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Andacoglu OM, Wiser G, Zimmerman M, Buff M, Selim M, Baker T. A perspective and review on nondirected liver donation. Clin Liver Dis (Hoboken) 2024; 23:e0235. [PMID: 38961879 PMCID: PMC11221845 DOI: 10.1097/cld.0000000000000235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/15/2024] [Indexed: 07/05/2024] Open
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2
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Cattral MS, Ghanekar A, Selzner N. Anonymous Living Donor Liver Transplantation: The Altruistic Strangers. Gastroenterology 2023; 165:1315-1317. [PMID: 37659671 DOI: 10.1053/j.gastro.2023.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/07/2023] [Accepted: 08/13/2023] [Indexed: 09/04/2023]
Affiliation(s)
- Mark S Cattral
- Ajmera Transplant Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anand Ghanekar
- Ajmera Transplant Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nazia Selzner
- Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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3
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Meena P, Kute VB, Bhargava V, Mondal R, Agarwal SK. Social Media and Organ Donation: Pros and Cons. Indian J Nephrol 2023; 33:4-11. [PMID: 37197042 PMCID: PMC10185012 DOI: 10.4103/ijn.ijn_158_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/06/2022] [Accepted: 07/14/2022] [Indexed: 12/28/2022] Open
Abstract
Shortage of organ donors is the most important obstacle standing in the way of lifesaving organ transplantation in a myriad of patients suffering from end-stage organ failure. It is vital that the transplant societies and associated appropriate authorities develop strategies to overcome the unmet needs for organ donation. The power of prominent social media (SoMe) platforms such as Facebook, Twitter, and Instagram, which reach millions of people, can increase awareness, provide education, and may ameliorate the pessimism toward organ donation among the general population. Additionally, public solicitation of organs may be helpful for waitlisted candidates for organ transplantation, who cannot find a suitable donor among near relations. However, the use of SoMe for organ donation has several ethical issues. This review attempts to highlight the advantages and limitations of using social media in the context of organ donation for transplantation. Some suggestions on the best utilization of social media platforms for organ donation while balancing ethical considerations have been highlighted here.
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Affiliation(s)
- Priti Meena
- Department of Nephrology, All India Institute of Medical Sciences Bhubaneswar, Odisha, India
| | - Vivek B. Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Vinant Bhargava
- Institute of Renal Science, Sir Gangaram Hospital, New Delhi, India
| | - Rishita Mondal
- Department of Nephrology, All India Institute of Medical Sciences Bhubaneswar, Odisha, India
| | - Sanjay K. Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
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4
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Nishio-Lucar AG, Hunt HF, Booker SE, Cartwright LA, Larkin L, Gonzalez SA, Spiers JA, Srinivas T, Ahmad MU, Levan ML, Singh P, Wertin H, McAdams C, Lentine KL, Schaffer R. Utilizing Social Media to Identify Potential Living Donors: Learning from US Living Donor Programs. CURRENT TRANSPLANTATION REPORTS 2022; 9:318-327. [PMID: 36466961 PMCID: PMC9684893 DOI: 10.1007/s40472-022-00382-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/24/2022]
Abstract
Abstract
Purpose of Review
Living donor transplantation provides the best possible recipient outcomes in solid organ transplantation. Yet, identifying potential living donors can be a laborious and resource intensive task that heavily relies on the recipient’s means and social network. Social media has evolved to become a key tool in helping to bring recipients and potential living donors together given its ease of utilization, widespread access, and improved recipient’s comfort with public solicitation. However, in the USA, formal guidelines to direct the use of social media in this context are lacking.
Recent Findings
To better inform the landscape and opportunities utilizing social media in living donation, the OPTN Living Donor Committee surveyed US transplant programs to explore programs’ experiences and challenges when helping patients use social media to identify potential living donors (September 2019). A large majority of survey participants (N = 125/174, 72%) indicated that their program provided education to use social media to identify potential living donors and most programs tracking referral source confirmed an increase utilization over time. The use of social media was compounded with program and recipient’s challenges including concerns about privacy, inadequate technology access, and knowledge gaps. In this review, we discuss the results of this national survey and recent literature, and provide suggestions to inform program practices and guidance provided to patients wishing to use social media to identify potential living donors.
Summary
Transplant programs should become competent in the use of social media for potential living donor identification to empower patients interested in using this tool. Social media education should be provided to all patients regardless of voiced interest and, when appropriate, revisited at multiple time points. Programs should consider developing a “team of experts” that can provide focused education and support to patients embarking in social media living donor campaigns. Care should be taken to avoid exacerbating disparities in access to living donor transplantation. Effective and timely guidance to patients in the use of social media could enhance the identification of potential living donors.
