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Slessarev M, Bain KL, Basmaji J, Blydt-Hansen TD, Cooper J, D'Aragon F, Del Sorbo L, Evans A, Gordon AC, Klein G, Meade MO, Murphy N, Thomas HL, Weiss MJ, Weijer C, Harvey D. Developing Guidance for Donor Intervention Randomized Controlled Trials: Initial Discussions From the Canada-United Kingdom 2022 Workshop. Transplantation 2024:00007890-990000000-00692. [PMID: 38499505 DOI: 10.1097/tp.0000000000004983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Donor interventions, including medications, protocols, and medical devices administered to donors, can enhance transplantable organ quality and quantity and maximize transplantation success. However, there is paucity of high-quality evidence about their effectiveness, in part because of ethical, practical, and regulatory challenges, and lack of guidance about conduct of donor intervention randomized controlled trials (RCTs). METHODS With the vision to develop authoritative guidance for conduct of donor intervention RCTs, we convened a workshop of Canadian-United Kingdom experts in organ donation and transplantation ethics, research, and policy to identify stakeholders, explore unique challenges, and develop research agenda to inform future work in this promising field. RESULTS Donor intervention trials should consider perspectives of broad group of stakeholders including donors, transplant recipients, and their families; researchers in donation and transplantation; research ethics boards; and healthcare providers and administrators involved in donation and transplantation. Unique challenges include (1) research ethics (living versus deceased status of the donor at the time of intervention, intervention versus outcomes assessment in different individuals, harm-benefit analysis in donors versus recipients, consent, and impact on research bystanders); (2) outcome data standardization and linkage; and (3) regulatory and governance considerations. CONCLUSIONS Donor intervention RCTs hold potential to benefit organ transplantation outcomes but face unique research ethics, outcome data, and regulatory challenges. By developing research agenda to address these challenges, our workshop was an important first step toward developing Canada-United Kingdom guidance for donor intervention RCTs that are poised to improve the quality and availability of transplantable organs.
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Affiliation(s)
- Marat Slessarev
- Department of Medicine, Western University, London, ON, Canada
- The Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
| | - Katie L Bain
- The Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - John Basmaji
- Department of Medicine, Western University, London, ON, Canada
| | - Tom D Blydt-Hansen
- Department of Pediatrics (Nephrology), University of British Columbia, Vancouver, BC, Canada
| | - Jessie Cooper
- Department of Health Services Research and Management, School of Health & Psychological Sciences, City, University of London, London, United Kingdom
| | - Frédérick D'Aragon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Lorenzo Del Sorbo
- Interdepartmental Division of Critical Care Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Amy Evans
- NHS Blood and Transplant, Clinical Trials Unit, Bristol, United Kingdom
| | - Anthony C Gordon
- Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London United Kingdom
| | - Gail Klein
- Centre for Clinical Trial Support, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Maureen O Meade
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nicholas Murphy
- Department of Medicine, Western University, London, ON, Canada
- The Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Department of Philosophy, Western University, London, ON, Canada
| | - Helen L Thomas
- NHS Blood and Transplant, Clinical Trials Unit, Bristol, United Kingdom
| | - Matthew J Weiss
- The Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Transplant Québec, Montréal, QC, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, Québec, QC, Canada
| | - Charles Weijer
- Department of Medicine, Western University, London, ON, Canada
- Department of Philosophy, Western University, London, ON, Canada
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
| | - Dan Harvey
- NHS Blood and Transplant, University of Nottingham, Nottingham, United Kingdom
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Williment C, Beaulieu L, Clarkson A, Gunderson S, Hartell D, Escoto M, Ippersiel R, Powell L, Kirste G, Nathan HM, Opdam H, Weiss MJ. Organ Donation Organization Architecture: Recommendations From an International Consensus Forum. Transplant Direct 2023; 9:e1440. [PMID: 37138552 PMCID: PMC10150918 DOI: 10.1097/txd.0000000000001440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 05/05/2023] Open
Abstract
This report contains recommendations from 1 of 7 domains of the International Donation and Transplantation Legislative and Policy Forum (the Forum). The purpose is to provide expert guidance on the structure and function of Organ and Tissue Donation and Transplantation (OTDT) systems. The intended audience is OTDT stakeholders working to establish or improve existing systems. Methods The Forum was initiated by Transplant Québec and co-hosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. This domain group included administrative, clinical, and academic experts in OTDT systems and 3 patient, family, and donor partners. We identified topic areas and recommendations through consensus, using the nominal group technique. Selected topics were informed by narrative literature reviews and vetted by the Forum's scientific committee. We presented these recommendations publicly, with delegate feedback being incorporated into the final report. Results This report has 33 recommendations grouped into 10 topic areas. Topic areas include the need for public and professional education, processes to assure timely referral of patients who are potential donors, and processes to ensure that standards are properly enforced. Conclusions The recommendations encompass the multiple roles organ donation organizations play in the donation and transplantation process. We recognize the diversity of local conditions but believe that they could be adapted and applied by organ donation organizations across the world to accomplish their fundamental objectives of assuring that everyone who desires to become an organ donor is given that opportunity in a safe, equitable, and transparent manner.
