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Kim E, Sung HC, Kaplow K, Bendersky V, Sidoti C, Muzaale AD, Akhtar J, Levan M, Esayed S, Khan A, Mejia C, Al Ammary F. Donor Perceptions and Preferences of Telemedicine and In-Person Visits for Living Kidney Donor Evaluation. Kidney Int Rep 2024; 9:2453-2461. [PMID: 39156145 PMCID: PMC11328557 DOI: 10.1016/j.ekir.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/24/2024] [Accepted: 05/06/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction Living kidney donor evaluation is a lengthy and complex process requiring in-person visits. Access to transplant centers, travel costs, lost wages, and dependent care arrangements are barriers to willing donors initiating evaluation. Telemedicine can help streamline and epedite the evaluation process. We aimed to deeply understand donor experiences and preferences using hybrid telemedicine video/in-person visits to ease access to donor evaluation or counseling. Methods We conducted in-depth, semistructured interviews with donors or donor candidates who completed their evaluation through telemedicine/in-person, or in-person only visits at a tertiary transplant center between November 27, 2019 and March 1, 2021. Enrollment continued until data saturation was reached (interviews with 20 participants) when no new information emerged from additional interviews. Transcripts were analyzed using inductive thematic analysis. Results Eight themes were identified as follows: (i) reducing financial and logistical burdens (minimizing travel time and travel-related expenses), (ii) enhancing flexibility with scheduling (less time off work and child or family caregiver arrangements), (iii) importance of a walkthrough and establishing shared understanding, (iv) supporting information with technology and visual aids, (v) key role of the coordinator, (vi) preferred visit by provider role (meeting donor surgeon in-person to create rapport and engaging primary care provider in donor evaluation/follow-up), (vii) comparing modality differences in human connection, and (viii) opportunity for family and support network engagement (allowing loved ones to be involved in telemedicine visits irrespective of geographic locations and pandemic restrictions). Conclusion Telemedicine/in-person hybrid model can make donor evaluation more accessible and convenient. Our findings help inform about determinants that influence the adoption of telemedicine to initiate donor evaluation to motivate willing donors. In addition, our results call for policy and legislation that support telemedicine services for living donor kidney transplantation across states.
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Affiliation(s)
- Ellie Kim
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hannah C. Sung
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Katya Kaplow
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Victoria Bendersky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carolyn Sidoti
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Abimereki D. Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jasmine Akhtar
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Macey Levan
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Suad Esayed
- Department of Medicine, University of California Irvine, California, USA
| | - Amir Khan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christina Mejia
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fawaz Al Ammary
- Department of Medicine, University of California Irvine, California, USA
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Dowling A, Lane H, Haines T. Community preferences for the allocation of scarce healthcare resources during the Covid-19 pandemic: a review of the literature. Public Health 2022; 209:75-81. [PMID: 35849934 PMCID: PMC9212404 DOI: 10.1016/j.puhe.2022.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
Objective The purpose of this thematic review is to examine the literature on the publics’ preferences of scarce medical resource allocation during COVID-19. Study design Literature review. Methods A review of Ovid MEDLINE, Embase, CINAHL and Scopus was performed between December 2019 and June 2022 for eligible articles. Results Fifteen studies using three methodologies and spanning five continents were included. Five key themes were identified: (1) prioritise the youngest; (2) save the most lives; (3) egalitarian allocation approaches; (4) prioritise healthcare workers; and (5) bias against particular groups. The public gave high priority to allocation that saved the most lives, particularly to patients who are younger and healthcare workers. Themes present but not supported as broadly were giving priority to individuals with disabilities, high frailty or those with behaviours that may have contributed to their ill-health (e.g. smokers). Allocation involving egalitarian approaches received the least support among community members. Conclusion The general public prefer rationing scarce medical resources in the COVID-19 pandemic based on saving the most lives and giving priority to the youngest and frontline healthcare workers rather than giving preference to patients with disabilities, frailty or perceived behaviours that may have contributed to their own ill-health. There is also little public support for allocation based on egalitarian strategies.
