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New York, NY
March 22, 2000
On June 1 and 2, 2000, a National Consensus Conference on Living Donor Organ Transplantation will be held in Kansas City, Missouri. Living donor transplants are a fast growing trend in the United States, which raises serious medical and psychosocial questions. The conference will feature analysis, debate and consensus development, with the goal of maximizing the opportunity for successful transplantation.
Transplants from living donors tripled between 1989 and 1998, according to the United Network for Organ Sharing (UNOS), which operates the nationwide transplant network. There were 4,273 living donors in 1998, accounting for one in five donated organs. UNOS also reports that, at many transplant centers in the United States, about half of kidney transplants are from living donors. Techniques are also being developed to obtain lungs and intestines for transplantation from living donors.
Sponsoring the conference are the National Kidney Foundation, the American Society of Transplantation and the American Society of Transplant Surgeons, in partnership with United Resource Networks. Additional support is also being provided by the American Society of Nephrology.
The theme of the conference will be the medical and social concerns for healthy individuals who provide organs for others. Medical/surgical issues to be debated include: new techniques for laparoscopic removal of a donor kidney, adult-to-adult liver donation, exclusion criteria for living donors, and methods for assessing long-term risk to the donor. Developing a registry of living donors will be discussed, as will the analysis of data on donors who gave organs 10 to 15 years ago.
Of equal importance are the ethical and social issues, which include: what constitutes informed consent, financial consequences of donation, prevention of coercion and compensation, and how to ensure the best interests of “Good Samaritan” donors who are not related to or acquainted with their recipients.
According to John Davis, chief executive officer of NKF, “This conference is very significant and is needed by everyone concerned with the success of transplantation. It focuses on frequently asked and important questions that accompany living donation. We will strive for consensus statements that can be disseminated and put into use throughout the country as donors, recipients and the health care team plan for more living donor transplants.”
“We face the issue of possible living donation every day because the shortage of cadaver donors persists,” says Francis Delmonico, MD, director of renal transplantation at The Massachusetts General Hospital in Boston, as well as medical director of the New England Organ Bank. “We must not only do what is right for our patients but we must also protect the health and interests of the living donor. The information we give our donors regarding their immediate and long-term well-being is critical to their decision to proceed with this transplant or not.”
Dr. Delmonico added, “The donor shortage makes us ask every potential transplant recipient if there is an opportunity for living donation. If there is, not only will that recipient’s transplant course be easier, but another patient, who does not have a suitable donor, can have an organ donated by a family after a loved one’s death. Ultimately, the increase in living donation will decrease the organ shortage.”
According to Charles Miller, MD, director of the Recanati/Miller Transplantation Institute at The Mount Sinai Hospital in New York, “Living organ donation is no longer restricted to kidney transplants but now includes the transplantation of portions of the liver and lung. By alleviating the shortage of vital organs, living donation has the potential to radically change the field of transplantation. We need a timely analysis from a national perspective. The medical and psychosocial issues involved with living donation need to be thoroughly examined and debated.”
Transplant professionals, recipients and candidates, as well as ethicists, researchers and living donors, have been invited by the steering committee to participate based on their experience and expertise. Professionals will include physicians and surgeons, social workers and transplant coordinators. Consensus work groups will be formed on kidney, liver and lung procedures and on informed consent, psychosocial process, donor sources and long-term follow-up.
There are currently 68,000 Americans waiting for a transplant. The consensus conference will benefit transplantation by focusing the judgment of experts and involved individuals on important questions that frequently arise regarding the use of living donors. Dissemination of the conference’s consensus statement and implementation of its recommendations will enhance the success and availability of transplantation for all those in need.