The ethics of liver transplantation from a living donor

Spital, Aaron; Spital, Max

doi:10.1016/0168-8510(90)90112-q

Cited by 8 publications

(9 citation statements)

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“…Even though a live donor will not benefit from the operation physically, the loss from failure to save the recipient can result in much psychological remorse. Based on the personal values of the donor and the recipient, they both should have a say 26. Voluntarism should not be hampered by negativism from the transplant community.…”

Section: Discussionmentioning

confidence: 99%

Working up donors for high-urgency and elective adult-to-adult live donor liver transplantation

et al. 2007

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Donor workup for adult-to-adult live donor liver transplantation is done to ensure that the donor remains physically and psychologically healthy after saving or improving the life of the recipient. Even though two-thirds of the liver transplants in our center were from live donors, this life-saving procedure remains a mere treatment option, given the magnitude of the donor operation with the associated donor risks. Live donor liver transplantation was also adopted for high-urgency situations provided that the donor was suitable and the recipient considered salvageable. Donor workup in this setting had not been reported in the literature. In this cohort of 399 potential donors, 128 (32.1%) ultimately underwent donor surgery. Donors in the high-urgency situation had a lower operation rate of 28.4% (64/225) compared with that of 36.8% (64/174) of donors in the elective situation (P ϭ 0.049). Dropouts from step 1 mainly because of ABO incompatibility, positive hepatitis serology, comorbidities, and voluntary donor withdrawal were 52.6% (210/399). Only 11.6% (22/189) of the potential donors who proceeded to subsequent steps of the workup dropped out (2 were psychologically unsuitable, 10 were anatomically prohibitive). The transplantation rate of potential recipients with 1 or more potential donors was also high. The rates were similar for the high-urgency (55%, 64/116) and the elective (51%, 64/125) situations. In a region with scarcity of deceased donor liver grafts, careful and expeditious initial donor workup minimizes dropouts from subsequent steps and allows timely transplantation in high-urgency situations. Liver Transpl 13: 509-515, 2007.

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Section: Discussionmentioning

confidence: 99%

Working up donors for high-urgency and elective adult-to-adult live donor liver transplantation

et al. 2007

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“…The informed donor ultimately may be the best qualified person to make the final judgment. 29 Regarding the informed consent in an emergency situation, the pressure on the donor is mainly internal rather than external. The benefit of graft availability outweighs concerns about coercion of donors, but it is our policy that family members should not be solicited for donation.…”

Section: Discussionmentioning

confidence: 99%

Adult-to-Adult Living Donor Liver Transplantation Using Extended Right Lobe Grafts

Lo¹,

Fan²,

Liu³

et al. 1997

Annals of Surgery

543

335

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ObjectiveThe authors report their experience with living donor liver transplantation (LDLT) using extended right lobe grafts for adult patients under high-urgency situations. Summary Background DataThe efficacy of LDLT in the treatment of children has been established. The major limitation of adult-to-adult LDLT is the adequacy of the graft size. A left lobe graft from a relatively small volunteer donor will not meet the metabolic demand of a larger recipient. MethodsFrom May 1996 to November 1996, seven LDLTs, using extended right lobe grafts, were performed under high-urgency situations. All recipients were in intensive care units before transplantation with five having acute renal failure, three on mechanical ventilation, and all with hepatic encephalopathy. The median body weight for the donors and recipients was 58 kg (range, 41-84 kg) and 65 kg (range, 53-90 kg), respectively. The body weights of four donors were less than those of the corresponding recipients, and the lowest donor-torecipient body weight ratio was 0.62:1. The extended right lobe graft was chosen because the left lobe volume was <40% of the ideal liver mass of the recipient. ResultsMedian blood loss for the donors was 900 mL (range, 700-1600 mL) and hospital stay was 19 days (range, 8-22 days). Homologous blood transfusion was not required. Two donors had complications (one incisional hernia and one bile duct stricture) requiring reoperation after discharge. All were well with normal liver function 5 to 10 months after surgery. The graft weight ranged from 490 g to 1 140 g. All grafts showed immediate function with normalization of prothrombin time and recovery of conscious state of the recipients. There was no vascular complication, but six recipients required reoperation. One recipient died of systemic candidiasis 16 days after transplantation and 6 (86%) were alive with the original graft at a median follow-up of 6.5 months (range, 5-10 (range, 53-90 kg). The body weights of four donors were less than those of the corresponding recipients and the lowest donor-to-recipient body weight ratio was 0.62:1 (donor, 41 kg; recipient, 66 kg). Pretransplant ManagementThe evaluation and management followed the same protocol as for any patient who was considered for transplantation in high-urgency status. All seven patients required admission to the intensive care unit before transplantation. In each case, moderate-to-severe hepatic encephalopathy was evident (Table 1) Surgical ProceduresThe donor hepatectomy (Fig. IA) consisted of an extended right lobectomy performed through a bilateral subcostal incision with median extension to the xyphoid. To avoid homologous blood transfusion, autologous blood was collected from the donor on induction of anesthesia, and a cell saver was used to collect blood lost during operation. Intraoperative ultrasound examination was performed to identify the major vascular structures of the liver. Special attention was paid to the anatomy of the junction of the middle and left hepatic veins and the possible existenc...

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“…However, these models cannot be applied directly to LDLT as the 2 procedures differ. Living donor kidney transplantation is an attempt to improve patient quality of life16 while LDLT serves as a “desperate remedy”:17 The patient will die if a donor is not found within a short period of time 18, 19. This study aims to construct a decision‐making model of the psychological process leading up to donation in adult LDLT for a donor.…”

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confidence: 99%

A model of donors' decision-making in adult-to-adult living donor liver transplantation in Japan: Having no choice

et al. 2006

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This study examined the decision-making processes of donors in adult-to-adult living donor liver transplantation. Twenty-two donors were interviewed using a semi-structured format. Interview contents were transcribed verbatim and analyzed qualitatively using grounded theory. A decision-making model was developed consisting of 5 stages: (1) recognition, (2) digestion, (3) decision-making, (4) reinforcement, and (5) resolution. The second and the third stages described donors' experiences of "reaching a decision"; the fourth and fifth stages described those of "facing transplantation." The central theme of this model was "having no choice," which consisted of 4 codes: (1) priority of life, (2) only LDLT, (3) for family, and (4) only me. In conclusion, this model can help health care professionals to understand the donor experience and, based on that understanding, to provide sufficient support to the donor. Liver Transpl 12: 768-774, 2006.

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The ethics of liver transplantation from a living donor

Cited by 8 publications

References 0 publications

Working up donors for high-urgency and elective adult-to-adult live donor liver transplantation

Working up donors for high-urgency and elective adult-to-adult live donor liver transplantation

Adult-to-Adult Living Donor Liver Transplantation Using Extended Right Lobe Grafts

A model of donors' decision-making in adult-to-adult living donor liver transplantation in Japan: Having no choice

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