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Siddique AB, Apte V, Fry-Revere S, Jin Y, Koizumi N. The impact of country reimbursement programmes on living kidney donations. BMJ Glob Health 2020; 5:bmjgh-2020-002596. [PMID: 32792408 PMCID: PMC7430320 DOI: 10.1136/bmjgh-2020-002596] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Living-donor kidney transplantation is the gold standard treatment for patients with end-stage kidney disease. However, potential donors ubiquitously face financial as well as logistical barriers. To remove these disincentives from living kidney donations, the governments of 23 countries have implemented reimbursement programmes that shift the burdens of non-medical costs from donors to the governments or private entities. However, scientific evidence for the effectiveness of these programmes is scarce. The present study investigates whether these reimbursement programmes designed to ease the financial and logistical barriers succeeded in increasing the number of living kidney donations at the country level. The study examined within-country variations in the timing of such reimbursement programmes. METHOD The study applied the difference-in-difference (two-way panel fixed-effect) technique on the Poisson distribution to estimate the effects of these reimbursement programmes on a 17 year long (2000-2016) dataset covering 109 countries where living donor kidney transplants were performed. RESULTS The results indicated that reimbursement programmes have a statistically significant positive effect. Overall, the model predicted that reimbursement programmes increased country-level donation numbers by a factor of 1.12-1.16. CONCLUSION Reimbursement programmes may be an effective approach to alleviate the kidney shortage worldwide. Further analysis is warranted on the type of reimbursement programmes and the ethical dimension of each type of such programmes.
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Affiliation(s)
- Abu Bakkar Siddique
- Schar School of Policy and Government, George Mason University-Arlington Campus, Arlington, Virginia, USA
| | - Vandana Apte
- Department of Agricultural, Food and Resource Economics, Rutgers University, New Brunswick, New Jersey, USA
| | - Sigrid Fry-Revere
- Independent Bioethics Scholar, Washington, District of Columbia, USA
| | - Yanhong Jin
- Department of Agricultural, Food and Resource Economics, Rutgers University, New Brunswick, New Jersey, USA
| | - Naoru Koizumi
- Schar School of Policy and Government, George Mason University-Arlington Campus, Arlington, Virginia, USA
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Stadlbauer V, Zink C, Likar P, Zink M. Family discussions and demographic factors influence adolescent's knowledge and attitude towards organ donation after brain death: a questionnaire study. BMC Med Ethics 2020; 21:57. [PMID: 32646404 PMCID: PMC7346659 DOI: 10.1186/s12910-020-00499-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/29/2020] [Indexed: 11/21/2022] Open
Abstract
Background Knowledge and attitude towards organ donation are critical factors influencing organ donation rate. We aimed to assess the knowledge and attitude towards organ donation in adolescents in Austria and Switzerland. Methods A paper-based survey was performed in two secondary schools (age range 11–20 years) in Austria and Switzerland. 354/400 surveys were sufficiently answered and analyzed. Results Our study found that knowledge on organ donation is scarce in adolescents. Less than 60% of those surveyed thinks that a person is dead when declared brain dead. 84.6% would authorize organ donation after brain death for themselves, but only 69% would authorize organ donation after brain death for a close relative. 93.7% would accept a donor organ if they needed one. Family discussions, rather than school discussions, influenced knowledge on organ donation, the percentage of respondents who have a firm opinion on organ donation and the rate of declaration of this opinion. Age, gender, nationality and religion also influenced knowledge and attitude towards organ donation. Nearly one third of adolescents are of the opinion that selling non-vital organs should be legalized. Conclusion Since having had family discussions, a potentially modifiable factor, was positively associated with knowledge and attitude towards organ donation, we postulate that educational programs stimulating family discussions on organ donation may be a promising strategy to increase knowledge.
