Extended criteria for organ acceptance. Strategies for achieving organ safety and for increasing organ pool

Abstract

The terms extended donor or expanded donor mean changes in donor acceptability criteria. In almost all cases, the negative connotations of these terms cannot be justified. Factors considered to affect donor or organ acceptability have changed with time, after showing that they did not negatively affect graft or patient survival per se or when the adequate measures had been adopted. There is no age limit to be an organ donor. Kidney and liver transplantation from donors older than 65 years can have excellent graft and patient actuarial survival and graft function. Using these donors can be from an epidemiological point of view the most important factor to esablish the final number of cadaveric liver and kidney transplantations. Organs with broad structural parenchyma lesion with preserved functional reserve and organs with reversible functional impairment can be safely transplanted. Bacterial and fungal donor infection with the adequate antibiotic treatment of donor and/or recipient prevents infection in the latter. The organs, including the liver, from donors with infection by the hepatitis B and C viruses can be safely transplanted to recipients with infection by the same viruses, respectively. Poisoned donors and non-heart-beating donors, grafts from transplant recipients, reuse of grafts, domino transplant and splitting of one liver for two recipients can be an important and safe source of organs for transplantation.

Towards Formalising Agent Argumentation over the Viability of Human Organs for Transplantation

“…Some would cite a donor's smoking history as sufficient reason for labelling a donor's lung as nonviable [8]. However, there are qualified physicians that reason that the donor's lung is viable given that there is no history of COPD [7].…”

Semantics for Possibilistic Disjunctive Programs

“…For instance, if an organ donor D has hepatitis, then an organ recipient R could be infected by an organ of D. According to (López-Navidad and Caballero 2003), there are cases in which the infection can oc-cur; however, the recipient can spontaneously clear the infection, for example hepatitis. This means that an organ donor's infection can be present or non-present in the organ recipient.…”

“…For instance, w.r.t. the first clause, one can wish to attach an degree of uncertainty in order to capture the uncertainty that is involved in this statement -keeping in mind that the organ recipient can be infected by the infection of the donor's organ; however, the infection can be spontaneously cleared by the organ recipient as it is the case of hepatitis (López-Navidad and Caballero 2003).…”

Agents Deliberating over Action Proposals Using the ProCLAIM Model

“…The medical guidelines indicate that a donor's smoking history is a sufficient reason for deeming a donor's lung as non-viable. However, there are qualified physicians that reason that the donor's lung is viable given that there is no history of COPD [9]. Similarly, the guidelines suggest discarding the kidney of a donor whose cause of death was streptococcus viridans endocarditis (sve).…”

“…This organ selection process does not account for the fact that: 1) medical doctors may disagree as to whether an organ is viable or non-viable; 2) different policies in different hospitals and regions exist, and; 3) viability is not an intrinsic property of the donor's organ, but rather, an integral concept that involves the donor and recipient characteristics as well as the courses of action to be undertaken in the transplantation process [9]. In particular, current organ selection process allow for a DA to discard an organ that medical doctors at the recipient site (Recipient Agents, RA) may claim to be viable and, given the chance, could provide strong arguments to support this claim.…”