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New York, NY
December 13, 2000
Responding to the 123% increase in living organ donation in the last decade, as compared with a mere 44.5% increase in non-living donation over the same time period, the National Kidney Foundation (NKF), the American Society of Transplantation and the American Society of Transplant Surgeons convened a National Consensus Conference on Living Donor Organ Transplantation. Although living donation of kidneys is a well-established practice, the acute shortage of organs in recent years has prompted transplantation of portions of the liver and lung and even the small intestine and pancreas. The Conference goal was to recommend practice guidelines for transplant physicians and health care providers and the resulting consensus statement is published in today’s issue of the Journal of the American Medical Association (JAMA).
Concern for the physical and psychosocial well-being of the living donor was a central theme of the statement, which says that living donors should be willing to donate “of their own volition, free of coercion and fully informed of the risks, benefits and alternative treatment available to the recipient. The benefits to both donor and recipient must outweigh the risks associated with the donation and transplantation of the living donor organ.”
In order to ensure that the donor’s health is of primary concern, the statement recommends the identification of an independent advocate for the donor. The donor advocate, whose sole focus would be the best interest of the donor, should be empowered with full veto authority for the transplant, if he deems the donation to be ill advised.
In order to evaluate the long term effects of living donation on the donor’s health, the statement recommends the establishment of a living organ donor registry that would allow for the careful study of this population over a long period of time.
Ethical issues surrounding new sources of living organ donors were addressed in the statement, including paired exchange, list-paired exchange of kidneys and donation by minors. Paired exchange, which involves the exchange of living donor kidneys between ABO blood type incompatible pairs, was deemed acceptable. List-paired exchange, in which incompatible living donors provide organs to patients on the non-living donor waiting list in exchange for the non-living donor pool providing a priority allograft to the donor’s incompatible recipient, was considered acceptable in most cases.
Live donation by minors was considered controversial but acceptable in certain cases, such as when the donor and recipient are identical twins or when there is no potential adult living donor available.
Currently, there are more than 73,000 Americans waiting for a transplant. Seventeen people die each day while waiting. To learn more about living donation and other issues related to the national organ shortage contact the National Kidney Foundation at (800)622-9010.
To view the Consensus Statement published in JAMA, click here.
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