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Oniscu GC, Rockell K, Martin DE. Challenges in undertaking research in transplantation. Lancet 2024:S0140-6736(24)00931-0. [PMID: 38788740 DOI: 10.1016/s0140-6736(24)00931-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024]
Affiliation(s)
- G C Oniscu
- Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Transplantation, Karolinska University Hospital, Huddinge, Sweden.
| | - K Rockell
- UK Organ Donation and Transplantation Research Network, Peterborough, UK
| | - D E Martin
- School of Medicine, Deakin University, Geelong, VIC, Australia
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Slessarev M, Bain KL, Basmaji J, Blydt-Hansen TD, Cooper J, D'Aragon F, Del Sorbo L, Evans A, Gordon AC, Klein G, Meade MO, Murphy N, Thomas HL, Weiss MJ, Weijer C, Harvey D. Developing Guidance for Donor Intervention Randomized Controlled Trials: Initial Discussions From the Canada-United Kingdom 2022 Workshop. Transplantation 2024:00007890-990000000-00692. [PMID: 38499505 DOI: 10.1097/tp.0000000000004983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Donor interventions, including medications, protocols, and medical devices administered to donors, can enhance transplantable organ quality and quantity and maximize transplantation success. However, there is paucity of high-quality evidence about their effectiveness, in part because of ethical, practical, and regulatory challenges, and lack of guidance about conduct of donor intervention randomized controlled trials (RCTs). METHODS With the vision to develop authoritative guidance for conduct of donor intervention RCTs, we convened a workshop of Canadian-United Kingdom experts in organ donation and transplantation ethics, research, and policy to identify stakeholders, explore unique challenges, and develop research agenda to inform future work in this promising field. RESULTS Donor intervention trials should consider perspectives of broad group of stakeholders including donors, transplant recipients, and their families; researchers in donation and transplantation; research ethics boards; and healthcare providers and administrators involved in donation and transplantation. Unique challenges include (1) research ethics (living versus deceased status of the donor at the time of intervention, intervention versus outcomes assessment in different individuals, harm-benefit analysis in donors versus recipients, consent, and impact on research bystanders); (2) outcome data standardization and linkage; and (3) regulatory and governance considerations. CONCLUSIONS Donor intervention RCTs hold potential to benefit organ transplantation outcomes but face unique research ethics, outcome data, and regulatory challenges. By developing research agenda to address these challenges, our workshop was an important first step toward developing Canada-United Kingdom guidance for donor intervention RCTs that are poised to improve the quality and availability of transplantable organs.
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Affiliation(s)
- Marat Slessarev
- Department of Medicine, Western University, London, ON, Canada
- The Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
| | - Katie L Bain
- The Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - John Basmaji
- Department of Medicine, Western University, London, ON, Canada
| | - Tom D Blydt-Hansen
- Department of Pediatrics (Nephrology), University of British Columbia, Vancouver, BC, Canada
| | - Jessie Cooper
- Department of Health Services Research and Management, School of Health & Psychological Sciences, City, University of London, London, United Kingdom
| | - Frédérick D'Aragon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Lorenzo Del Sorbo
- Interdepartmental Division of Critical Care Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Amy Evans
- NHS Blood and Transplant, Clinical Trials Unit, Bristol, United Kingdom
| | - Anthony C Gordon
- Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London United Kingdom
| | - Gail Klein
- Centre for Clinical Trial Support, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Maureen O Meade
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nicholas Murphy
- Department of Medicine, Western University, London, ON, Canada
- The Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Department of Philosophy, Western University, London, ON, Canada
| | - Helen L Thomas
- NHS Blood and Transplant, Clinical Trials Unit, Bristol, United Kingdom
| | - Matthew J Weiss
- The Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Transplant Québec, Montréal, QC, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, Québec, QC, Canada
| | - Charles Weijer
- Department of Medicine, Western University, London, ON, Canada
- Department of Philosophy, Western University, London, ON, Canada
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
| | - Dan Harvey
- NHS Blood and Transplant, University of Nottingham, Nottingham, United Kingdom
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Williment C, Beaulieu L, Clarkson A, Gunderson S, Hartell D, Escoto M, Ippersiel R, Powell L, Kirste G, Nathan HM, Opdam H, Weiss MJ. Organ Donation Organization Architecture: Recommendations From an International Consensus Forum. Transplant Direct 2023; 9:e1440. [PMID: 37138552 PMCID: PMC10150918 DOI: 10.1097/txd.0000000000001440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 05/05/2023] Open
Abstract
This report contains recommendations from 1 of 7 domains of the International Donation and Transplantation Legislative and Policy Forum (the Forum). The purpose is to provide expert guidance on the structure and function of Organ and Tissue Donation and Transplantation (OTDT) systems. The intended audience is OTDT stakeholders working to establish or improve existing systems. Methods The Forum was initiated by Transplant Québec and co-hosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. This domain group included administrative, clinical, and academic experts in OTDT systems and 3 patient, family, and donor partners. We identified topic areas and recommendations through consensus, using the nominal group technique. Selected topics were informed by narrative literature reviews and vetted by the Forum's scientific committee. We presented these recommendations publicly, with delegate feedback being incorporated into the final report. Results This report has 33 recommendations grouped into 10 topic areas. Topic areas include the need for public and professional education, processes to assure timely referral of patients who are potential donors, and processes to ensure that standards are properly enforced. Conclusions The recommendations encompass the multiple roles organ donation organizations play in the donation and transplantation process. We recognize the diversity of local conditions but believe that they could be adapted and applied by organ donation organizations across the world to accomplish their fundamental objectives of assuring that everyone who desires to become an organ donor is given that opportunity in a safe, equitable, and transparent manner.
