AJT Report: How do we convey the risks of organ donation to potential donors?

[Clark]

http://onlinelibrary.wiley.com/doi/10.1111/ajt.13471/full


The AJT Report
Sue PondromDOI: 10.1111/ajt.13471

Playing the Odds
How do we convey the risks of organ donation to potential donors?

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How to Move Forward
Dr. Reese has wondered whether there might be ways to directly bring a potential donor's voice into selection committee meetings, perhaps as video or a recorded message. This would allow donors to explain why the procedure really matters to them, and what effect the decision would have on them if they are declined.

Dr. Reese, Dr. Gordon and their colleagues at Yale University in New Haven, Conn., are advocates of a donor-centered approach to risk assessment. Additionally, the team is more than halfway through a grant from the Greenwall Foundation to look at donor autonomy in decision making. The principal investigator of the grant, Sanjay Kulkarni, MD, director of kidney and pancreas transplantation at the Yale Transplant Research Unit, would like to develop tools to objectively assess donor risk tolerance, and develop donor–center models of care where potential donors engage in a joint decision-making process with transplant centers.

Dr. Lentine would like to see the development of more objective guidelines for donor selection, and use of center-specific thresholds for acceptable, predicted risk of events such as ESRD. However, she does not support proposals for varying acceptance thresholds by donor–recipient relationship, as the psychosocial benefits of donation, including emotional gains from pure altruism, are highly personal.

“I think we're in a transition period right now,” says Dr. Reese. “We may have a challenging period where people struggle with this new information, decide what it means, and if they believe it. My belief is we are going to change our approach a little bit so that, in the future, we'll wind up taking about as many donors as we do now, but because of concerns about ESRD, we'll start thinking about choosing a different profile of donor.”