Potential yield of imminent death kidney donation

Abstract

About 99 000 people are waiting for a kidney in the United States, and many will die waiting. The concept of "imminent death" donation, a type of living donation, has been gaining attention among physicians, patients, and ethicists. We estimated the number of potential imminent death kidney donors at the University of Wisconsin Hospital and Clinics by assessing the number of annual deaths in individuals with normal kidney function. Based on a previous survey suggesting that one-third of patients might be willing to donate at imminent death, we estimate that between 76 and 396 people in the state of Wisconsin would be medically eligible and willing to donate each year at the time of imminent death. We extrapolated these numbers to all transplant centers in the United States, estimating that between 5925 and 31 097 people might be eligible and willing to donate each year. Our results suggest that allowing donation at imminent death and including discussions about organ donation in end-of-life planning could substantially reduce the nation's kidney waiting list while providing many more donors the opportunity to give this gift.

Survey of public attitudes towards imminent death donation in the United States

“…donors and donation, ethics, ethics and public policy, organ procurement, organ procurement and allocation, social sciences, survey to donate within their system. 4 Our group reviewed all donation after cardiac death (DCD) donors who would have also qualified as IDD donors in 2015. We identified just over 100 eligible left lateral lobe liver donors who could have theoretically covered the pediatric liver waitlist patients who do not get transplanted every year.…”

“…5 While these data are theoretical and cannot be proven until practiced, they suggest substantial prospects for our transplant candidates. Although IDD has the potential to substantially ameliorate the allograft shortage for transplant waiting lists, [4][5][6] the policy remains largely controversial. [7][8][9][10] The Organ Procurement and Transplantation Network/United Network for Organ Sharing (UNOS) Ethics Committee determined that IDD may be ethical and justified, but lack of community support and the potential to violate the public trust were considered major challenges to implementation.…”

“…Preliminary studies suggest that IDD would likely increase the available number and quality of organs available for transplantation. One study from a Wisconsin hospital extrapolated a potential of 6000‐31 000 kidneys that could be donated annually in the US via IDD based on calculations using number of annual deaths with normal renal function and percentage of those willing to donate within their system 4 . Our group reviewed all donation after cardiac death (DCD) donors who would have also qualified as IDD donors in 2015.…”

Imminent Death Donation: Beyond Ethical Analysis and into Practice

“…Though a single-center study has projected that IDD could increase the overall number of organs procured, it will be important to first gauge public acceptance of IDD and then empirically compare organ procurement rates between IDD and DCD protocols to determine the true net potential of IDD versus usual practice. 10 As Potter notes, the requirement for high-quality surrogate decision-making related to end-of-life care is the other substantial barrier for IDD by incapacitated living donors. If IDD causes living donation by those who cannot provide informed consent to become widespread, it is difficult and daunting to estimate how much the general public or the medical community might begin to mistrust the organ donation process.…”

“…Though a single-center study has projected that IDD could increase the overall number of organs procured, it will be important to first gauge public acceptance of IDD and then empirically compare organ procurement rates between IDD and DCD protocols to determine the true net potential of IDD versus usual practice. 10…”