Barriers to live and deceased kidney donation by patients with chronic neurological diseases: Implications for donor selection, donation timing, logistics, and regulatory compliance.
Am J Transplant
; 19(8): 2168-2173, 2019 08.
Article
en En
| MEDLINE
| ID: mdl-30582272
Live and deceased kidney donation by the numerous patients with advanced, progressive systemic neurological diseases, and other chronic neurological conditions (eg, high C-spine injury) remains largely unexplored. In a review of our current clinical practice, we identified multiple regulatory and clinical barriers. For live donation, mandatory reporting of postdonation donor deaths within 2 years constitutes a strong programmatic disincentive. We propose that the United Network for Organ Sharing should provide explicit regulatory guidance and reassurance for programs wishing to offer live donation to patients at higher risk of death during the reporting period. Under the proposal, live donor deaths within 30 days would still be regarded as donation-related, but later deaths would be related to the underlying disease. For deceased donation, donation after circulatory death (DCD) immediately following self-directed withdrawal of life-sustaining treatment ("conscious DCD") is not universally covered by existing DCD agreements with donor hospitals. Organ procurement organizations should thus systematically strive to revise these agreements. Obtaining adequate first-person consent from these communicatively severely impaired patients may be challenging. Optimized preservation and allocation protocols may maximize utilization of these DCD kidneys. Robust public debate and action by all stakeholders is necessary to lower existing barriers and maximize donation opportunities for patients with chronic neurological conditions.
Palabras clave
Organ Procurement and Transplantation Network (OPTN); clinical research/practice; donors and donation: donation after circulatory death (DCD); donors and donation: donor evaluation; donors and donation: living; ethics; ethics and public policy; kidney transplantation/nephrology; law/legislation; organ procurement and allocation
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Obtención de Tejidos y Órganos
/
Muerte Encefálica
/
Trasplante de Riñón
/
Donadores Vivos
/
Selección de Donante
/
Esclerosis Amiotrófica Lateral
Tipo de estudio:
Guideline
/
Prognostic_studies
Límite:
Adult
/
Humans
/
Male
Idioma:
En
Revista:
Am J Transplant
Asunto de la revista:
TRANSPLANTE
Año:
2019
Tipo del documento:
Article
Pais de publicación:
Estados Unidos