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Affiliation(s)
- Claire Williment
- Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | | | - Anthony Clarkson
- Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | | | - David Hartell
- Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Manuel Escoto
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Richard Ippersiel
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Linda Powell
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Gunter Kirste
- Albert Ludwigs University Freiburg, Medical Center, Freiburg, Germany
| | | | - Helen Opdam
- Australian Organ and Tissue Authority, Canberra, Australia
| | - Matthew J. Weiss
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Gift of Life Donor Program, Philadelphia, PA
- Transplant Québec, Montréal, QC, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, QC, Canada
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Gardiner D, McGee A, Simpson C, Ahn C, Goldberg A, Kinsella A, Nagral S, Weiss MJ. Baseline Ethical Principles and a Framework for Evaluation of Policies: Recommendations From an International Consensus Forum. Transplant Direct 2023; 9:e1471. [PMID: 37138553 PMCID: PMC10150897 DOI: 10.1097/txd.0000000000001471] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 11/26/2022] [Accepted: 12/15/2022] [Indexed: 05/05/2023] Open
Abstract
To maintain public trust and integrity in organ and tissue donation and transplantation (OTDT), policymakers, governments, clinical leaders, and decision-makers must ensure that policies proposed to increase donation and transplant activity satisfy baseline ethical principles established by international agreement, declaration, and resolution. This article describes the output of the Baseline Ethical Domain group of an international forum designed to guide stakeholders in considering these aspects of their system. Methods This Forum was initiated by Transplant Québec and co-hosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. The domain working group members included administrative, clinical, and academic experts in deceased and living donation ethics and 2 Patient, Family, and Donor partners. Identification of internationally accepted baseline ethical principles was done after literature reviews performed by working group members, and a framework for consideration of existing or novel policies was completed over a series of virtual meetings from March to September 2021. Consensus on the framework was achieved by applying the nominal group technique. Recommendations We used the 30 baseline ethical principles described in World Health Organization Guiding Principles, Declaration of Istanbul, and Barcelona Principles to generate an ethical framework-presented graphically as a spiral series of considerations-designed to assist decision makers in incorporating these ethical principles into practice and policy. We did not seek to determine what is ethical but instead described a method of evaluation for policy decisions. Conclusions The proposed framework could be applied to new or existing OTDT policy decisions to facilitate the transformation of widely accepted ethical principles into practical evaluations. The framework includes adaptation for local contexts and could be applied broadly internationally.
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Affiliation(s)
- Dale Gardiner
- Medical Directorate, NHS Blood and Transplant, Nottingham, United Kingdom
| | - Andrew McGee
- Australian Centre for Health Law Research, QUT, Brisbane, Australia
- Faculty of Business and Law, QUT, Brisbane, Australia
| | - Christy Simpson
- Australian Centre for Health Law Research, QUT, Brisbane, Australia
- Department of Bioethics, Dalhousie University, Halifax, Canada
- Canadian Blood Services, Ottawa, Canada
| | - Curie Ahn
- Division of Nephrology, National Medical Center, Seoul, South Korea
| | - Aviva Goldberg
- Department of Pediatric Nephrology, University of Manitoba, Winnipeg, Canada
| | - Austin Kinsella
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Sanjay Nagral
- Department of Surgical Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India
- Co-chair: Declaration of Istanbul Custodian Group
| | - Matthew J. Weiss
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
- Transplant Québec, Montréal, Québec, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, Québec, Québec, Canada
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