Ethical Considerations for Participation of Nondirected Living Donors in Kidney Exchange Programs

Woodle, E. Steve; Daller, John A.; Aeder, Mark I.; Shapiro, R; Sandholm, Tüomas; Casingal, Vincent; Goldfarb, David A.; Lewis, Richard M.; Goebel, Jens; Siegler, Mark

doi:10.1111/j.1600-6143.2010.03136.x

Cited by 50 publications

(29 citation statements)

References 16 publications

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“…Donors with postoperative complications felt ignored by both hospital staff and family, similar to other studies reporting that donors "feel forgotten" after donation (3,8,11,16,18,37,38). Our study reinforces on a grander scale the need for improved attention afterward.…”

Section: Discussionsupporting

confidence: 75%

Emotional and Financial Experiences of Kidney Donors over the Past 50 Years

Jacobs¹,

Gross²,

Messersmith³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Most kidney donors view their experience positively, but some may experience psychosocial and financial burdens. We hypothesized that certain donor characteristics, poor outcome of the recipient, negative perceptions of care, and lack of support may be associated with poor psychosocial outcomes for donors.Design, setting, participants, & measurements The Renal and Lung Living Donors Evaluation Study (RELIVE) examined long-term medical and psychosocial outcomes for kidney donors (at three U.S. transplant centers) who donated between 1963 and 2005. Standardized questionnaires evaluated donor perspectives, recovery time, social support, motivation, financial impact, insurability after donation, and current psychological status. Questionnaires were mailed to 6909 donors.Results Questionnaires were returned by 2455 donors, who had donated 17610 years earlier (range, 5-48 years), a response rate of 36%. Most (95%) rated their overall donation experience as good to excellent. Rating the overall donor experience more negatively was associated with donor complications, psychological difficulties, recipient graft failure, and longer time since donation. Nine percent (n=231) reported one or more of the following poor psychosocial outcomes: fair or poor overall donor experience, financial burden, regret or discomfort with decision to donate, or psychological difficulties since donation. Recipient graft failure was the only predictor for reporting one or more of these poor psychosocial outcomes (odds ratio, 1.77; 95% confidence interval, 1.33 to 2.34). Donors with lower educational attainment experienced greater financial burden. One of five employed donors took unpaid leave; 2% reported health and life insurability concerns.Conclusions Although the majority of donors viewed their overall donation experience positively, almost 1 in 10 donors reported at least one negative consequence related to donation. Recipient graft failure was associated with poor psychosocial outcome, defined as one or more of these negative consequences. Some donors were financially disadvantaged, and some experienced insurance difficulties. Interventions to avoid negative psychosocial and financial consequences are warranted.

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Section: Discussionsupporting

confidence: 75%

Emotional and Financial Experiences of Kidney Donors over the Past 50 Years

Jacobs¹,

Gross²,

Messersmith³

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…Fielded kidney exchanges also gain great utility through the use of chains (see, e.g., [4,14,16,17,21,22,23,28]). Chains start with an altruistic donor donating his kidney to a patient, whose paired donor donates her kidney to another patient, and so on.…”

Section: Kidney Exchange Modelmentioning

confidence: 99%

Price of Fairness in Kidney Exchange.

2014

Self Cite

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Kidney exchange provides a life-saving alternative to long waiting lists for patients in need of a new kidney. Fielded exchanges typically match under utilitarian or near-utilitarian rules; this approach marginalizes certain classes of patients. In this paper, we focus on improving access to kidneys for highly-sensitized, or hard-tomatch, patients. Toward this end, we formally adapt a recently introduced measure of the tradeoff between fairness and efficiencythe price of fairness-to the standard kidney exchange model. We show that the price of fairness in the standard theoretical model is small. We then introduce two natural definitions of fairness and empirically explore the tradeoff between matching more hard-tomatch patients and the overall utility of a utilitarian matching, on real data from the UNOS nationwide kidney exchange and simulated data from each of the standard kidney exchange distributions.

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“…There have also been concerns about coercion with PEKT where the donors are unable to use 'incompatibility' as an excuse to avoid donation and cannot withdraw at a later date especially when their incompatible recipients have already received transplant via PEKT [26][27][28]. It has been proposed to institute "time limits" to prevent donor reneging, limit open chain PEKT and encourage bridge donors to donate to patients on deceased donor wait list [28].…”

Section: Financial and Ethical Considerationsmentioning

confidence: 99%

Paired Exchange: A New Innovation in Live Donor Kidney Transplantation

Arora¹

2014

J Nephrol Ther

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Barriers to traditional living-donor kidney transplantation include ABO incompatibility and positive cross-match. Paired exchange kidney transplantation (PEKT) is a viable an increasingly popular method to increase live donation. We discuss the pros and cons as well as the various ways to achieve PEKT along with a review of existing literature. To achieve the full potential of PEKT, the transplant community at large needs to work toward a national kidney paired donation program along with a centralized financial intermediary.

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Ethical Considerations for Participation of Nondirected Living Donors in Kidney Exchange Programs

Cited by 50 publications

References 16 publications

Emotional and Financial Experiences of Kidney Donors over the Past 50 Years

Emotional and Financial Experiences of Kidney Donors over the Past 50 Years

Price of Fairness in Kidney Exchange.

Paired Exchange: A New Innovation in Live Donor Kidney Transplantation

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