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Affiliation(s)
- Vanessa Stadlbauer
- Department of Internal Medicine, Research Unit "Transplantation Research", Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Christoph Zink
- Department of Anaesthesiology and Intensive Care Medicine, Hospital of the Brothers of St. John of God, St. Veit an der Glan, Austria and Hospital of the Elisabethinen Klagenfurt, Klagenfurt, Austria
| | - Paul Likar
- Department of Anaesthesiology and Intensive Care Medicine, Hospital of the Brothers of St. John of God, St. Veit an der Glan, Austria and Hospital of the Elisabethinen Klagenfurt, Klagenfurt, Austria
| | - Michael Zink
- Department of Anaesthesiology and Intensive Care Medicine, Hospital of the Brothers of St. John of God, St. Veit an der Glan, Austria and Hospital of the Elisabethinen Klagenfurt, Klagenfurt, Austria
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Ethical Implications in Donor and Recipient Utilization for Liver Transplant. CURRENT TRANSPLANTATION REPORTS 2019. [DOI: 10.1007/s40472-019-00252-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Mai K, Boldt A, Hau HM, Kirschfink M, Schiekofer S, Keller F, Beige J, Giannis A, Sack U, Rasche FM. Immunological Alterations due to Hemodialysis Might Interfere with Early Complications in Renal Transplantation. Anal Cell Pathol (Amst) 2019; 2019:8389765. [PMID: 31019876 PMCID: PMC6452532 DOI: 10.1155/2019/8389765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/04/2019] [Accepted: 02/18/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chronic or intercurrent alterations of the immune system in patients with end-stage renal disease (CKD) and intermittent hemodialysis (CKD5D, HD) have been attributed to an acute rejection of renal allograft. METHODS Leukocyte subsets in flow cytometry, complement activation, and concentrations of TGFβ, sCD30 (ELISA), and interleukins (CBA) of fifteen patients eligible for renal transplantation were analyzed before, during, and after a regular HD. RESULTS Before HD, the median proportion of CD8+ effector cells, CD8+ CCR5+ effector cells, and HLA-DR+ regulatory T cells as well as the median concentration of soluble CD30 increased and naive CD8+ T cells decreased. During HD, there was a significant decrease in CD4- CD8- T cells (p < 0.001) and an increase in CD25+ T cells (p = 0.026), sCD30 (p < 0.001), HLA-DR+ regulatory T cells (p = 0.005), and regulatory T cells (p = 0.003). TGFβ and sCD30 increased significantly over time. The activity of the classical complement pathway started to slightly increase after the first hour of HD and lasted until fifteen minutes after finishing dialysis. The decrease in the functional activity of the alternative pathway was only transient and was followed by a significant increase within 15 minutes after finishing the treatment. CONCLUSION HD might interact with the allograft outcome by influencing T cell subsets and activation of the complement system in a biphasic course.
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Affiliation(s)
- Kristin Mai
- Institute of Clinical Immunology, Medical Faculty, University of Leipzig, Leipzig, Germany
- Department of Internal Medicine, Neurology and Dermatology, Clinic for Endocrinology and Nephrology, Section of Nephrology, University Hospital Leipzig, Leipzig, Germany
| | - Andreas Boldt
- Institute of Clinical Immunology, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Hans-Michael Hau
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Leipzig, Leipzig, Germany
| | | | - Stephan Schiekofer
- Center for Geriatric Medicine, Bezirksklinikum Regensburg, Regensburg, Germany
- Sigmund Freud PrivatUniversität, Wien, Österreich, Austria
| | - Frieder Keller
- Medical Department I, Nephrology Division, University Hospital Ulm, Ulm, Germany
| | - Joachim Beige
- Department of Nephrology, KfH Renal Unit, Hospital St. Georg, Leipzig, Germany
- Martin-Luther-University Halle/Wittenberg, Halle, Germany
| | | | - Ulrich Sack
- Institute of Clinical Immunology, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Franz Maximilian Rasche
- Department of Internal Medicine, Neurology and Dermatology, Clinic for Endocrinology and Nephrology, Section of Nephrology, University Hospital Leipzig, Leipzig, Germany
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8
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Opinions of Health Care Personnel Regarding Disincentives and Incentives for Living Kidney Donation at a Single Center. Transplant Proc 2018; 50:3053-3058. [PMID: 30577165 DOI: 10.1016/j.transproceed.2018.