The relevance of EU directive 2010/53/EU for living organ donation practice

With the recent transposition of Directive 2010/53/EU into the transplant regulation of EU Member States, the time is right to have a closer look at its implications for living organ donation practice. We first discuss the relevance of the Action Plan which forms the basis for the policy of the European Commission in the field of organ donation and transplantation. We then analyze the impact of Directive 2010/53/EU which was adopted to support the implementation of the Priority Actions set out in the Action Plan. We more specifically focus on the obligations of transplant centers engaged in living organ donation and highlight their significance for clinical practice. Finally, we point out some strengths and weaknesses of the Directive in addressing living organ donation

Raising awareness of unspecified living kidney donation: An ELPAT

Background: Living donor kidney transplantation (LDKT) is the preferred treatment for patients with end-stage renal disease and unspecified living kidney donation is morally justified. Despite the excellent outcomes of LDKT, unspecified kidney donation (UKD) is limited to a minority of European countries due to legal constraints and moral objections. Consequently, there are significant variations in practice and approach between countries and the contribution of UKD is undervalued. Where UKD is accepted as routine, an increasing number of patients in the kidney exchange programme are successfully transplanted when a 'chain' of transplants is triggered by a single unspecified donor. By expanding the shared living donor pool, the benefit of LDKT is extended to patients who do not have their own living donor because a recipient on the national transplant list always completes the chain. Is there a moral imperative to increase the scope of UKD and how could this be achieved? Methods: An examination of the literature and individual country practices was performed to identify the limitations on UKD in Europe and recommend strategies to increase transplant opportunities. Results: Primary limitations to UKD, key players and their roles and responsibilities were identified. Conclusions: Raising awareness to encourage the public to volunteer to donate is appropriate and desirable to increase UKD. Recommendations are made to provide a framework for increasing awareness and engagement in UKD. The public, healthcare professionals, policy makers and society and religious leaders have a role to play in creating an environment for change

Donor autonomy and self-sacrifice in living organ donation : an ethical legal and psychological aspects of transplantation (ELPAT) view

Clinical teams understandably wish to minimise risks to living kidney donors undergoing surgery, but are often faced with uncertainty about the extent of risk, or donors who wish to proceed despite those risks. Here we explore how these difficult decisions may be approached and consider the conflicts between autonomy and paternalism, the place of self-sacrifice and consideration of risks and benefits. Donor autonomy should be considered as in the context of the depth and strength of feeling, understanding risk and competing influences. Discussion of risks could be improved by using absolute risk, supra-regional MDMs and including the risks to the clinical team as well as the donor. The psychological effects on the donor of poor outcomes for the untransplanted recipient should also be taken into account. There is a lack of detailed data on the risks to the donor who has significant co-morbidities

The essence of living kidney donation

Aim Nephrectomy performed on healthy individuals for the purpose of transplantation is an exceptional activity. It confers great responsibilities to the medical staff involved. Potential donors must be carefully informed and assessed with respect to medical and psychosocial aspects. This thesis focuses on information, motives for donation, setting medical limits and the experience of undergoing nephrectomy.Materials and MethodsThe contents of written information from transplant units in 14 countries were investigated. Interviews were conducted with potential donors, and analysed using a phenomenological approach (n=12). Categories of motives were identified. Questionnaires were sent to potential donors in Sweden and Norway, asking respondents to mark on a Visual Analogue Scale the importance of several motives and concerns (n=154). The outcome of transplantation was evaluated with respect to several risk factors, including a low glomerular filtration rate of the living donor (n=344). From medical records and in interviews performed 4 weeks post donation, the degree of pain, fatigue and physical activity were evaluated and compared between donors who underwent open and laparoscopic nephrectomy (n= 55 and 45, respectively).ResultsThe contents of the information brochures varied greatly, and many lacked important aspects. The decision to donate was mainly emotionally based. Seven major motives for donation were identified - a desire to help, a logic motive, pressure, identification, increased self-esteem, self-benefit and moral duty. A desire to help, identification and self-benefit were the strongest motives. In contrast, pressure, guilt and religion were weak incentives. A glomerular filtration rate below 80 ml/min was shown to be an independent risk factor for graft loss. The laparoscopic nephrectomy technique conferred less pain than the open procedure. Irrespective of surgical method, most donors had not recovered physically or mentally after 4 weeks.ConclusionsTo inform potential donors is of paramount importance, but difficult because the decision to donate is rarely based on actual facts. Most potential live kidney donors have a combination of motives for donation and mixed feelings about it. A lower limit for donor GFR should be set. Regardless of surgical technique, living kidney donation is more demanding, mentally and physically, than commonly recognised. These are important aspects of the pre-donation evaluation

DONORS SELF-REPORTED EXPERIENCES OF LIVE KIDNEY DONATION-A PROSPECTIVE STUDY.

Many reports on living kidney donation describe rapid recovery. In our experience rehabilitation is rather slow. This study aimed to explore self-reported health status among living donors (LDs) three to four weeks and six months post-donation with a longitudinal design. In this study. LDs (n = 112) reported their physical and mental health by responding to a questionnaire before surgery, after three to four weeks and after six months. Points could range from 1 (normal) to 5 (severe trouble), total score 7-35. Age (n = 112) was 50 years (median) and 52% were females. Before surgery, the total score was 9 (7-21). After three to four weeks, the score was 15 (7-31), with a rise in all measured variables. Women noted higher score rises than men (p= 0.01). The majority showed complete recovery after six months. It is clear that professional nursing support in the recuperation period is needed. Nursing interventions should aim at preventing delay and setbacks in the donors' recovery process