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5
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Humar S, Jung J, Krause S, Selzner N, Abbey S. Anonymity: What does it mean and why is it important to anonymous living liver donors? Liver Transpl 2022; 28:1299-1305. [PMID: 35229446 DOI: 10.1002/lt.26445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 02/13/2022] [Accepted: 02/21/2022] [Indexed: 01/13/2023]
Abstract
Anonymous living organ donation has recently become more common in select transplantation programs, with donors voluntarily offering a kidney or a lobe of their liver to those in need. These anonymous donations may be directed to a specific recipient or nondirected, and anonymity may be one way or reciprocal. Given their unique situation, we interviewed a cohort of anonymous living liver donors and explored their opinions surrounding anonymity and its implications in living liver donation. A total of 26 anonymous donors completed a semistructured qualitative interview consisting of questions regarding their experiences as a living liver donor. The interviews were audio-recorded, transcribed, and analyzed for common themes, specifically those pertaining to the donor's perceptions and experiences with anonymity. Five main themes related to anonymity were identified: (1) the moral importance of an unencumbered gift, (2) wanting internal satisfaction rather than seeking external accolades, (3) anonymity as a protection against potential negative outcomes in the recipient, (4) feelings of ambivalence toward meeting the recipient, and (5) concerns about negative perceptions among their own friends and family. These insights into the range of donors' attitudes toward anonymity will help improve awareness and provide the best possible mental and physical care for the anonymous donor.
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Affiliation(s)
- Sapna Humar
- Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada.,Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Judy Jung
- Multi-Organ Transplant & Medical Specialties, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sandra Krause
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Nazia Selzner
- Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada.,Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan Abbey
- Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada.,Centre for Mental Health, University Health Network, Toronto, Ontario, Canada.,Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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6
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Anonymous Nondirected Living Liver Donation in the United States. Transplant Direct 2021; 8:e1275. [PMID: 34966843 PMCID: PMC8710328 DOI: 10.1097/txd.0000000000001275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
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7
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Lam NN, Dipchand C, Fortin MC, Foster BJ, Ghanekar A, Houde I, Kiberd B, Klarenbach S, Knoll GA, Landsberg D, Luke PP, Mainra R, Singh SK, Storsley L, Gill J. Canadian Society of Transplantation and Canadian Society of Nephrology Commentary on the 2017 KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Can J Kidney Health Dis 2020; 7:2054358120918457. [PMID: 32577294 PMCID: PMC7288834 DOI: 10.1177/2054358120918457] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/25/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose of review: To review an international guideline on the evaluation and care of living
kidney donors and provide a commentary on the applicability of the
recommendations to the Canadian donor population. Sources of information: We reviewed the 2017 Kidney Disease: Improving Global Outcomes (KDIGO)
Clinical Practice Guideline on the Evaluation and Care of Living Kidney
Donors and compared this guideline to the Canadian 2014 Kidney Paired
Donation (KPD) Protocol for Participating Donors. Methods: A working group was formed consisting of members from the Canadian Society of
Transplantation and the Canadian Society of Nephrology. Members were
selected to have representation from across Canada and in various
subspecialties related to living kidney donation, including nephrology,
surgery, transplantation, pediatrics, and ethics. Key findings: Many of the KDIGO Guideline recommendations align with the KPD Protocol
recommendations. Canadian researchers have contributed to much of the
evidence on donor evaluation and outcomes used to support the KDIGO
Guideline recommendations. Limitations: Certain outcomes and risk assessment tools have yet to be validated in the
Canadian donor population. Implications: Living kidney donors should be counseled on the risks of postdonation
outcomes given recent evidence, understanding the limitations of the
literature with respect to its generalizability to the Canadian donor
population.
