Minimum criteria ensure consistent evaluation

Living donors are evaluated in a consistent fashion.

There is “an enormous disparity” between the number of patients with end-stage organ failure and the number of organs available for transplantation, resulting in patients dying on the waiting list, according to Christie P. Thomas, MD, professor in the Division of Nephrology at University of Iowa Health Care in Iowa City and chair of the Organ Procurement and Transplantation Network’s (OPTN) Living Donor Committee. “This has led to attempts by various societies to increase both deceased and living organ donation, which can raise new ethical concerns,” he says. “There are always safety and privacy concerns for the recipient of the organ, whether it comes from a living or a deceased donor.”

There are similar safety and privacy concerns in the evaluation and acceptance of living donors, but there are additional concerns about informed consent, ensuring that there is no inducement or coercion of the donor and that there is no financial gain or other “quid pro quo” for the donor in exchange for the donation, explains Thomas.

“Societal needs for more organs have resulted in live donors stepping up to fill the gap between supply and demand. Living donors place themselves at risk for the sake of another human being, despite the lack of benefit to themselves,” says Thomas.

Living donation will never be without risk, and given the pressure to increase donation, the transplant community must strive to keep living donation as safe as possible, he urges. “We must ensure that the living donor is well-informed, is aware of the short- and long-term risks of donation, and that donation is truly voluntary,” says Thomas.

New mandatory policies

The OPTN’s new mandatory policies that all transplant centers must follow became effective in February 2013. These cover all aspects of the living donation process, from informed consent through evaluation to follow-up. “These new policies are designed to maintain and enhance safety for living donors, and should make the living donation process a more consistent experience for them,” says Thomas.

Transplant centers that have the best interests of their patients on the waiting list are usually the same centers that evaluate and consent living donors and perform their donor surgeries, notes Thomas. “While this can introduce a conflict between the well being of the living donor and the needs of the transplant candidate, centers have multiple ways to manage this conflict,” he says. First, every center provides the living donor candidate with an independent donor advocate who is knowledgeable about the risks and benefits associated with the donation process.

“The independent donor advocate assists the potential living kidney donor with the evaluation process, and promotes the best interests of and advocates for the potential living donor,” he says. Second, every living donor interacts individually with many health care professionals, who approach the living donor with a different perspective and a different goal. All members of the team must be satisfied that the living donor is acceptable.

Finally, the new policies that govern all aspects of living donation set minimum criteria that all centers must follow during all phases of the living donation process, which ensures that living donors are evaluated in a consistent fashion. “This set of policies also categorizes particular conditions or circumstances that, if identified in a living donor candidate, will result in the candidate being excluded from donation,” adds Thomas.