An ethical appraisal of living-anonymous kidney donation using Adam Smith's Theory of Moral Sentiments

A Conceptual Framework for Evaluating National Organ Donation and Transplantation Programs

Conceptual frameworks are valuable resources that can be used to guide the planning, evaluation, and development of healthcare services. However, there are currently no comprehensive frameworks focused on organ donation and transplantation that identify the critical factors underlying a successful national program. To address this knowledge gap, we developed a conceptual framework that takes into account all major domains of influence, including political and societal aspects as well as clinical implementation. The framework was initially constructed based on a targeted review of the relevant medical literature. Feedback provided by a panel of international experts was incorporated into the framework via an iterative process. The final framework features 16 essential domains that are critical for initiating and maintaining a successful program and improving the health of patients with organ failure. Of particular note, these domains are subject to three overarching health system principles: responsiveness, efficiency, and equity. This framework represents a first attempt to develop a whole-system view of the various factors that contribute to the success of a national program. These findings provide a useful tool that can be adapted to any jurisdiction and used to plan, evaluate, and improve organ donation and transplantation programs.

Willingness to Donate Remnant Human Biospecimens in the Context of the COVID-19 Pandemic

Background: Studies using biospecimens can help reveal pathogenic mechanisms and improve prevention, diagnosis, and treatment of diseases. However, there is still a lack of relevant investigation data, which can provide initial evidence for establishing or improving relevant laws and regulations, on people's willingness to donate biospecimens, and whether they agree to waive the right of obtaining informed consent in the special period of sudden outbreak of new infectious diseases. Objectives: To investigate people's willingness to donate their remnant biospecimens of clinical tests for research in the context of the COVID-19 pandemic and their willingness to sign the informed consent for research using their biospecimens. Methods: We conducted a survey using an online questionnaire, which included questions on basic personal information, COVID-19-related information, donation of remnant biospecimens, willingness to sign informed consent, and reasons to do so. Results: Among the 721 valid responses, 620 respondents (86.0%) reported that they would be willing to donate their remnant biospecimens for research, of whom 434 (70.0%) reported that they would donate their remnant biospecimens without signing the informed consent. Of the 11 specified influencing factors, occupation, household income, and degree of concern about the COVID-19 pandemic were associated with willingness to donate remnant biospecimens. Gender and age were associated with willingness to donate remnant biospecimens without signing the informed consent. The main reasons for unwillingness to donate remnant biospecimens and sign the informed consent were a limited knowledge of research and privacy concerns. Conclusions: Most respondents reported that they would be willing to donate their remnant biospecimens for biomedical research without signing an informed consent in the context of the COVID-19 pandemic. Lack of understanding of the proposed research and concerns about personal privacy were the main reasons for unwillingness to donate biospecimens and signing the informed consent.

Anonymous Living Liver Donation: Literature Review and Case Series Report

Background

Anonymous living liver donations (ALLDs) raise ethical concerns regarding the donors' motivations. Thus, ALLDs are not as widely accepted as directed donations from friends and family. Literature on ALLDs is limited. Understanding this particular group of individuals is crucial, as they could further help mitigate the shortage of liver grafts worldwide.

Methods

A literature review was performed to identify current definitions, ethical considerations, different approaches, and barriers to ALLD worldwide. Furthermore, we present our current experience after the establishment of a protocol to enable an ALLD program in our center and surveyed potential donors to better understand their motives throughout the process.

Results

Literature regarding ALLD is scarce. Canada leads the experience with the majority of case reports published to date. Survey-based evaluation of this unique group of individuals reflects the selflessness nature of anonymous living donors and shows that most of them experience the donation as a positive and life-changing event. In our experience, 41 individuals initiated the process of ALLD during the study period. Most were lost to follow-up or deemed ineligible. Five candidates fully completed the donation process and successfully underwent living liver donation. Given that 2 candidates have a follow-up period <3 mo from donation, we have only included data on the first 3 donors in this analysis. Eight individuals (19.5%) responded to the survey with respondents sharing similar reasons for initiating ALLD but varied and multifactorial reasons for terminating.

Conclusions

Different institutional protocols can be used to accomplish ALLD, including the one utilized by our institution. Adopting policies to allow for ALLDs and reducing modifiable factors that contribute to ending donation has the potential to increase grafts and decrease wait times.Supplemental Visual Abstract: http://links.lww.com/TP/C251.