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Affiliation(s)
- Ngan N Lam
- Division of Nephrology, University of Calgary, AB, Canada
| | | | | | - Bethany J Foster
- Division of Pediatric Nephrology, McGill University, Montréal, QC, Canada
| | - Anand Ghanekar
- Department of Surgery, University of Toronto, ON, Canada
| | - Isabelle Houde
- Division of Nephrology, Centre Hospitalier de l'Université de Québec, Québec City, Canada
| | - Bryce Kiberd
- Division of Nephrology, Dalhousie University, Halifax, NS, Canada
| | | | - Greg A Knoll
- Division of Nephrology, University of Ottawa, ON, Canada
| | - David Landsberg
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - Patrick P Luke
- Division of Urology, Western University, London, ON, Canada
| | - Rahul Mainra
- Division of Nephrology, University of Saskatchewan, Saskatoon, Canada
| | - Sunita K Singh
- Division of Nephrology, University of Toronto, ON, Canada
| | - Leroy Storsley
- Section of Nephrology, University of Manitoba, Winnipeg, Canada
| | - Jagbir Gill
- Division of Nephrology, University of British Columbia, Vancouver, Canada
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8
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Raza MH, Aziz H, Kaur N, Lo M, Sher L, Genyk Y, Emamaullee J. Global experience and perspective on anonymous nondirected live donation in living donor liver transplantation. Clin Transplant 2020; 34:e13836. [PMID: 32154620 DOI: 10.1111/ctr.13836] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/21/2020] [Accepted: 02/16/2020] [Indexed: 12/13/2022]
Abstract
Anonymous nondirected living liver donation (ANLLD), sometimes referred to as "altruistic" donation, occurs when a biologically unrelated person comes forward to donate a portion of his/her liver to a transplant candidate who is unknown to the donor. Here, we explore the current status of ANLLD with special consideration of published reports; US experience; impact on donor psychosocial outcomes; barriers to donation; and current global trends with respect to ethical considerations. Between 1998 and 2019, 105 anonymous nondirected living liver donor (ND-LLD) transplants have been documented in the US Scientific Registry of Transplant Recipients. Sixteen donors (15%) were reported to experience a postoperative complication. Currently, 89 donors remain alive (85%), 16 (15%) have unknown status, and none are confirmed deceased. Although there are only a handful of case series, these data suggest that ANLLD is a feasible option. While there are no liver-specific data, studies involving anonymous nondirected kidney donors suggest that anonymous donation does not adversely impact psychosocial outcomes in donors or recipients. There are substantial financial burdens and ethical considerations related to ANLLD. Further studies are required to assess donor demographics, psychosocial motivations, long-term health-related quality of life, and financial impact of ANLLD.
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Affiliation(s)
- Muhammad H Raza
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hassan Aziz
- Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Navpreet Kaur
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Mary Lo
- Department of Preventative Medicine, University of Southern California, Los Angeles, CA, USA
| | - Linda Sher
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Yuri Genyk
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Juliet Emamaullee
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
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9
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Public Solicitation and The Canadian Media: Two Cases of Living Liver Donation, Two Different Stories. Transplant Direct 2019; 5:e508. [PMID: 32095503 PMCID: PMC7004592 DOI: 10.1097/txd.0000000000000950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/19/2019] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. Background . Two stories of public solicitation for living liver donors received substantial Canadian media attention in 2015: The Wagner family, with twin toddlers, each needing transplants, and Eugene Melnyk, wealthy owner of a professional hockey team. This study compared the print media coverage of these 2 stories to understand how public solicitation was portrayed and whether coverage differed depending on the individual making the plea. Methods. We conducted a content analysis on 155 relevant Canadian newspaper articles published between January 1, 2015 and December 31, 2016. Articles were analyzed for their description of public solicitation, benefits and issues associated with public solicitation, and overall tone with respect to public solicitation. Results. The foregrounding of public solicitation and associated ethical issues featured heavily in articles focused on Melnyk but were largely absent when discussing the Wagner family. The fairness of Melnyk's solicitation was the most prominent ethical issue raised. Laws and policies surrounding public solicitation also featured in the Melnyk story but not in articles focused on the Wagners. Public solicitation was portrayed more negatively in the Melnyk articles, but overall, was portrayed positively in relation to both Melnyk and the Wagner family. Conclusions. Public solicitation was generally portrayed as a positive phenomenon in Canadian print media, yet there were stark differences in how these cases were presented. The Wagner story was largely portrayed as a human-interest piece about a family in dire circumstances, whereas Melnyk's wealth, status, and influence raised questions of the fairness of his transplant.
