Living Donor Advocacy

The inadequate supply of organs in the United States and other countries continues to drive the reliance on living donor transplantation. In 2000, representatives of the transplant community convened for a meeting on living donation in an effort to provide guidelines to promote the welfare of living donors. The consensus statement that resulted from this meeting recommended that transplant centers retain an Independent Living Donor Advocate (ILDA) to focus on the best interest of the donor. A decade later, nearly every transplant center in the United States, performing living donor surgeries, has incorporated an ILDA into their living donor screening and/or evaluation process Living Donor Advocate provides an overview of living donation and its risks, ethical challenges and future developments​, as well as details about the role a Living Donor Advocate plays in the transplantation process. This book will interest health professionals across various disciplines and patients undergoing transplantation or living donor surgery.

This book provides a complete guide to the evaluation, care, and follow-up of living kidney donors. Living donor kidney transplantation is established as the best treatment option for kidney failure. However, despite the tremendous benefits of living donation to recipients and society, the outcomes and optimal care of donors themselves have received relatively less attention. Fortunately, things are changing – including recent landmark developments in living donor risk assessment, policy and guidance. This volume offers authoritative, evidence-based guidance on the full range of clinical scenarios encountered in the evaluation and care of living kidney donors. The approach to key elements of risk assessment, ethical considerations and informed consent is accompanied by recommendations for patient-centered care before, during, and after donation. Advocacy initiatives and policies to remove disincentives to donation and advance a defensible system of practice are also discussed. General and transplant nephrologists, as well as related allied health professionals, can look to this book as a comprehensive resource addressing contemporary clinical topics in the practice of living kidney donation.

Rates of organ donation lag far behind the increasing need. At the start of 2006, more than 90,000 people were waiting to receive a solid organ (kidney, liver, lung, pancreas, heart, or intestine). Organ Donation examines a wide range of proposals to increase organ donation, including policies that presume consent for donation as well as the use of financial incentives such as direct payments, coverage of funeral expenses, and charitable contributions. This book urges federal agencies, nonprofit groups, and others to boost opportunities for people to record their decisions to donate, strengthen efforts to educate the public about the benefits of organ donation, and continue to improve donation systems. Organ Donation also supports initiatives to increase donations from people whose deaths are the result of irreversible cardiac failure. This book emphasizes that all members of society have a stake in an adequate supply of organs for patients in need, because each individual is a potential recipient as well as a potential donor.

Cover -- Title -- Copyright -- Contents -- Acknowledgments -- Introduction: The Organ Shortage Crisis in America -- Motivations for Giving, Especially of Precious Goods -- Civic Duty -- A Word about the Audience and Purpose of This Book -- Organization -- Notes -- 1. The Case for Legalizing the Sale of Organs -- The Market as a Solution, If Not a Virtue -- Costs and Equity -- The "Tyranny of the Gift -- Financial Incentives, Libertarianism, and the Black Market -- The Unique Case of Iran -- A Legal, Regulated Market for Organ Trade -- Notes -- 2. Ethical Concerns with Legalizing the Sale of Organs -- The Utility of Utility -- Selling Organs and the Impoverished -- Selling Organs and Public Safety -- Commodification -- Moving from Ethical to Pragmatic Considerations -- Notes -- 3. Organ Donation, Financial Motivation, and Civic Duty -- Paying It Forward -- Wolfenschiessen, Switzerland -- How Buying a Good Changes a Good -- The Difference between Lump-Sum Incentives and Compensatory Measures -- Civic Duty -- Notes -- 4. Living Donors and the Confluence of Altruism and Self-Regard -- Complex Human Motivations and the Myth of Unmotivated Altruism -- Living Donors and Living Donor Advocacy -- The Health Benefits of Living Donation -- Reflections of a Living Donor Advocate -- Notes -- 5. Making Altruism Practical -- Reducing Disincentives and Opening Doors to Virtue -- Paired Exchanges and Donor Chains -- Creating Incentives to Opt In -- Lost Wages and Travel Expenses -- Publicly Acknowledging Living Donors -- Nonmonetary Valuable, Comparable Goods -- Helping Virtue Along -- Notes -- Conclusion: Two to Four Hours of Your Life -- Notes -- Index -- A -- B -- C -- D -- E -- F -- G -- H -- I -- J -- K -- L -- M -- N -- O -- P -- Q -- R -- S -- T -- U -- V -- W -- Z -- About the Author

The organ donation and transplantation system strives to honor the gift of donated organs by fully using those organs to save and improve the quality of the lives of their recipients. However, there are not enough donated organs to meet the demand and some donated organs may not be recovered, some recovered organs may not be transplanted, and some transplanted organs may not function adequately. Organ donor intervention research can test and assess interventions (e.g., medications, devices, and donor management protocols) to maintain or improve organ quality prior to, during, and following transplantation. The intervention is administered either while the organ is still in the deceased donor or after it is recovered from the donor but before it is transplanted into a recipient. Organ donor intervention research presents new challenges to the organ donation and transplantation community because of ethical questions about who should be considered a human subject in a research study, whose permission and oversight are needed, and how to ensure that such research does not threaten the equitable distribution of a scarce and valuable resource. Opportunities for Organ Donor Intervention Research focuses on the ethical, legal, regulatory, policy, and organizational issues relevant to the conduct of research in the United States involving deceased organ donors. This report provides recommendations for how to conduct organ donor intervention research in a manner that maintains high ethical standards, that ensures dignity and respect for deceased organ donors and their families, that provides transparency and information for transplant candidates who might receive a research organ, and that supports and sustains the public's trust in the process of organ donation and transplantation.

Edited by leaders at one of the acclaimed transplant institutions in the United States, this reference covers all aspects of living donor solid organ and cellular transplantation in current clinical practice, including the kidney, liver, pancreas, lung, small bowel, islet, and hematopoietic stem cell transplantation. Detailed, engaging, and organ-

With a current US need of over 115,000 organs one would think that Good Samaritan donors would be welcomed with open arms by transplant centers and society in general; however, this is often not the case. Tell someone that you have donated an organ to a stranger and the reaction is likely to be one of astonishment and disbelief. Some doctors even consider people who offer their organs to strangers crazy. Why would anyone do that? Who are these people so committed to helping others-strangers-that they would undergo surgery, discomfort, and disruption of their lives? This book profiles donors who have offered their organs to strangers and helps readers understand the meanings behind their donations. For the donor, altruism should always be the primary motivation, though other motivations often come into play. Often, there are also subconscious reasons for performing this great act of kindness. The Organ Donor Experience gives living anonymous organ donors of kidneys, liver lobes, and lung lobes the opportunity to tell their stories as they understand them, and for others to understand the motivations and the meaning of true altruism.