The Declaration of Istanbul defines organ transplant commercialism as ‘…a policy or practice in which an organ is treated as a commodity, including by being bought or sold or used for material gain.’ ...It is this treatment of the organ that inevitably leads to its financial value being placed before the welfare of either its donor or its recipient or others in need of organ transplantation. International experience over the past two decades has proven this point and outcomes of commercial donation for both organ donors and their recipients have been poor. Commercial organ donation also comes at the expense of, not in addition to, unpaid, ‘altruistic’ donation. Other consequences of commercial donation are discussed in addition to a review of measures taken by the international community to put an end to the exploitation of vulnerable organ donors and the provision of ethically acceptable options for those in need of organ transplantation.
An Unusual Cause of Abdominal Bruit Mousavi, Ava; McWilliams, Justin P; Danovitch, Gabriel M ...
Urology (Ridgewood, N.J.),
07/2023, Letnik:
177
Journal Article
Determination of Brain Death Danovitch, Gabriel M; Delmonico, Francis L; Greer, David M
The New England journal of medicine,
04/2022, Letnik:
386, Številka:
16
Journal Article
Recenzirano
Odprti dostop
To the Editor:
In his otherwise excellent Clinical Practice article on the determination of brain death, Greer (Dec. 30, 2021, issue)
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concludes with the following misleading sentence: “Once brain ...death has been declared (but not earlier), it would be appropriate to speak with the family regarding the patient’s wishes to donate organs to patients who might benefit.” This statement compels a clarification. The timing of the approach to the family regarding organ donation may occur before or after the determination of brain death. Staff members in the intensive care unit regularly consult with the Organ Procurement Organization (OPO) before a . . .
The association between pretransplant body composition and posttransplant outcomes in renal transplant recipients is unclear. It was hypothesized that in hemodialysis patients higher muscle mass ...(represented by higher pretransplant serum creatinine level) and larger body size (represented by higher pretransplant body mass index BMI) are associated with better posttransplant outcomes.
Linking 5-year patient data of a large dialysis organization (DaVita) to the Scientific Registry of Transplant Recipients, 10,090 hemodialysis patients were identified who underwent kidney transplantation from July 2001 to June 2007. Cox regression hazard ratios and 95% confidence intervals of death and/or graft failure were estimated.
Patients were 49 ± 13 years old and included 49% women, 45% diabetics, and 27% African Americans. In Cox models adjusted for case-mix, nutrition-inflammation complex, and transplant-related covariates, the 3-month-averaged postdialysis weight-based pretransplant BMI of 20 to <22 and < 20 kg/m(2), compared with 22 to <25 kg/m(2), showed a nonsignificant trend toward higher combined posttransplant mortality or graft failure, and even weaker associations existed for BMI ≥ 25 kg/m(2). Compared with pretransplant 3-month- averaged serum creatinine of 8 to <10 mg/dl, there was 2.2-fold higher risk of combined death or graft failure with serum creatinine <4 mg/dl, whereas creatinine ≥14 mg/dl exhibited 22% better graft and patient survival.
Pretransplant obesity does not appear to be associated with poor posttransplant outcomes. Larger pretransplant muscle mass, reflected by higher pretransplant serum creatinine level, is associated with greater posttransplant graft and patient survival.
INTRODUCTIONA new program of advanced donation is being piloted in the US to address a barrier to living kidney donation in the form of “chronological incompatibility” between potential donors and ...their intended beneficiaries. In this program, a person whose kidney is not currently required for transplantation in a specific recipient may instead donate to the paired exchange programin 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. This commitment has been symbolically described as a “voucher”.
METHODSWe evaluated the current model of advanced donation to identify ethical risks and potential benefits of the program.
RESULTSThe program enables advanced donors to help their intended beneficiaries obtain a transplant in the future, while helping to meet public needs for transplantation in the present. However, conditions imposed in the current program unduly limit the potential benefits of the program, particularly the prohibition of transfer of “vouchers” during the lifetime of the donor. If a person close to the donor unexpectedly develops the need for transplantation but is unable to take advantage of the voucher, the donor may experience significant decisional regret, especially if they would have been eligible to donate at this time in the absence of advanced donation.
CONCLUSIONAdvanced donation enables a form of public virtual banking of kidneys obtained through living donation by providing opportunities for donation to the common pool of organs for public allocation, while preserving the future opportunity for donors to benefit a designated individual. If advanced donation vouchers were transferable, this program might greatly increase non-directed donation by those who are chronologically incompatible with their intended transplant recipient, and those who are willing to make an altruistic donation but concerned about potential future transplant needs of loved ones.
Financial Neutrality in Organ Donation Capron, Alexander M; Delmonico, Francis L; Danovitch, Gabriel M
Journal of the American Society of Nephrology,
01/2020, Letnik:
31, Številka:
1
Journal Article
In kidney‐alone recipients, dual‐kidney transplantation using “higher‐risk” donor organs has shown outcomes comparable to those of single‐kidney transplantation using extended criteria donor (ECD) ...organs. To investigate the feasibility of a similar approach with combined kidney‐liver transplantation, we identified 22 dual‐kidney liver transplantations (DKLTs) and 3044 single‐kidney liver transplantations (SKLTs) performed in the United States between 2002 and 2012 using United Network for Organ Sharing/Organ Procurement and Transplantation Network registry data. We compared donor/recipient characteristics as well as graft/recipient survival between DKLT recipients and SKLT recipients of “higher‐risk” kidneys (ECD and high kidney donor profile index KDPI; >85% donors). Despite having overall similar donor and recipient characteristics compared with both “higher‐risk” donor groups, recipient survival in the DKLT group at 36 months was markedly inferior at 40.9% (compared with 67.5% for ECD SKLT recipients and 64.5% for high‐KDPI SKLT recipients); nondeath‐censored graft survival did not differ. Death was the most common cause of graft loss in all groups. Contrary to dual‐kidney transplantation data in kidney‐alone recipients, DKLT recipients in our study had inferior survival when compared with SKLT recipients of “higher‐risk” donor kidneys. These findings would suggest that dual kidney‐liver transplantation has an uncertain role as a strategy to expand the existing kidney donor pool in combined transplantation.
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