How Young Is Too Young to Be a Living Donor?

Campbell, Michael; Wright, Linda; Greenberg, RA; Grant, David

doi:10.1111/ajt.12307

Cited by 33 publications

(24 citation statements)

References 19 publications

(27 reference statements)

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“…Minors are not qualified due to lack of sufficient psychological maturity to give a valid consent to donation considering the short‐term and longterm medical and psychological risks. In general, because there is no interest in minors themselves to be an organ donor, donation from minors should be prohibited . However, in Korea, a patient of the age of 16 years is not considered an adult but is allowed to donate.…”

Section: Discussionmentioning

confidence: 99%

“…In general, because there is no interest in minors themselves to be an organ donor, donation from minors should be prohibited. (19)(20)(21)(22) However, in Korea, a patient of the age of 16 years is not considered an adult but is allowed to donate. We applied a more strict evaluation process in potential donors between 16 and 18 years of age.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of donor workups and exclusions in a single‐center experience of living donor liver transplantation

et al. 2017

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The process of evaluating potential donors in liver transplantation is important to ensure donor safety and provide optimal recipient outcomes. However, there has been no report about donor exclusion rates and reasons for such exclusion in Korea. In this study, we aimed to elucidate the outcomes of potential living liver donor evaluation in a major living donor liver transplantation center. From July 2011 to June 2015, prospectively collected data of 726 potential donors for 588 matched recipients were subsequently evaluated. Among 726 potential donors, 374 potential donors (51.5%) finally reached donation; 352 potential donors (48.5%) were excluded for various reasons. Donor reasons were 29.8%, including medical problems, withdrawal of consent, graft volume issues, and identification of a better suitable donor. Recipient reasons were 20.7%, including recipient death or recovery, allocation to deceased donor, and progressions of hepatocellular carcinoma. A total of 38 (5.2%) potential donors had a fatty liver. Among them, 15 (39.5%) potential donors tried short-term weight reduction and eventually were able to donate. In conclusion, the main reasons for donor exclusion were medical problems and withdrawal of consent. Therefore, thorough medical screening and careful examination for donor voluntarism are important in the donor evaluation process. Liver Transplantation 23 614-624 2017 AASLD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of donor workups and exclusions in a single‐center experience of living donor liver transplantation

et al. 2017

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“…Some potential donors lack the maturity to identify themselves as vulnerable to risk (often associated with life stage) [40]; others demonstrate 'magical thinking' about what living donation will do for the intended recipient [41]. Each of these factors could be described as a relative contraindication or risk factor, warranting assessment and review.…”

Section: Methods Of Assessing Understandingmentioning

confidence: 99%

Informed Consent of Living Kidney Donors: Pitfalls and Best Practice

Hays

2015

Curr Transpl Rep

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Informed consent is clearly considered the ethical bedrock fundamental to living organ donation, a procedure lacking medical benefits for its participants. Recent guidelines have focused on strengthening content components of living kidney donor informed consent, including Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) policies that prescribe key components, and integration of the Independent Living Donor Advocate (ILDA), as mandated by Centers for Medicare and Medicaid Services (CMS) and the OPTN/UNOS. The European Union member states' Working Group on Living Donation provided recommendations for care standardization in the "Toolbox Living Kidney Donation," including integration of an independent clinician advocate. However, even with these changes, studies suggest inconsistency in informed consent elements across transplant programs, and retrospective studies show that although the vast majority of living donors (LDs) reflect back positively on the experience of donation, some describe lacking complete knowledge of risks (or process) before donation. Processes to assure achievement of informed consent remain in the purview of individual transplant centers to implement and measure. Herein, methods to assess prospective LD intentionality, voluntariness, and understanding of risks/benefits are described, with promising techniques highlighted and recommendations for best practice outlined. Specific clinical challenges are addressed, including ambivalence, risk of secondary gain, and difficulty integrating understanding of risks. Finally, additional content elements are proposed to improve validity of informed consent in specific clinical circumstances.

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“…Parents represent 80 % of LD [18]. The minimum legal age for living donation varies by jurisdiction, ranging from no minimum age limit (in England, Wales and North Ireland) to age 19 years in some Canadian provinces, with underaged living donation even forbidden in some European countries, including France [19]. Donor age is decreasing in the USA according to the "Share 35" program [16].…”

Section: Pediatric Organ Donors and Their Managementmentioning

confidence: 99%

Strategies to optimize kidney recovery and preservation in transplantation: specific aspects in pediatric transplantation

et al. 2014

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In renal transplantation, live donor kidney grafts are associated with optimum success rates due to the shorter period of ischemia during the surgical procedure. The current shortage of donor organs for adult patients has caused a shift towards deceased donors, often with co-morbidity factors, whose organs are more sensitive to ischemia-reperfusion injury, which is unavoidable during transplantation. Donor management is pivotal to kidney graft survival through the control of the ischemiareperfusion sequence, which is known to stimulate numerous deleterious or regenerative pathways. Although the key role of endothelial cells has been established, the complexity of the injury, associated with stimulation of different cell signaling pathways, such as unfolded protein response and cell death, prevents the definition of a unique therapeutic target. Preclinical transplant models in large animals are necessary to establish relationships and kinetics and have already contributed to the improvement of organ preservation. Therapeutic strategies using mesenchymal stem cells to induce allograft tolerance are promising advances in the treatment of the pediatric recipient in terms of reducing/withdrawing immunosuppressive therapy. In this review we focus on the different donor management strategies in kidney graft conditioning and on graft preservation consequences by highlighting the role of endothelial cells. We also propose strategies for preventing ischemia-reperfusion, such as cell therapy.

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How Young Is Too Young to Be a Living Donor?

Cited by 33 publications

References 19 publications

Evaluation of donor workups and exclusions in a single‐center experience of living donor liver transplantation

Evaluation of donor workups and exclusions in a single‐center experience of living donor liver transplantation

Informed Consent of Living Kidney Donors: Pitfalls and Best Practice

Strategies to optimize kidney recovery and preservation in transplantation: specific aspects in pediatric transplantation

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