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/19/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Transplant societies continue to actively concentrate on increasing rates of living kidney donation (LKD) to bridge the gap between individuals awaiting transplantation and the number of kidneys available. A widely discussed strategy to increase living donation rates is the provision of incentives and removal of disincentives. Though opinions of the public regarding this strategy have been studied, the opinions of health care providers, including younger professionals, are less clear. We studied the opinions of medical students and other health care providers on strategies to increase LKD to determine if opinions were different among those < 25 or ≥ 25 years of age. METHODS A simple cross-sectional survey was conducted at an academic medical center. Participants included medical students and employees in Internal Medicine, General Surgery, and the Organ Transplantation Center. Pearson's χ2 and Fisher's exact test were conducted on the responses regarding disincentives and incentives to determine whether opinions differed based on age. RESULTS Six hundred and twenty-four participants completed the survey. There was no statistical difference in opinions between groups on reimbursing transportation costs, loss of wages, or childcare costs, but those aged ≥ 25 were more agreeable with covering food/lodging costs compared to those < 25 (96.5% vs 90.7%, P = .009). Respondents < 25 years old were more willing to donate a kidney for a financial incentive (P = .0002) accepting a median amount of $25,000. CONCLUSIONS Health care personnel broadly support removing financial disincentives for living kidney donation, and those ≥ 25 were more in favor of covering food/lodging costs compared to those < 25. Those < 25 years old were more likely to accept financial incentives towards donating their kidney compared to those ≥ 25 years.
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Optimizing Efficiency in the Evaluation of Living Donor Candidates: Best Practices and Implications. CURRENT TRANSPLANTATION REPORTS 2018. [DOI: 10.1007/s40472-018-0184-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
The number of patients with organ failure who could potentially benefit from transplantation continues to exceed the available supply of organs. Despite numerous efforts to increase the number of donors, there remains an enormous mismatch between demand and supply. Large numbers of people still die with potentially transplantable organs remaining in situ, most frequently as a result of family objections. I argue that there are no persuasive moral arguments against mandated organ retrieval from all dead individuals who meet clinical criteria. However, because of continuing endemic prejudice in United States society and its healthcare system and the distrust this engenders, I conclude that proceeding with a policy of compulsory organ retrieval, even if morally unobjectionable, would not be warranted.
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Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, Gallon L, Garvey CA, Guleria S, Li PKT, Segev DL, Taler SJ, Tanabe K, Wright L, Zeier MG, Cheung M, Garg AX. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation 2017; 101:S1-S109. [PMID: 28742762 PMCID: PMC5540357 DOI: 10.1097/tp.0000000000001769] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
Abstract
The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1-S109.
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Affiliation(s)
| | | | | | | | - Josefina Alberú
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | - Dorry L. Segev
- Johns Hopkins University, School of Medicine, Baltimore, MD
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Rodrigue JR, Schold JD, Mandelbrot DA, Taber DJ, Phan V, Baliga PK. Concern for Lost Income Following Donation Deters Some Patients From Talking to Potential Living Donors. Prog Transplant 2016; 26:292-298. [PMID: 27495327 DOI: 10.1177/1526924816661332] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CONTEXT Some living kidney donors report lost income during recovery from surgery. Little is known about whether concern for living donor's lost income affects the decision to undergo donation evaluation and the willingness of transplant candidates to discuss living kidney donation (LKD) with others. OBJECTIVE To examine whether transplant patients were told by potential donors about lost income concerns and whether patients chose not to discuss LKD with others due to lost income concerns. DESIGN, SETTING, AND PATIENTS Kidney transplant patients (185 wait-listed candidates, 171 deceased donor recipients, and 100 live donor recipients) at 2 centers completed a questionnaire to assess whether concern about donor's lost income was a consideration in discussion about LKD with others. RESULTS One-third (32%) were told by a family member/friend that they were willing to donate but were concerned about potential lost income. The majority of those who expressed financial concern (64%) did not initiate donation evaluation. Many patients (42%) chose not to discuss living donation with a family member/friend due to concern about the impact of lost income on the donor. In the multivariable model, lower annual household income was the only statistically significant predictor of both having a potential donor expressing lost income concern and choosing not to talk to someone because of lost income concern. CONCLUSION Findings from the current study underscore how concern about income loss for living donors may affect decision-making by both transplant candidates and potential donors.
