilitarian value of mutual assistance, it would promote the attitude that self-interest sometimes requires the perception that we are all part of a common humanity.
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SantaCruz PL, Sánchez O, González A, Agüero F, Agüero C. The altruistic living donor: a commentary and two questions. Nephrol Dial Transplant 2001; 16:2109-10. [PMID: 11572911 DOI: 10.1093/ndt/16.10.2109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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