RESUMO
Current literature and policy in pediatric liver allocation and organ procurement are reviewed here in narrative fashion, highlighting historical context, ethical framework, technical/procurement considerations, and support for a logical way forward to an equitable pediatric liver allocation system that will improve pediatric wait-list and posttransplant outcomes without adversely affecting adults. Where available, varying examples of successful international pediatric liver allocation and split-liver policy will be compared to current US policy to highlight potential strategies that can be considered globally. Liver Transplantation 23:86-95 2017 AASLD.
Assuntos
Doença Hepática Terminal/cirurgia , Transplante de Fígado/legislação & jurisprudência , Seleção de Pacientes/ética , Coleta de Tecidos e Órgãos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Listas de Espera/mortalidade , Adulto , Aloenxertos/normas , Brasil , Canadá , Criança , Doença Hepática Terminal/mortalidade , Europa (Continente) , Sobrevivência de Enxerto , Política de Saúde , Humanos , Cooperação Internacional/legislação & jurisprudência , Transplante de Fígado/ética , Transplante de Fígado/tendências , Índice de Gravidade de Doença , Coleta de Tecidos e Órgãos/ética , Coleta de Tecidos e Órgãos/métodos , Coleta de Tecidos e Órgãos/tendências , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/métodos , Obtenção de Tecidos e Órgãos/tendências , Estados UnidosRESUMO
Recommendations from the 2014 Consensus Conference on Best Practices in Living Kidney Donation reflect increasing attention to overcoming barriers to donation as a means of expanding access to living donor kidney transplantation. "High priority" initiatives include empowering transplant candidates and their loved ones in their search for a living kidney donor. Transplant programs are assuming an unprecedented role as facilitators of patients' solicitation for donors, and nonprofits are promoting living kidney donation (LKD) in the community. New strategies to promote LKD incorporate "nonargumentative" forms of influence (i.e. approaches to shaping behavior that do not attempt to persuade through reason) such as appeals to emotion, messenger effects and social norms. These approaches have raised ethical concerns in other settings but have received little attention in the transplantation literature despite their increasing relevance. Previous work on using nonargumentative influence to shape patient behavior has highlighted implications for (1) the relationship between influencer and influenced and (2) patient autonomy. We argue that using nonargumentative influence to promote LKD is a promising strategy that can be compatible with ethical standards. We also outline potential concerns and solutions to be implemented in practice.
Assuntos
Transplante de Rim/ética , Doadores Vivos , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto/normas , Coleta de Tecidos e Órgãos/ética , Consenso , Humanos , NefrectomiaRESUMO
El progreso de la ciencia y en especial el de los trasplantes de riñón amerita muchas reflexiones éticas, pues no todos los dilemas que se presentan se han solucionado y algunos no han sido tomados como tales. Los donantes vivos pueden ser sujetos a coacción, pues adquieren un compromiso con la familia, la sociedad y el equipo de salud para donar su riñón. Muchos en realidad no lo quieren hacer, aunque en los libros aparezca la donación como el mayor acto de amor y solidaridad. No todos los hijos quieren a sus padres y viceversa, ni todos los hermanos se quieren entre sí. Son muy importantes los conceptos de solidaridad y amor, que no suelen aparecer de manera espontánea en la vida de los individuos. Amor es un arte que implica dar pero de una forma madura. ¿Tendrán todos los donantes esta capacidad de dar? Si no la tienen es probable que estén siendo víctima de una coacción. Como existen tantos dilemas éticos con el trasplante de riñón, la bioética ayuda a dar respuesta a tantas inquietudes para poder colaborar con más efectividad a los involucrados en él.
Scientific breakthroughs, especially kidney transplantation, deserve serious ethical reflections for not all dilemmas that arise have been addressed and some have not been contemplated as such. Live donors could be subject to coercion in favor of donating their kidney for they have acquired a commitment with their relatives, society and health teams. Although donation appears in literature as the greatest act of love and solidarity not all live donors are actually willing to give up their kidney. Not all sons and daughters love their parents or parents love their children, nor all siblings love each other. Such important concepts as solidarity and love are not commonly manifest spontaneously in the life of individuals. Love is considered an art which implies giving in a mature manner. Will all donors have this ability? If they lack this ability they are more likely being victims of coercion. As various ethical dilemmas on kidney transplantation exist, bioethics has helped answer many questions in order to furnish an effective support to all who are involved.
Assuntos
Humanos , Insuficiência Renal , Transplante de Rim/ética , Coleta de Tecidos e Órgãos/ética , Transplante de Órgãos/éticaRESUMO
A discussion of four aspects of the legislation and of the medical ethics of the transplants is presented: the concept of death, the donation of organs, the selection of receivers and the future of the therapeutic transplants. The prominent paragraphs of the General Law of Health of the country about cerebral death, the two legal forms and organs donors' ethics, the criteria and more frequent problems for the selection of receivers, and the character of medical technology of transition of the therapeutic transplants are included.
Assuntos
Transplante/ética , Transplante/legislação & jurisprudência , Adulto , Morte Encefálica/diagnóstico , Cadáver , Criança , Mercantilização , Morte , Diagnóstico Diferencial , Doação Dirigida de Tecido , Previsões , Parada Cardíaca , Direitos Humanos , Humanos , Consentimento Livre e Esclarecido , Cuidados para Prolongar a Vida , México , Propriedade , Seleção de Pacientes , Estado Vegetativo Persistente/diagnóstico , Doadores de Tecidos , Coleta de Tecidos e Órgãos/ética , Coleta de Tecidos e Órgãos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/legislação & jurisprudênciaRESUMO
End-stage liver disease is being treated by liver transplantation since more than 20 years. Despite social and legislative efforts, the number of cadaveric organs suitable for liver transplantation has not grown to match the surplus of patients with end-stage liver disease. With the growing discrepancy between donors and recipients, the median waiting time for liver transplantation has increased dramatically. As a result, the number of patients who die while waiting is increasing. To attempt to meet the growing needs of recipients, surgeons are developing innovative techniques to increase the number of donated livers. These include: split liver transplantation and transplantation of a part of the liver from living donors. This review will focus on adult-to-adult transplantation of the right lobe from a living donor.