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Affiliation(s)
- James R Rodrigue
- 1 Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Jesse D Schold
- 3 Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | | | - David J Taber
- 5 Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.,6 Department of Pharmacy, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Van Phan
- 5 Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Prabhakar K Baliga
- 5 Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
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Abstract
In March 1966, the Ciba Foundation sponsored the first international, interdisciplinary symposium focused on ethical and legal issues in transplantation. The attendees included not only physicians and surgeons but also judges and legal scholars, a minister, and a science journalist. In this article, we will consider some of the topics in organ transplantation that were discussed by the attendees, what we have learned in the intervening half century, and the relevance of their discussions today. Specifically, we examine the definition of death and its implications for organ procurement, whether it is ethical and legal to "maim" a living individual for the benefit of another, how to ensure that the consent of the living donor is voluntary and informed, the case of identical twins, the question of whether ethically minors can serve as living donors, the health risks of living donation, the ethics and legality of an organ market, and the economic barriers to living donation. We show that many of the concerns discussed at the Ciba symposium remain highly relevant, and their discussions have helped to shape the ethical boundaries of organ transplantation today.
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Almeida N, Almeida RF, Almeida K, Almeida A. Attitude of medical professionals regarding controversial issues in kidney donation/transplantation. Indian J Nephrol 2016; 26:393-397. [PMID: 27942168 PMCID: PMC5131375 DOI: 10.4103/0971-4065.176147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
There is a dire need to evaluate new strategies to bridge the wide kidney demand-supply gap. The current study examined the attitude of medical professionals regarding controversial issues pertaining to transplantation. A questionnaire, presenting controversial issues related to kidney transplantation, in an agree-disagree format with supporting reasons, was employed. The research was exploratory. Data were analyzed quantitatively and qualitatively. The sample comprised 140 doctors from Mumbai (mean = 38.1 years, standard deviation = 17.95; Males = 44.3%, Females = 55.7%). Whereas 47.1% of the participants felt that live donors should be given incentives for kidney donation, others (52.9%) disagreed, fearing commercialization and illegal activities. The eligibility of patients with HIV/hepatitis for a transplant was denied by 52.9% because of poor outcomes, with the others (47.1%) maintaining that these individuals too had a right to live. A substantial majority (90.7%) of the participants maintained that organ donors should be given priority in the event of a future need for an organ because their previous humane act should be rewarded (47.1%). Most of the participants (91.4%) felt that individuals from the higher socioeconomic strata should not receive preference for kidney transplantation. A majority (77.1%) of them were also against kidney selling getting legalized. Compulsory possession of a donor card elicited mixed responses, with some accepting (56.4%), but others rejecting (43.6%) this idea as donation was perceived to be a voluntary act (33.6%). While compulsory kidney donation found favor with 44.3%, it found disfavor with others (55.7%). This study will benefit transplant healthcare personnel to formulate new policies in relation to kidney donation/transplantation.
