Barriers to live and deceased kidney donation by patients with chronic neurological diseases: Implications for donor selection, donation timing, logistics, and regulatory compliance
| Autor: | Junichiro Sageshima, Richard V Perez, Chandrasekar Santhanakrishnan, John P. McVicar, Christoph Troppmann |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male United Network for Organ Sharing Brain Death medicine.medical_specialty Time Factors Tissue and Organ Procurement Public debate 030230 surgery Donor Selection Compliance (psychology) 03 medical and health sciences 0302 clinical medicine Living Donors medicine Humans Immunology and Allergy Pharmacology (medical) Intensive care medicine Transplantation Donor selection business.industry Amyotrophic Lateral Sclerosis Graft Survival Kidney donation Kidney Transplantation Circulatory death Organ procurement Donation business |
| Zdroj: | American Journal of Transplantation. 19:2168-2173 |
| ISSN: | 1600-6135 |
| DOI: | 10.1111/ajt.15230 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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