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10
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Anonymous living donation in liver transplantation: Squaring the circle or condemned to vanish? J Hepatol 2019; 71:864-866. [PMID: 31561912 DOI: 10.1016/j.jhep.2019.08.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 01/31/2023]
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11
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Goldaracena N, Jung J, Aravinthan AD, Abbey SE, Krause S, Pritlove C, Lynch J, Wright L, Selzner N, Stunguris J, Greig P, Ghanekar A, McGilvray I, Sapisochin G, Ng VL, Levy G, Cattral M, Grant D. Donor outcomes in anonymous live liver donation. J Hepatol 2019; 71:951-959. [PMID: 31279899 DOI: 10.1016/j.jhep.2019.06.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 06/18/2019] [Accepted: 06/20/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Death rates on liver transplant waiting lists range from 5%-25%. Herein, we report a unique experience with 50 anonymous individuals who volunteered to address this gap by offering to donate part of their liver to a recipient with whom they had no biological connection or prior relationship, so called anonymous live liver donation (A-LLD). METHODS Candidates were screened to confirm excellent physical, mental, social, and financial health. Demographics and surgical outcomes were analyzed. Qualitative interviews after donation examined motivation and experiences. Validated self-reported questionnaires assessed personality traits and psychological impact. RESULTS A total of 50 A-LLD liver transplants were performed between 2005 and 2017. Most donors had a university education, a middle-class income, and a history of prior altruism. Half were women. Median age was 38.5 years (range 20-59). Thirty-three (70%) learned about this opportunity through public or social media. Saving a life, helping others, generativity, and reciprocity for past generosity were motivators. Social, financial, healthcare, and legal support in Canada were identified as facilitators. A-LLD identified most with the personality traits of agreeableness and conscientiousness. The median hospital stay was 6 days. One donor experienced a Dindo-Clavien Grade 3 complication that completely resolved. One-year recipient survival was 91% in 22 adults and 97% in 28 children. No A-LLD reported regretting their decision. CONCLUSIONS This is the first and only report of the characteristics, motivations and facilitators of A-LLD in a large cohort. With rigorous protocols, outcomes are excellent. A-LLD has significant potential to reduce the gap between transplant organ demand and availability. LAY SUMMARY We report a unique experience with 50 living donors who volunteered to donate to a recipient with whom they had no biological connection or prior relationship (anonymous living donors). This report is the first to discuss motivations, strategies and facilitators that may mitigate physical, social and ethical risk factors in this patient population. With rigorous protocols, anonymous liver donation and recipient outcomes are excellent; with appropriate clinical expertise and system facilitators in place, our experience suggests that other centers may consider the procedure for its significant potential to reduce the gap between transplant organ demand and availability.
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Affiliation(s)
- Nicolas Goldaracena
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Division of Transplant Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Judy Jung
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Canada.
| | - Aloysious D Aravinthan
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada; NDDC, School of Medicine, University of Nottingham; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Susan E Abbey
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Centre for Mental Health, University Health Network, Toronto, Canada
| | - Sandra Krause
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Centre for Mental Health, University Health Network, Toronto, Canada
| | - Cheryl Pritlove
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada
| | - Joanna Lynch
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Centre for Mental Health, University Health Network, Toronto, Canada
| | - Linda Wright
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Nazia Selzner
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Jennifer Stunguris
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Canada
| | - Paul Greig
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Anand Ghanekar
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Canada
| | - Ian McGilvray
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Gonzalo Sapisochin
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Vicky Lee Ng
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Canada
| | - Gary Levy
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Mark Cattral
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Canada
| | - David Grant
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Canada
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12
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Fisher RA. Anonymous live liver donor: the Good Samaritan Stranger. Nat Rev Gastroenterol Hepatol 2019; 16:650-651. [PMID: 31501587 DOI: 10.1038/s41575-019-0207-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- Robert A Fisher
- Beth Israel Deaconess Medical Center Transplant Institute, Boston, MA, USA.
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13
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Shanker RR, Anthony SJ, Wright L. A Scoping Review of the Literature on Public Solicitations for Living Organ and Hematopoietic Stem Cell Donations. Prog Transplant 2018; 28:288-295. [DOI: 10.1177/1526924818781578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Evolving methods of communication have increased public appeals for living organ and hematopoietic stem cell donations from strangers, giving public solicitations more visibility. Within the academic literature, perspectives have been divisive, reflecting ethical justifications for and against appeals for living unrelated donors. Transplant programs and clinicians face a variety of ethical dilemmas when patients and their solicited donors present to the hospital. Objective: A scoping review methodology was designed to (1) explore the academic literature and (2) summarize and disseminate key research findings. Methods: We used the Arksey & O’Malley framework for conducting and reporting scoping reviews and to review the prominent ethical arguments, counterarguments, and policy implications in the literature. From 4616 articles identified through MEDLINE, EMBASE, PsycInfo, and CINAHL, we screened titles and abstracts to assess eligibility for full-text review. Results: We retrieved 280 full texts, extracted data from 61, and coded and analyzed 41 papers. Of these, 36 were from or based in the US context. Two articles originated from Canada. Three articles addressed public solicitations of hematopoietic stem cell donation. We mapped themes under 3 major headings related to public solicitations of living unrelated donors for organs and hematopoietic stem cells: (1) interpretations and modes, (2) ethical arguments for and against, and (3) policy implications and suggestions to address challenges for clinical practice. Discussion: The academic literature contains divisive perspectives of public solicitations for organ and hematopoietic stem cell donation, each of which deserves further reflection for implications for policy and practice.
