Is it ethical to invite compatible pairs to participate in exchange programmes?

Fortin, Marie-Chantal

doi:10.1136/medethics-2012-101129

Cited by 19 publications

(17 citation statements)

References 17 publications

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“…13,14 Ethical issue in compatible pair is that should recipients in compatible pairs receive a ''better organ'' than the one they would otherwise have received from their intended donor with acceptable delay before RTx. 3 We need to allocate O blood group kidneys from compatible donors to overcome the barrier of HLA, non-HLA antibodies and other donor related factors (sex and age matching, pre-donation kidney volume and function, DÀ/RÀ CMV serology, full DR matching) to improve transplant quality and long term outcomes in near future. [15][16][17][18][19][20][21][22][23][24][25] From our personal experience in our country, despite legal permission for KPD from Transplantation of Human Organs Act 2011 amendments, one of the most challenging barriers to KPD at this time is the time required for permission from different state government authorization committee rather than financial reimbursement for donor evaluation as in US and prohibit participation of patients in KPD from different states.…”

Section: Discussionmentioning

confidence: 99%

“…A way to remedy this situation is through altruistic unbalanced paired kidney exchange (AUPKE), in which a compatible pair consisting of an O blood group donor and a non-O recipient is invited to participate in an exchange program. 3 Broader implementation of KPD would lead to more than 1000 additional live donor RTx every year. 4,5 The number of patients on the waiting lists for transplantation would be decreased by the widespread use of voluntary exchange RTx.…”

Section: Introductionmentioning

confidence: 99%

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Successful three-way kidney paired donation with compatible pairs to increase donor pool

et al. 2013

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Despite heightened international interest in performing living donor kidney paired donation (KPD) transplantation after the publication of a research protocol by Ross and colleagues in 1997, only a few hundred have been performed worldwide. The major obstacle is that many individuals in end-stage renal disease are of blood type O and can only receive an organ from a donor of blood type O, whereas blood type O donors are "universal donors" and will be able to donate directly with an intended recipient of any blood type unless there is a positive crossmatch. To overcome this, patients with compatible but non-HLA identical donors over 45 years of age should be approached for inclusion in KPD program especially O blood group donors. Inclusion of all these additional pairs into the algorithm greatly increases chances of possible matches for O blood group recipients. We report successful three-way KPD transplantation resulting in transplantation of O blood group patient using compatible O blood group donor from India. None of the patients had delayed graft function or rejection and all had stable graft function on discharge without any medical and surgical complications. We need to allocate O blood group kidneys from compatible donors to overcome the barrier of HLA, non-HLA antibodies and other donor related factors to improve transplant quality and long term outcomes. This will increase transplantation of O blood group patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Successful three-way kidney paired donation with compatible pairs to increase donor pool

et al. 2013

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“…There is little empiric information about the psychological benefits of anonymous donations within or outside of KPD programs (16). Participation of CPs in KPD could also alter the gift relationship and weaken the emotional link between the donor and the recipient (8). Alternatively, participation in KPD might benefit some recipients by making it easier to manage the sense of indebtedness to their donor (8).…”

Section: Discussionmentioning

confidence: 99%

Reciprocity to Increase Participation of Compatible Living Donor and Recipient Pairs in Kidney Paired Donation

Tinckam

Fortin

Rose

et al. 2017

American Journal of Transplantation

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Inclusion of compatible living donor and recipient pairs (CPs) in kidney paired donation (KPD) programs could increase living donor transplantation. We introduce the concept of a reciprocity-based strategy in which the recipient of a CP who participates in KPD receives priority for a repeat deceased donor transplant in the event their primary living donor KPD transplant fails, and then we review the practical and ethical considerations of this strategy. The strategy limits prioritization to CPs already committed to living donation, minimizing the risk of unduly influencing donor behavior. The provision of a tangible benefit independent of the CP's actual KPD match avoids many of the practical and ethical challenges with strategies that rely on finding the CP recipient a better-matched kidney that might provide the CP recipient a future benefit to increase KPD participation. Specifically, the strategy avoids the potential to misrepresent the degree of future benefit of a better-matched kidney to the CP recipient and minimizes delays in transplantation related to finding a better-matched kidney. Preliminary estimates suggest the strategy has significant potential to increase the number of living donor transplants. Further evaluation of the acceptance of this strategy by CPs and by waitlisted patients is warranted.

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“…These donors (and especially bridge donors) should also consent to process differences (e.g., timing unpredictability; potential for additional testing) [55]. NDDs and LDs for paired exchange should be advised of confidentiality guidelines limiting information exchange about 'actual' recipient outcomes, particularly as this information has been linked to donor satisfaction [24,[54][55][56][57].…”

Section: Content Elements For Informed Consent Within Specific Livingmentioning

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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Is it ethical to invite compatible pairs to participate in exchange programmes?

Cited by 19 publications

References 17 publications

Successful three-way kidney paired donation with compatible pairs to increase donor pool

Successful three-way kidney paired donation with compatible pairs to increase donor pool

Reciprocity to Increase Participation of Compatible Living Donor and Recipient Pairs in Kidney Paired Donation

Informed Consent of Living Kidney Donors: Pitfalls and Best Practice

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