BACKGROUNDMany nations are able to prosecute transplant-related crimes committed in their territory, but transplant recipients, organ sellers and brokers, and transplant professionals may escape ...prosecution by engaging in these practices in foreign locations where they judge the risk of criminal investigation and prosecution to be remote.
METHODSThe Declaration of Istanbul Custodian Group convened an international working group to evaluate the possible role of extraterritorial jurisdiction in strengthening the enforcement of existing laws governing transplant-related crimes across national boundaries. Potential practical and ethical concerns about the use of extraterritorial jurisdiction were examined, and possible responses were explored.
RESULTSExtraterritorial jurisdiction is a legitimate tool to combat transplant-related crimes. Further, development of a global registry of transnational transplant activities in conjunction with a standardized international referral system for legitimate travel for transplantation is proposed as a mechanism to support enforcement of national and international legal tools.
CONCLUSIONSStates are encouraged to include provisions on extraterritorial jurisdiction in their laws on transplant-related crimes and to collaborate with professionals and international authorities in the development of a global registry of transnational transplant activities. These actions would assist in the identification and evaluation of illicit activities and provide information that would help in developing strategies to deter and prevent them.
Transplant "tourism" typically refers to the practice of traveling outside the country of residence to obtain organ transplantation. This study describes the characteristics and outcomes of 33 kidney ...transplant recipients who traveled abroad for transplant and returned to University of California, Los Angeles (UCLA) for follow-up.
Posttransplantation outcomes were compared between tourists and a matched cohort of patients who underwent transplantation at UCLA (matched for age, race, transplant year, dialysis time, previous transplantation, and donor type). Median follow-up time was 487 d (range 68 to 3056).
Compared with all patients who underwent transplantation at UCLA, tourists included more Asians and had shorter dialysis times. Most patients traveled to their region of ethnicity with the majority undergoing transplantation in China (44%), Iran (16%), and the Philippines (13%). Living unrelated transplants were most common. Tourists presented to UCLA a median of 35 d after transplantation. Four patients required urgent hospitalization, three of whom lost their grafts. Seventeen (52%) patients had infections, with nine requiring hospitalization. One patient lost her graft and subsequently died from complications related to donor-contracted hepatitis B. One-year graft survival was 89% for tourists and 98% for the matched UCLA cohort (P = 0.75). The rate of acute rejection at 1 yr was 30% in tourists and 12% in the matched cohort.
Tourists had a more complex posttransplantation course with a higher incidence of acute rejection and severe infectious complications.
PURPOSE OF REVIEWDespite improvement in short-term renal allograft survival in recent years, renal transplant recipients (RTR) have poorer long-term allograft outcomes. Allograft function slowly ...declines with periods of stable function similar to natural progression of chronic kidney disease in nontransplant population. Nearly all RTR transitions to failing renal allograft (FRG) period and require transition to dialysis. Conservative chronic kidney disease management before transition to end-stage renal disease is an increasingly important topic; however, there is limited data in RTR regarding how to delay dialysis initiation with conservative management.
RECENT FINDINGSSince immunological and nonimmunological factors unique to RTR contribute to decline in allograft function, therapies to slow progression of FRG should take both sets of factors into account. Renal replacement therapy either incremental dialysis or rekidney transplantation should be explored. This required taking benefits and risks of continuing immunosuppressive medications into account when allograft nephrectomy may be necessary.
SUMMARYFRG may benefit from various interventions to slow progression of worsening allograft function. Until there are stronger evidence to guide interventions to preserve renal function, extrapolating evidence from nontransplant patients and clinical judgment are necessary. The goal is to provide individualized care for conservative management of RTR with FRG.
The choice of induction agent in the elderly kidney transplant recipient is unclear.
The risks of rejection at 1 year, functional graft loss, and death by induction agent (IL2 receptor antibodies ...IL2RA, alemtuzumab, and rabbit antithymocyte globulin rATG) were compared among five groups of elderly (≥60 years) deceased-donor kidney transplant recipients on the basis of recipient risk and donor risk using United Network of Organ Sharing data from 2003 to 2008.
In high-risk recipients with high-risk donors there was a higher risk of rejection and functional graft loss with IL2RA versus rATG. Among low-risk recipients with low-risk donors there was no difference in outcomes between IL2RA and rATG. In the two groups in which donor or recipient was high risk, there was a higher risk of rejection but not functional graft loss with IL2RA. Among low-risk recipients with high-risk donors, there was a trend toward a higher risk of death with IL2RA.
rATG may be preferable in high-risk recipients with high-risk donors and possibly low-risk recipients with high-risk donors. In the remaining groups, although rATG is associated with a lower risk of acute rejection, long-term outcomes do not appear to differ. Prospective comparison of these agents in an elderly cohort is warranted to compare the efficacy and adverse consequences of these agents to refine the use of induction immunosuppressive therapy in the elderly population.
Transplant Tourism into the United States Delmonico, Francis L; Pruett, Timothy; Danovitch, Gabriel M ...
Transplantation,
2017-August, 2017-08-00, Letnik:
101 Suppl 8S-2
Journal Article
Recenzirano
INTRODUCTIONSince 2012, the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) has required transplant centers to record the country residence of every ...patient undergoing transplantation in the United States. This policy replaced the quota 5% limit of non-US citizen/non-residents (NC/NR) traveling to the US for the purpose of transplantation.
METHODSSince April 1, 2015 the country of residence for the NC/NR on the wait list has also been recorded. The citizenship data of the candidate listed for transplantation was obtained from the Transplant Center Registrations (TCR) forms. These data excluded registrations of patients removed the wait list following living donor transplantation.
