Live liver donation, ethics and practitioners: ‘I am between the two and if I do not feel comfortable about this situation, I cannot proceed’

Thomas, Elin; Bramhall, Simon R.; Herington, Jonathan; Draper, Heather

doi:10.1136/medethics-2012-101261

Cited by 17 publications

(15 citation statements)

References 16 publications

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“…The extent of the harm is relative to the different kinds of harm i they may experience if their child does not receive a transplant (and continues to suffer or dies) 22. Dialysis reduces life expectancy; the probability of a child surviving 5 years on dialysis is 0.8, a mortality of about 1% 23.…”

Section: Discussionmentioning

confidence: 99%

Coercion and choice in parent–child live kidney donation

2014

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This paper explores whether donor-parents felt coerced to donate a kidney to their child. There is a paucity of UK literature on parental live kidney donors and the voluntariness of their decision-making. Data were gathered as part of a study exploring parental experiences of consenting for live donation at a UK specialist children's hospital. Parents who donated a kidney to their child between September 2006 and December 2010 and who consented at their child's hospital to be referred to an adult unit for consideration for live donation were invited to participate. Of the 19 eligible parents, seven fathers and three mothers consented to be interviewed. Their primary motivation for donation was being a parent (more specifically, the parent of a sick child). Participants expressed this in terms of parental love and concern. Participants conveyed certainty about their decision and viewed live donation as a positive opportunity. Most participants regarded the decision to donate, or not donate, as one every parent is entitled to make for their own reasons. In discussing our findings, we argue that when parents do not separate their child's interests from their own, this does not necessarily compromise autonomous decision-making: using one's own moral values to constrain one's own choices can be compatible with voluntary decision-making. Indeed, choices may be more constrained when parents are unable to donate, because this reduces the options available to parents to help their child.

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Section: Discussionmentioning

confidence: 99%

Coercion and choice in parent–child live kidney donation

2014

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“…In this case, the donor and recipient were distant relatives, so it was unlikely that they had an emotional relationship. Research has found that LT clinicians find it more acceptable to justify the donation when donors have emotional relationships with recipients because of motivations to donate (eg, to help improve the recipient’s health) and potential benefits to the donor (eg, seeing the recipient get better and/or retaining the family unit) are recognizable . Thus, the time pressures could be attenuated or deemed less of an issue.…”

Section: Case 2: Ldlt In a Patient Under A Time‐sensitive Situationmentioning

confidence: 99%

“…Research has found that LT clinicians find it more acceptable to justify the donation when donors have emotional relationships with recipients because of motivations to donate (eg, to help improve the recipient's health) and potential benefits to the donor (eg, seeing the recipient get better and/or retaining the family unit) are recognizable. (21) Thus, the time pressures could be attenuated or deemed less of an issue. Yet, it is unclear what this distant familial donor's motivation may be, if the benefits from donating outweigh the risks to both the donor and recipient, and how the relationship may influence the decision-making process.…”

Section: Case 2: Ldlt In a Patient Under A Time-sensitive Situationmentioning

confidence: 99%

Living Donor Liver Transplantation When Deceased Donor Is Not Possible or Timely: Case Examples and Ethical Perspectives

Levitsky¹,

Gordon²

2020

Liver Transpl

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This article analyzes the ethical soundness of living donor liver transplantation (LDLT) in situations where the transplant team does not consider deceased donor liver transplantation (DDLT) a clinical or timely option. Given that patients with end‐stage liver disease have a high risk of death without DDLT, the option of LDLT becomes compelling and may save lives. We present 3 representative cases from our center that raise concerns over social behavior, limited time constraints for decision making, and high potential for disease recurrence that render DDLT an unlikely option. Thereafter, we discuss ethical issues for each patient, which predominantly pertain to compromises to the living donor informed consent process and the feasibility of LDLT. We conclude with recommendations regarding whether LDLT is an acceptable ethical option for those patients, which may inform clinical practice in the broader transplant community.

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“…That said, these general ILDA concepts apply to live liver donor care and are incorporated in Organ Transplantation and Procurement Network policy. Furthermore, an emerging literature highlights special concerns for live liver donors, who must learn content elements about higher risks associated with donation (versus kidney donation) and may feel added urgency about limited treatment options for the intended recipient . The limited treatment options, and associated sense of urgency, may affect internally felt pressure for the potential live liver donor (as opposed to the potential live kidney donor), but assessment components of donor decision making, and strength of motivation (by the ILDA and other care providers) remain essentially the same.…”

mentioning

confidence: 99%