A Report of the Vancouver Forum on the Care of the Live Organ Donor: Lung, Liver, Pancreas, and Intestine Data and Medical Guidelines

Barr, Mark L.; Belghiti, Jacques; Villamil, Federico; Pomfret, Elizabeth A.; Sutherland, David S.; Gruessner, Rainer W.G.; Langnas, Alan Norman; Delmonico, Francis L.

doi:10.1097/01.tp.0000216825.56841.cd

Cited by 335 publications

(290 citation statements)

References 31 publications

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“…The provision of care for living donors before, during, and after surgery, as described in the reports of the international forums organized by the Transplantation Society in Amsterdam and Vancouver (2)(3)(4), is no less essential than taking care of the transplant recipient. A positive outcome for a recipient can never justify harm to a live donor; on the contrary, for a transplant with a live donor to be regarded as a success means that both the recipient and the donor have done well.…”

mentioning

confidence: 99%

The Declaration of Istanbul on Organ Trafficking and Transplant Tourism

2008

Clinical Journal of the American Society of Nephrology

215

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mentioning

confidence: 99%

The Declaration of Istanbul on Organ Trafficking and Transplant Tourism

2008

Clinical Journal of the American Society of Nephrology

215

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“…19 Arguments against different criteria for LDLT and DDLT include the following: (1) the requirement for the health care team to respect nonmaleficence by overriding a patient's request and refusing to participate in a transplant if the team truly believes that the recipient survival rate is too low to justify the potential risk to the donor, (2) paternalism (the argument that doctors are imposing their values on other people who should have the freedom to make decisions about their own lives), (3) the high potential for donor coercion when LDLT is offered as the only lifesaving treatment, (4) the potential need to use deceased donor livers to salvage LDLT patients who develop arterial thrombosis, and (5) the risk of donor dissatisfaction when a highrisk cancer patient dies of recurrent cancer after LDLT. 20 The lack of high-quality, longitudinal, longterm data for both physical and psychosocial outcomes of living liver donation makes it difficult to evaluate the importance of these concerns with particular relevance to the risks to the donor.…”

Section: Quality Of the Evidence (Cebm Level 2b)mentioning

confidence: 99%

Should the liver transplant criteria for hepatocellular carcinoma be different for deceased donation and living donation?

et al. 2011

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Should the liver transplant criteria for hepatocellular carcinoma (HCC) be different for deceased donation and living donation? Living donor liver transplantation (LDLT) for HCC offers the opportunity to provide a neoadjuvant treatment organized around a scheduled time for the transplant and to restore excellent liver function with a high-quality graft. However, some centers have been reluctant to offer LDLT for HCC because of concerns about higher rates of cancer recurrence and inferior patient survival after LDLT versus deceased donor liver transplantation (DDLT). 1-6 Theoretical reasons for concerns about the potential for higher rates of HCC recurrence after LDLT include the following: (1) the stimulation of residual cancer cells by growth factors in the regenerating liver 7 ; (2) the relatively brief waiting time for LDLT, which may allow transplantation for patients whose aggressive or rapidly progressive HCC tumors might progress with a longer waiting time and exclude them from transplantation 8 ; and (3) more limited oncological clearance with the inferior vena cava-sparing technique used for LDLT. Another explanation for the reports of higher recurrence rates after LDLT is the presence of programmatic biases that lead these centers to unknowingly offer LDLT to patients with a higher risk of HCC recurrence.To determine whether the liver transplant criteria for HCC should be the same or different for deceased donation and living donation, we examine 2 questions: 1. Are recurrence or cancer-free survival rates after DDLT and LDLT for HCC so inherently different that different transplant criteria are justified? 2. Should LDLT be offered to patients whose tumor stage prevents the use of allocation exception points [eg, Model for End-Stage Liver Disease (MELD) points] and, therefore, limits the availability of deceased donor livers?These questions are analyzed in this article. MATERIALS AND METHODSWe undertook literature searches in June 2010 to identify English publications solely focused on comparisons of outcomes of LDLT and DDLT for HCC. Embase was searched with the following sets of

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“…7 A second step was undertaken at the Vancouver Forum. 8 Emerging data pertaining to the aggregate risks and benefits of live lung, liver, pancreas, and intestine transplantation provided more information regarding the factors that enter into the ethical decision to place a healthy person in harms' way. 8 The limited availability of information about outcomes for the donors and recipients mandated that live lung, liver, pancreas, and intestine organ donation and transplantation must proceed with thoughtful independent oversight and transparency.…”

Section: Ethics and Legal Attitudesmentioning

confidence: 99%

“…8 Emerging data pertaining to the aggregate risks and benefits of live lung, liver, pancreas, and intestine transplantation provided more information regarding the factors that enter into the ethical decision to place a healthy person in harms' way. 8 The limited availability of information about outcomes for the donors and recipients mandated that live lung, liver, pancreas, and intestine organ donation and transplantation must proceed with thoughtful independent oversight and transparency. Because organs recovered from deceased donors offer substantial (and sometimes superior) benefits to potential recipients, with no risk to a healthy live donor, efforts to maximize the use of organs from deceased donors must not be impeded by the development of live organ donation.…”

Section: Ethics and Legal Attitudesmentioning

confidence: 99%

Donor Advocacy with Special Reference to Belgium

2011

Transplantation Proceedings

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Before any published Belgian law, EU Directive, and/or EU Action Plan, the donor advocate was naturally a member of the transplantation team performing living kidney donation. The need of donor advocacy appeared obvious with liver living donation, which was and is still a risky procedure. Today, it is clear that the donor advocacy must not be limited to living donation but extended to brain-dead and cardiac-dead donation. Nevertheless, its complexity will need experienced persons in the field of organ donation as well as transplantation, while remembering that patients' first right is the right to donate.

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A Report of the Vancouver Forum on the Care of the Live Organ Donor: Lung, Liver, Pancreas, and Intestine Data and Medical Guidelines

Cited by 335 publications

References 31 publications

The Declaration of Istanbul on Organ Trafficking and Transplant Tourism

The Declaration of Istanbul on Organ Trafficking and Transplant Tourism

Should the liver transplant criteria for hepatocellular carcinoma be different for deceased donation and living donation?

Donor Advocacy with Special Reference to Belgium

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