Transplant Community Issues Consensus Statement on Live Organ Donation

Representatives of the transplant community, including recipients and donors, physicians and other healthcare providers, ethicists, lawyers, and scientists, met in June to develop a consensus statement that would apply to all living organ donors.

“The transplant community came together to address a most important issue,” Dr. Francis L. Delmonico, of Harvard Medical School, in Boston, told Reuters Health.

The statement of the Live Organ Donor Consensus Group, of which Dr. Delmonico was an executive committee member, appears in the December 13th issue of The Journal of the American Medical Association.

Central to the consent process is that the potential donor be fully informed of risk and benefits to self and to the recipient, the group holds. The donor should be aware of potential complications, including death, and medical uncertainties regarding long-term donor complications. The group also notes that donors should be informed of the potential impact on their ability to obtain health and life insurance, or even future employment.

“Perhaps the best measure of a successfully informed donor,” the group writes, “is determined by whether the donor is surprised by anything that happens after consent is given.” The authors suggest several possible ways “to help the potential donor gracefully withdraw from an uncomfortable situation.”

According to Dr. Delmonico, the group had particular difficulty reaching consensus on aspects of the living donor exchange programs, such as situations where “the incompatible living donor would provide an allograft to a patient on the cadaver waiting list in exchange for the cadaver donor pool providing a priority allograft (ie, ABO compatible) to the donor’s incompatible recipient.”

The group endorsed the development of a living donor registry to contain demographic, clinical, and outcome information. According to Dr. Delmonico, “The American Society of Transplant Surgeons has initiated a live donor liver registry, and the National Kidney Foundation is eager to do so with kidney donors.”

The group also supports the initiation of a steering committee to oversee the development of a registry that would include live donors of pancreas, liver, intestine, lung, and kidney. However, Dr. Delmonico said, lack of funding has prevented the formation of such a committee thus far.