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Affiliation(s)
- N Almeida
- Department of Human Development, Nirmala Niketan College of Home Science, Mumbai, Maharashtra, India
| | - R F Almeida
- Department of Emergency Medical Services, Institute of Health Sciences, Mumbai, Maharashtra, India
| | - K Almeida
- Department of Psychology, Mumbai University, Mumbai, Maharashtra, India
| | - A Almeida
- PD Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India
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16
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Bruzzone P. Paid Organ Donation: An Italian Perspective. Transplant Proc 2015; 47:2109-12. [PMID: 26361655 DOI: 10.1016/j.transproceed.2015.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/11/2015] [Accepted: 01/28/2015] [Indexed: 11/30/2022]
Abstract
The only countries that have allowed financial incentives for organ donation are Iran since 1988, and later on, Singapore and Saudi Arabia. In Europe, and of course in Italy, financial incentives for donors are prohibited. The author has completed extensive research via the Internet (PubMed) of worldwide scientific literature on paid organ donation, also researching studies concerning public opinion on organ commercialism and "regulated markets". Italian transplant laws also have been reported and analyzed.
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Affiliation(s)
- P Bruzzone
- Department of General Surgery, Surgical Sciences and Transplantation "Paride Stefanini", Università di Roma "La Sapienza", Rome, Italy.
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Martin DE, White SL. Financial Incentives for Living Kidney Donors: Are They Necessary? Am J Kidney Dis 2015; 66:389-95. [DOI: 10.1053/j.ajkd.2015.03.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/06/2015] [Indexed: 12/17/2022]
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Tong A, Ralph AF, Chapman JR, Wong G, Gill JS, Josephson MA, Craig JC. Focus group study of public opinion about paying living kidney donors in Australia. Clin J Am Soc Nephrol 2015; 10:1217-26. [PMID: 25908793 PMCID: PMC4491296 DOI: 10.2215/cjn.10821014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/26/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The unmet demand for kidney transplantation has generated intense controversy about introducing incentives for living kidney donors to increase donation rates. Such debates may affect public perception and acceptance of living kidney donation. This study aims to describe the range and depth of public opinion on financial reimbursement, compensation, and incentives for living kidney donors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Twelve focus groups were conducted with 113 participants recruited from the general public in three Australian states in February 2013. Thematic analysis was used to analyze the transcripts. RESULTS Five themes were identified: creating ethical impasses (commodification of the body, quandary of kidney valuation, pushing moral boundaries), corrupting motivations (exposing the vulnerable, inevitable abuse, supplanting altruism), determining justifiable risk (compromising kidney quality, undue harm, accepting a confined risk, trusting protective mechanisms, right to autonomy), driving access (urgency of organ shortage, minimizing disadvantage, guaranteeing cost-efficiency, providing impetus, counteracting black markets), and honoring donor deservingness (fairness and reason, reassurance and rewards, merited recompense). Reimbursement and justifiable recompense are considered by the Australian public as a legitimate way of supporting donors and reducing disadvantage. Financial payment beyond reimbursement is regarded as morally reprehensible, with the potential for exploitative commercialism. Some contend that regulated compensation could be a defensible strategy to increased donation rates provided that mechanisms are in place to protect donors. CONCLUSIONS The perceived threat to community values of human dignity, goodwill, and fairness suggests that there could be strong public resistance to any form of financial inducements for living kidney donors. Policy priorities addressing the removal of disincentives may be more acceptable to the public.
