Ethical issues surrounding adult-to-adult living donor liver transplantation

Shapiro, Robyn S.; Adams, Mark B.

doi:10.1053/jlts.2000.19014

Cited by 43 publications

(21 citation statements)

References 5 publications

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“…The consensus conference on Living Kidney Donor Follow-Up emphasized the critical need to inform donors about risks specific to themselves (34). Further, potential LDs must be willing to donate and be free from undue pressure to consent to the procedure (20). Moreover, respect for autonomy means that LDs have the right to determine how much risk they are willing to accept, and conversely, that LDs (and the recipients) have the right to refuse the donation (20,35).…”

Section: Importance Of Informed Consentmentioning

confidence: 99%

“…Yet relatively little is known about longterm outcomes in donors, particularly for liver donors (18), although complications are known to be 18% in kidney donors (19) and 40% in liver donors (16). The absence of information about LDs' long-term health risks and insurance coverage (20) compounds efforts to balance risks and benefits of living donation to ethically justify allowing LDs to undergo the procedure. Accordingly, transplant professionals emphasize the importance Gordon of ensuring prospective LDs' autonomy to determine whether to incur the risks through informed consent (21,22).…”

Section: Introductionmentioning

confidence: 99%

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Informed Consent for Living Donation: A Review of Key Empirical Studies, Ethical Challenges and Future Research

Gordon

2012

American Journal of Transplantation

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Given the organ scarcity, live organ donation is increasingly considered a viable alternative for kidney and liver transplantation. Yet living donation challenges the ethical principle of nonmaleficence by subjecting healthy individuals to medical, psychosocial and unknown risks. Therefore, transplant providers, policymakers and donors are committed to ensuring that prospective donors provide adequate informed consent to undergo the procedure. Informed consent for living donation is ethically required as a means of demonstrating respect for donor's autonomy and protecting their safety. However, all elements of informed consent are fraught with difficulties due to the unique nature of the donation process and outcome. This paper reviews empirical research on informed consent for live kidney donors (LKD) and live liver donors (LLD) for both adult and pediatric recipients. As this review shows, studies that empirically assessed the quality of informed consent elements reveal considerable variability and deficiencies across the informed consent process, suggesting the need for improvement. This review highlights challenges to each element of consent for both LKDs and LLDs, and situates trends within broader policy contexts, ethical debates and avenues for future innovative research.

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Section: Importance Of Informed Consentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Informed Consent for Living Donation: A Review of Key Empirical Studies, Ethical Challenges and Future Research

Gordon

2012

American Journal of Transplantation

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“…37 The impact of a donor death on the surviving recipient, the whole family, and the transplant team are immense and far reaching. 38 Dual graft LDLT puts 2 donors at risk for 1 recipient.…”

Section: Ethical Debatesmentioning

confidence: 99%

Living donor liver transplantation using dual grafts: Experience and lessons learned from cases worldwide

Chen

Yeh

et al. 2015

Liver Transpl

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In living donor liver transplantation (LDLT), insufficient graft volume could result in small-for-size syndrome in recipients, whereas major liver donation predisposes the donor to a high risk of posthepatectomy liver failure. Dual graft LDLT is therefore introduced to obtain combined graft sufficiency. To date, 367 patients have been reported worldwide. We reviewed all the relevant literature, with a special focus on 43 case reports containing enough data to extract and analyze. A simple decision-making algorithm was developed. Dual graft LDLT is indicated when (1) a single donation is unacceptable due to graft-to-recipient size mismatch; (2) the future liver remnant is insufficient in the single donor after major resection; or (3) there is a significant underlying disorder or anatomical variation within the donor liver. The outcome of dual graft LDLT is reported to be comparable with that of single donor LDLT. Unilateral graft atrophy was found in 7 of the 43 patients, predominantly in the right-sided, heterotopic and initially smaller grafts. Technically, the heterotopic implantation and complex vascular reconstruction are the most demanding. Elaborate surgical planning and modification are needed. Ethical concerns about involving a second living donor need to be addressed. In conclusion, dual graft LDLT should be prudently performed in select cases by surgeons of proven expertise when single donation is unacceptable and a second living donor is available. The decision-making criteria need to be standardized. More surgical modification and clinical research are needed. Liver transplantation (LT) is now a gold standard treatment for patients with end-stage or irreversible liver disease, which may restore liver function and yield optimal oncologic outcome as well. The shortage of organ donors, however, has long been the main obstacle in LT activities. Various surgical strategies have been adopted to address the increasing donor-recipient disproportion, including cadaveric split liver transplantation (SLT),

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“…Unter ethischen Gesichtspunkten kann die Durchführung einer Operation an einer gesunden Person wegen möglicher Schädigung der Gesundheit und der körperlichen Integrität dieser Person durch perioperative Komplikationen infrage gestellt werden [1,38,39]. Seit der Einführung der LOLT wird ihre Berechtigung unter den Aspekten der Ethik kontrovers diskutiert [1,38].…”

Section: Ethische Aspekteunclassified

Leberlebendspende

Broelsch

Frilling²,

Nadalin³

et al. 2003

Chirurg

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Living liver donation is a prominent and innovative method in the therapy of terminal liver disease in children and adults. Live donation of livers was first used in 1989 for children. After only 10 years, the concept was also established for application in adults. Due to the imminent lack of donor organs and the constantly increasing need of liver transplantation, this method will continue to grow in importance.

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Ethical issues surrounding adult-to-adult living donor liver transplantation

Cited by 43 publications

References 5 publications

Informed Consent for Living Donation: A Review of Key Empirical Studies, Ethical Challenges and Future Research

Informed Consent for Living Donation: A Review of Key Empirical Studies, Ethical Challenges and Future Research

Living donor liver transplantation using dual grafts: Experience and lessons learned from cases worldwide

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