Transplantation
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Editorial Review
Whose consent matters? Controlled donation after cardiac death and premortem organ-preserving measures.
The goal of this overview is to discuss the ethics of premortem organ-protective measures with the aim of improving donation outcome for the recipient. A literature review was undertaken to find out which such measures were implemented in published articles on controlled donation after cardiac death. We reviewed studies on controlled human organ donation after cardiac death that were published in PUBMED and EMBASE between 2000 and 2010. ⋯ The authors conclude that premortem measures have the potential to instrumentalize the organ donor and that they should be restricted to cases in which the donor wish is known-directly, through a donor card, or through a surrogate decision maker-and specific consent to premortem procedures has been given. This specific consent should be required at least until the general public is aware that premortem measures may be performed. If potential donors were informed about premortem measures as part of a community information effort, for example, school curricula, and again when they signed their donor card, one might consider their consent to be truly informed and valid.
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Israel's rates of organ donation have been one of the lowest among developed countries. An attempt to change this has led to the introduction of a pioneering new law, the Organ Transplant Act 2008, which came into effect in January 2010 and sets out principles underlying a new policy in relation to the allocation of organs for transplantation. ⋯ In this opinion piece, we argue that although this approach merits attention for its innovative aspects and its potential benefits, it raises some ethical difficulties. In particular, we discuss some problems of justice and fairness inherent in the system, focusing on inequalities because of the (a) number of relatives one might have, (b) the type of living donation one makes, (c) the potential for strategic behavior, and (d) problems regarding the consent of family members.
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Prior analyses of transplant outcomes in lupus transplant recipients have not consisted of multivariate analyses in the modern immunosuppressive era. Here, we compared patient and graft outcomes in lupus and non-lupus recipients transplanted between 1996 to 2000 using the United Network of Organ Sharing/Organ Procurement Transplant Network database. We evaluated the impact of recipient and donor demographic factors, time on dialysis and the initial immunosuppression regimen on rejection rates and transplant outcomes. ⋯ Risk of graft failure was lower for deceased donor recipients receiving MMF (five-year graft loss rate=29.6% for MMF vs. 40.2% for those not receiving MMF, P<0.0001), but no differences were seen among living donor recipients. Outcomes were similar regardless of type of calcineurin inhibitor, induction therapy, and time on dialysis. We conclude that lupus transplant recipients have outcomes generally equivalent to non-lupus transplant recipients.