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Affiliation(s)
- Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia;
| | - Angelique F Ralph
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Jeremy R Chapman
- The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - John S Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada; and
| | | | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Vanholder R, Lameire N, Annemans L, Van Biesen W. Cost of renal replacement: how to help as many as possible while keeping expenses reasonable? Nephrol Dial Transplant 2015; 31:1251-61. [PMID: 26109485 DOI: 10.1093/ndt/gfv233] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 05/12/2015] [Indexed: 02/06/2023] Open
Abstract
The treatment of kidney diseases consumes a substantial amount of the health budget for a relatively small fraction of the overall population. If the nephrological community and society do not develop mechanisms to contain those costs, it will become impossible to continue assuring optimal outcomes and quality of life while treating all patients who need it. In this article, we describe several mechanisms to maintain sustainability of renal replacement therapy. These include (i) encouragement of transplantation after both living and deceased donation; (ii) stimulation of alternative dialysis strategies besides classical hospital haemodialysis, such as home haemodialysis, peritoneal dialysis or self-care and necessitating less reimbursement; (iii) promotion of educational activities guiding the patients towards therapies that are most suited for them; (iv) consideration of one or more of cost containment incentives such as bundling of reimbursement (if not affecting quality of the treatment), timely patient referral, green dialysis, start of dialysis based on clinical necessity rather than renal function parameters and/or prevention of CKD or its progression; (v) strategically planned adaptations to the expected growth of the ageing population in need of renal replacement; (vi) the necessity for support of research in the direction of helping as large as possible patient populations for acceptable costs; and (vii) the need for more patient-centred approaches. We also extend the discussion to the specific situation of kidney diseases in low- and middle-income countries. Finally, we point to the dramatic differences in accessibility and reimbursement of different modalities throughout Europe. We hope that this text will offer a framework for the nephrological community, including patients and nurses, and the concerned policy makers and caregivers on how to continue reaching all patients in need of renal replacement for affordable expenses.
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Affiliation(s)
- Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium
| | - Norbert Lameire
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health, University Ghent, Ghent, Belgium
| | - Wim Van Biesen
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium
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Rodrigue JR, Kazley AS, Mandelbrot DA, Hays R, LaPointe Rudow D, Baliga P. Living Donor Kidney Transplantation: Overcoming Disparities in Live Kidney Donation in the US--Recommendations from a Consensus Conference. Clin J Am Soc Nephrol 2015; 10:1687-95. [PMID: 25883072 DOI: 10.2215/cjn.00700115] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Despite its superior outcomes relative to chronic dialysis and deceased donor kidney transplantation, live donor kidney transplantation (LDKT) is less likely to occur in minorities, older adults, and poor patients than in those who are white, younger, and have higher household income. In addition, there is considerable geographic variability in LDKT rates. Concomitantly, in recent years, the rate of living kidney donation (LKD) has stopped increasing and is declining, after decades of consistent growth. Particularly noteworthy is the decline in LKD among black, younger, male, and lower-income adults. The Live Donor Community of Practice within the American Society of Transplantation, with financial support from 10 other organizations, held a Consensus Conference on Best Practices in Live Kidney Donation in June 2014. The purpose of this meeting was to identify LKD best practices and knowledge gaps that might influence LDKT, with a focus on patient and donor education, evaluation efficiencies, disparities, and systemic barriers to LKD. In this article, we discuss trends in LDKT/LKD and emerging novel strategies for attenuating disparities, and we offer specific recommendations for future clinical practice, education, research, and policy from the Consensus Conference Workgroup focused on disparities.
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Affiliation(s)
- James R Rodrigue
- Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Abby Swanson Kazley
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Didier A Mandelbrot
- Transplant Center, University of Wisconsin Hospital and Clinics, Madison, Wisconsin; and
| | - Rebecca Hays
- Transplant Center, University of Wisconsin Hospital and Clinics, Madison, Wisconsin; and
| | - Dianne LaPointe Rudow
- Recanati Miller Transplantation Institute, Mount Sinai Medical Center, New York, New York
| | - Prabhakar Baliga
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina;
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Hamidian Jahromi A, Fry-Revere S, Bastani B. Compensation and incentives for living organ donors: a double-edged sword that may resolve the current organ shortage crisis. Am J Kidney Dis 2015; 65:343-4. [PMID: 25616636 DOI: 10.1053/j.ajkd.2014.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 06/23/2014] [Indexed: 01/18/2023]
Affiliation(s)
| | | | - Bahar Bastani
- Saint Louis University School of Medicine, St Louis, Missouri
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22
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Sood P, Hariharan S. Incentivization of living donation: is it time to cross the bridge? Am J Kidney Dis 2014; 64:484-5. [PMID: 25257322 DOI: 10.1053/j.ajkd.2014.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/06/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Puneet Sood
- University of Pittsburgh Medical Center, Pittsburgh, PA
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