Evaluation of Living Donor Liver Transplantation: Causes for Exclusion

Araújo, Cristina Carvalho Viana de; Balbi, E.; Pacheco-Moreira, L.F.; Enne, Marcelo; Alves, Juliano; Fernandes, Reinaldo; Steinbrück, Klaus; Martinho, José Manoel

doi:10.1016/j.transproceed.2010.01.006

Cited by 9 publications

(6 citation statements)

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“…Nonetheless, LKD and LLD candidates' reports of hesitancy, reluctance (76), anxiety (60,61), fear (77), and insecurity about the decision to donate (67) suggest that LDs may feel undue pressure. On the other hand, the fact that donors do withdraw from evaluation indicates that they are capable of expressing a voluntary, autonomous decision not to donate (78).…”

Section: Voluntarinessmentioning

confidence: 99%

Informed Consent for Living Donation: A Review of Key Empirical Studies, Ethical Challenges and Future Research

Gordon

2012

American Journal of Transplantation

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Given the organ scarcity, live organ donation is increasingly considered a viable alternative for kidney and liver transplantation. Yet living donation challenges the ethical principle of nonmaleficence by subjecting healthy individuals to medical, psychosocial and unknown risks. Therefore, transplant providers, policymakers and donors are committed to ensuring that prospective donors provide adequate informed consent to undergo the procedure. Informed consent for living donation is ethically required as a means of demonstrating respect for donor's autonomy and protecting their safety. However, all elements of informed consent are fraught with difficulties due to the unique nature of the donation process and outcome. This paper reviews empirical research on informed consent for live kidney donors (LKD) and live liver donors (LLD) for both adult and pediatric recipients. As this review shows, studies that empirically assessed the quality of informed consent elements reveal considerable variability and deficiencies across the informed consent process, suggesting the need for improvement. This review highlights challenges to each element of consent for both LKDs and LLDs, and situates trends within broader policy contexts, ethical debates and avenues for future innovative research.

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Section: Voluntarinessmentioning

confidence: 99%

Informed Consent for Living Donation: A Review of Key Empirical Studies, Ethical Challenges and Future Research

Gordon

2012

American Journal of Transplantation

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“…Clarity of research question (nϭ20) (11-14, 16, 17, 19, 20, 22-27, 29-33, 35) Methodology Sampling technique (nϭ6) (11,14,15,22,24,26) Inclusion criteria (nϭ9) (13-15, 20, 21, 24, 27, 32, 35) Exclusion criteria (nϭ4) (11,16,17,33) Recruitment approach (nϭ16) (11-14, 16, 17, 19, 21-28, 30) Setting (nϭ19) (11-14, 19-27, 30-33, 35) Population (nϭ24) (11)(12)(13)(14)(15)(16)(17)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) Sample size (nϭ24) (11)(12)(13)(14)(15)(16)(17)(19)(20)(21)(22)(23)…”

Section: Research Questionmentioning

confidence: 99%

“…One study examining both adult and pediatric recipients was included but results pertaining only to adult recipients were included in this review (11). One half were quantitative studies using survey questionnaires (50%); others were qualitative, using semistructured interviews or focus groups (38%) (25,26); the remaining were observational studies using medical chart reviews (12%) (31,34,35). Most studies had clear definitions of the study question (80%) and reported details of population and setting (100%).…”

Section: Study Qualitymentioning

confidence: 99%

“…Although seven studies used the term "coercion" when interpreting results, no studies or survey questionnaires using this term defined it, which limited the ability to interpret study findings (16,19,22,(27)(28)(29)31). Because 39% of potential donors evaluated at one center withdrew suggests that they are capable of expressing a voluntary agreement to donate (34). Because 39% of potential donors evaluated at one center withdrew suggests that they are capable of expressing a voluntary agreement to donate (34).…”

Section: Voluntarinessmentioning

confidence: 99%

“…(11-17, 19-30, 32) Observational (nϭ3) (31,34,35) Retrospective (nϭ14) (11-13, 15-17, 24, 27-31, 34, 35) Prospective (nϭ10) (14, 19-23, 25, 26, 32, 33) This review identifies information needs, gaps in knowledge and understanding, and perceptions about the informed consent process.…”

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confidence: 99%

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Informed Consent and Decision-Making About Adult-to-Adult Living Donor Liver Transplantation: A Systematic Review of Empirical Research

et al. 2011

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Adult-to-adult living donor liver transplantation (LDLT) is a complex procedure that poses serious health risks to and provides no direct health benefit for the donor. Because of this uneven risk-benefit ratio, ensuring donor autonomy through informed consent is critical. To assess the current knowledge pertaining to informed consent for LDLT, we conducted a systematic review of the empirical literature on donors' decision-making process, comprehension about risks and outcomes, and information needs for LDLT. Of the 1423 identified articles, 24 met final review criteria, representing the perspective of approximately 2789 potential and actual donors. As donors' decisions to donate often occur before evaluation, they often make uninformed decisions. The review found that 88% to 95% of donors reported understanding information clinicians disclosed about risks and benefits. However, donors reported unmet information needs, knowledge gaps regarding risks, and unanticipated complications. Few donors reported feeling pressure to donate. Most studies were limited by cultural differences, small sample sizes, inconsistent measures, and poor methodological approaches. This systematic review suggests that informed consent for LDLT is sub-optimal as donors do not adequately appreciate disclosed information during the informed consent process, despite United Network for Organ Sharing/CMS regulations requiring formal psychological evaluation of donor candidates. Interventions are needed to improve donor-clinician communication during the LDLT informed consent process such as through the use of comprehension assessment tools and e-health educational tools that leverage adult learning theory to effectively convey LDLT outcome data.

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Living Donors for Fulminant Hepatic Failure in Children

Segedi

Dhani

et al. 2016

Ethical Issues in Pediatric Organ Transplantation

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Evaluation of Living Donor Liver Transplantation: Causes for Exclusion

Cited by 9 publications

References 10 publications

Informed Consent for Living Donation: A Review of Key Empirical Studies, Ethical Challenges and Future Research

Informed Consent for Living Donation: A Review of Key Empirical Studies, Ethical Challenges and Future Research

Informed Consent and Decision-Making About Adult-to-Adult Living Donor Liver Transplantation: A Systematic Review of Empirical Research

Living Donors for Fulminant Hepatic Failure in Children

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