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Affiliation(s)
- Ruby Rajendra Shanker
- Department of Bioethics, University Health Network and Women’s College Hospital, Toronto, Ontario, Canada
- Division of Clinical Public Health, Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- School of Graduate Studies, University of Toronto, Toronto, Ontario, Canada
| | - Samantha J. Anthony
- Department of Social Work, Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Canadian National Transplant Research Program, Edmonton, Alberta, Canada
| | - Linda Wright
- Canadian National Transplant Research Program, Edmonton, Alberta, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
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14
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Pronk MC, Slaats D, Zuidema WC, Hilhorst MT, Dor FJMF, Betjes M, Weimar W, van de Wetering J, Massey EK. "What if this is my chance to save my life?" A semistructured interview study on the motives and experiences of end-stage renal disease patients who engaged in public solicitation of a living kidney donor. Transpl Int 2017; 31:318-331. [PMID: 29130538 DOI: 10.1111/tri.13095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 07/31/2017] [Accepted: 11/02/2017] [Indexed: 11/27/2022]
Abstract
The increase in patients using public solicitation (PS) to find a living kidney donor has generated a debate about the ethical complexities of PS. To investigate why patients engaged in PS and what they experienced during PS, we conducted semistructured interviews with 20 Dutch patients with end-stage renal disease who had publicly solicited a living donor. Transcripts were thematically analyzed. We identified ten themes on patients' considerations preceding PS: cautiousness in discussing living donation within social network; reluctance to accept a kidney from loved ones; rejection/withdrawal of related donor candidates; moral objections to paid donation; the ease of social media; encouraged by others; ends justifying the means; despair and urge to take action; public disclosure of vulnerability; fear of being (perceived to be) selfish. We identified nine themes on patients' experiences: positive emotions and support generated by action; genuine and ulterior motives for donation; patients acting as educators and screeners; time- and energy-consuming process; emotionally taxing process; positive interactions with donor candidates; feeling of dependency and obligation; limited cooperation from health professionals; demands a proactive attitude and media strategy. These results can inform and complement (existing) policies on PS and provide content for education of patients who are considering PS.
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Affiliation(s)
- Mathilde C Pronk
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC, Rotterdam, The Netherlands
| | - Dorthe Slaats
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC, Rotterdam, The Netherlands
| | - Willij C Zuidema
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC, Rotterdam, The Netherlands
| | - Medard T Hilhorst
- Department of Medical Ethics and Philosophy, Erasmus MC, Rotterdam, The Netherlands
| | - Frank J M F Dor
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Renal and Transplant Services, Hammersmith Hospital, Imperial College, London, UK
| | - Michiel Betjes
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC, Rotterdam, The Netherlands
| | - Willem Weimar
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC, Rotterdam, The Netherlands
| | | | - Emma K Massey
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC, Rotterdam, The Netherlands
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15
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Henderson ML, Clayville KA, Fisher JS, Kuntz KK, Mysel H, Purnell TS, Schaffer RL, Sherman LA, Willock EP, Gordon EJ. Social media and organ donation: Ethically navigating the next frontier. Am J Transplant 2017; 17:2803-2809. [PMID: 28744966 DOI: 10.1111/ajt.14444] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/30/2017] [Accepted: 07/17/2017] [Indexed: 01/25/2023]
Abstract
As the organ shortage continues to grow, the creation of social media communities by transplant hospitals and the public is rapidly expanding to increase the number of living donors. Social media communities are arranged in myriad ways and without standardization, raising concerns about transplant candidates' and potential donors' autonomy and quality of care. Social media communities magnify and modify extant ethical issues in deceased and living donation related to privacy, confidentiality, professionalism, and informed consent, and increase the potential for undue influence and coercion for potential donors and transplant candidates. Currently, no national ethical guidelines have been developed in the United States regarding the use of social media to foster organ transplantation. We provide an ethical framework to guide transplant stakeholders in using social media for public and patient communication about transplantation and living donation, and offer recommendations for transplant clinical practice and future research.
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Affiliation(s)
- M L Henderson
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - J S Fisher
- Scripps Clinic/Green Hospital, La Jolla, CA, USA
| | - K K Kuntz
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - H Mysel
- The Living Kidney Donors Network, Chicago, IL, USA
| | - T S Purnell
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - R L Schaffer
- Scripps Clinic/Green Hospital, La Jolla, CA, USA
| | - L A Sherman
- Medical College of Wisconsin Milwaukee, WI, USA
| | - E P Willock
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - E J Gordon
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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16
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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: 198] [Impact Index Per Article: 28.3] [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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