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Affiliation(s)
- Claire Williment
- Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | | | - Anthony Clarkson
- Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | | | - David Hartell
- Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Manuel Escoto
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Richard Ippersiel
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Linda Powell
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Gunter Kirste
- Albert Ludwigs University Freiburg, Medical Center, Freiburg, Germany
| | | | - Helen Opdam
- Australian Organ and Tissue Authority, Canberra, Australia
| | - Matthew J. Weiss
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Gift of Life Donor Program, Philadelphia, PA
- Transplant Québec, Montréal, QC, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, QC, Canada
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Toews M, Chandler JA, Pope T, Pape R, Weiss M, Sandiumenge A. Legislation and Policy Recommendations on Organ and Tissue Donation and Transplantation From an International Consensus Forum. Transplant Direct 2023; 9:e1395. [PMID: 37138556 PMCID: PMC10150854 DOI: 10.1097/txd.0000000000001395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/12/2022] [Accepted: 08/25/2022] [Indexed: 05/05/2023] Open
Abstract
There is a shared global commitment to improving baseline donation and transplantation performance metrics in a manner consistent with ethics and local cultural and social factors. The law is one tool that can help improve these metrics. Although legal systems vary across jurisdictions, our objective was to create expert, consensus guidance for law and policymakers on foundational issues underlying organ and tissue donation and transplantation (OTDT) systems around the world. Methods Using the nominal group technique, a group composed of legal academics, a transplant coordinator/clinician, and a patient partner identified topic areas and recommendations on foundational legal issues. The recommendations were informed by narrative literature reviews conducted by group members based on their areas of expertise, which yielded a range of academic articles, policy documents, and sources of law. Best practices were identified from relevant sources in each subtopic, which formed the basis of the recommendations contained herein. Results We reached consensus on 12 recommendations grouped into 5 subtopics: (i) legal definitions and legislative scope, (ii) consent requirements for donation' (iii) allocation of organs and tissue' (iv) operation of OTDT systems' and (v) travel for transplant and organ trafficking. We have differentiated between those foundational legal principles for which there is a firm basis of support with those requiring further consideration and resolution. Seven such areas of controversy are identified and discussed alongside relevant recommendations. Conclusions Our recommendations encompass some principles staunchly enshrined in the OTDT landscape (eg, the dead donor rule), whereas others reflect more recent developments in practice (eg, mandatory referral). Although some principles are widely accepted, there is not always consensus as to how they ought to be implemented. As the OTDT landscape continues to evolve, recommendations must be reconsidered for the law to keep pace with developments in knowledge, technology, and practice.
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Affiliation(s)
- Maeghan Toews
- University of Adelaide, Law School, Adelaide, SA, Australia
| | - Jennifer A. Chandler
- Faculty of Law and Centre for Health Law, Policy and Ethics, University of Ottawa, Ottawa, ON, Canada
| | - Thaddeus Pope
- Mitchell Hamline School of Law, Saint Paul, MN
- Fulbright Canada Research Chair in Health Law, Policy and Ethics, University of Ottawa, Ottawa, ON, Canada
| | - Roger Pape
- National Institutes for Health Research/NHS Blood and Transplant Research Unit, University of Cambridge and Newcastle University, Cambridge and Newcastle, UK
| | - Matthew Weiss
- Transplant Québec, Montréal, QC, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, Québec, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Alberto Sandiumenge
- Transplant Coordination Department, University Hospital Vall d'Hebron, Organ, Tissue and Cell Donation and Transplantation Research Group, Vall d'Hebron Research Instititute (VHIR), Barcelona, Spain
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