RESULTSBetween April 1, 2015 and May 31, 2016, there were 42,754 waitlist additions for kidney transplantation, 551 of whom were NC/NR. Of the 14,394 waitlist additions for liver transplantation there were 191 NC/NR. The most NC/NR registrations for kidney and liver combined were from Saudi Arabia (70 total, 15 kidney and 55 liver) and Kuwait (37 total, 15 kidney and 22 liver).Of the 14,798 kidney transplants performed from deceased organ donors there were 163 NC/NR. Of the 8168 liver transplants performed from deceased organ donors there were 124 NC/NR. 49% of the NC/NR patients undergoing liver and kidney transplantation were from Saudi Arabia and Kuwait. 7% of the kidney and 20% of the liver allografts from deceased donors were allocated to NC/NR children. There were 44 NC/NR that were removed from the list because of death or severity of illness (21 kidney and 23 liver).A tabulation of the wait list duration, MELD score, UNOS Regions, and transplant centers that performed NC/NR transplants will be presented. The severity of illness of the wait listed candidates and the mortality rate of patients awaiting transplants in the specific UNOS region should be addressed.
CONCLUSIONSSince the adoption of the transparency policy, < 1% of waitlist additions and < 1% of transplants have been NC/NR recipients. However, there is a disproportionate representation from 2 Middle East Countries. Review of NC/NR data is intended to promote public trust and the US to be model for the WHO principle of transparency.1. Organ transplantation for nonresidents of the United Statesa policy for transparency. Glazier AK, Danovitch GM, Delmonico FL. Am J Transplant. 2014 Aug;14(8):1740-3.
We describe the parallel changes that have taken place in recent years in two countries, Israel and The Philippines, the former once an “exporter” of transplant tourists and the latter once an ...“importer” of transplant tourists. These changes were in response to progressive legislation in both countries under the influence of the Declaration of Istanbul. The annual number of Israeli patients who underwent kidney transplantation abroad decreased from a peak of 155 in 2006 to an all-time low of 35 in 2011 while in the Philippines the annual number of foreign transplant recipients fell from 531 in 2007 to two in 2011. The experience of these two countries provides a “natural experiment” on the potential impact of legal measures to prevent transplant tourism.
Public surveys conducted in many countries report widespread willingness of individuals to donate a kidney while alive to a family member or close friend, yet thousands suffer and many die each year ...while waiting for a kidney transplant. Advocates of financial incentive programs or "regulated markets" in kidneys present the problem of the kidney shortage as one of insufficient public motivation to donate, arguing that incentives will increase the number of donors. Others believe the solutions lie-at least in part-in facilitating so-called "altruistic donation;" harnessing the willingness of relatives and friends to donate by addressing the many barriers which serve as disincentives to living donation. Strategies designed to minimize financial barriers to donation and the use of paired kidney exchange programs are increasingly enabling donation, and now, an innovative program designed to address what has been termed "chronologically incompatible donation" is being piloted at the University of California, Los Angeles, and elsewhere in the United States. In this program, a person whose kidney is not currently required for transplantation in a specific recipient may instead donate to the paired exchange program; in return, a commitment is made to the specified recipient that priority access for a living-donor transplant in a paired exchange program will be offered when or if the need arises in the future. We address here potential ethical concerns related to this form of organ "banking" from living donors, and argue that it offers significant benefits without undermining the well-established ethical principles and values currently underpinning living donation programs.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
ABSTRACTGovernmental and private programs that pay next of kin who give permission for the removal of their deceased relative’s organs for transplantation exist in a number of countries. Such ...payments, which may be given to the relatives or paid directly for funeral expenses or hospital bills unrelated to being a donor, aim to increase the rate of donation. The Declaration of Istanbul Custodian Group—in alignment with the World Health Organization Guiding Principles and the Council of Europe Convention Against Trafficking in Human Organs—has adopted a new policy statement opposing such practices. Payment programs are unwise because they produce a lower rate of donations than in countries with voluntary, unpaid programs; associate deceased donation with being poor and marginal in society; undermine public trust in the determination of death; and raise doubts about fair allocation of organs. Most important, allowing families to receive money for donation from a deceased person, who is at no risk of harm, will make it impossible to sustain prohibitions on paying living donors, who are at risk. Payment programs are also unethical. Tying coverage for funeral expenses or healthcare costs to a family allowing organs to be procured is exploitative, not “charitable.” Using payment to overcome reluctance to donate based on cultural or religious beliefs especially offends principles of liberty and dignity. Finally, while it is appropriate to make donation “financially neutral”—by reimbursing the added medical costs of evaluating and maintaining a patient as a potential donor—such reimbursement may never be conditioned on a family agreeing to donate.
Live donor kidney transplantation is the best treatment option for most patients with late‐stage chronic kidney disease; however, the rate of living kidney donation has declined in the United States. ...A consensus conference was held June 5–6, 2014 to identify best practices and knowledge gaps pertaining to live donor kidney transplantation and living kidney donation. Transplant professionals, patients, and other key stakeholders discussed processes for educating transplant candidates and potential living donors about living kidney donation; efficiencies in the living donor evaluation process; disparities in living donation; and financial and systemic barriers to living donation. We summarize the consensus recommendations for best practices in these educational and clinical domains, future research priorities, and possible public policy initiatives to remove barriers to living kidney donation.
This article summarizes the proceedings of the June 2014 Consensus Conference on Best Practices in Live Kidney Donation, which include recommendations for educating transplant candidates and potential living donors, improving efficiencies in the living donor evaluation process, reducing disparities in living kidney donation, and steering future research and policy priorities to remove barriers to donation.
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