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Ethical Considerations Living Donor Protections

American Society of Transplantation and Living Donor Protections

AST, aka the American Society of Transplantation, recently announced the launch of new “Live Donor Community of Practice“. According to the website, the COP will:

“work to define standards and promote best practices for the evaluation and care of live organ donors while enhancing the quality, effectiveness and integrity of the living donor process.”

 

AST doesn’t have a membership directory available to the public, so I looked up their membership definitions, which are as follows:

 

Full Membership..any individual residing within the United States, Canada or Mexico who is actively engaged in the science and clinical practice of organ and tissue transplantation. Physicians and surgeons…shall have primary Board certification by one of the American Boards or their foreign equivalents and shall have completed one year of committed advanced training or have at least one year of experience in the science and clinical practice of organ and tissue transplantation. Individuals not holding MD, PhD, PharmD DO, or an equivalent doctoral degree shall have demonstrated a committed interest by having at least one year of professional experience in the field of transplantation.

International Membership shall have the same qualifications as full members except that these members shall be residents of countries other than the United States, Canada and Mexico.

Trainee Membership shall be limited to individuals who is enrolled in a predoctoral or postdoctoral training programs relevant to the science and clinical practice of organ and tissue transplantation and individuals who have completed their training but have not yet qualified for full or international membership.

 

So, in all probability, the members of AST are employed at hospitals (or universities affiliated with hospitals) containing transplant programs – or they will be soon.

And transplant programs are all members of OPTN.

And OPTN is responsible for developing policies related to living donation, including standards of care. Such policies, which originate in various committees populated by members of the transplant industry, must be approved or rejected by its members before being implemented.

 

In other words, the folks at AST have had nearly sixty years since the first living kidney donor transplant, or almost thirty years since the advent of OPTN, to ‘define standards’ and ‘promote best practices’ for living donors. Yet now they’ve created a COP to do what they’ve so far failed to do.

Hmm.

 

Quick web searches turned up the following information on the COP’s Executive Committee members:

 

Dianne LaPointe Rudow, DNP – Director, Living Donor Wellness Center, Mt. Sinai hospital

David Cohen, MD – Professor of Clinical Medicine, Columbia University (Presbyterian Hospital)

Catherine Garvey, RN, BA, CCTC – Living donor transplant coordinator at the University of Minnesota Medical Center in Minneapolis. Also, a member of the advisory committee for the National Living Donor Assistance Center (this is the group that uses tax money to fly a living donor across the country so they can give up a kidney, but does nothing to ensure they receive high quality care).

Rebecca Hayes, MSW – University of Wisconsin Hospital. Editorial Board of NKF’s Transplant Chronicles in 2006, current member of NKF’s Council of Nephrology Social Workers, and NKF’s* Living Donor Council.

Dr. Didier Mandelbrot – Medical Director of the Living Kidney Donor Program at Beth Israel Medical Center

Jim Rodrigue, PhD – Transplant Psychologist at Beth Israel. Please note his job description is purely recipient-oriented and says nothing about the well-being of living donors.

Helen Spicer, RN, CCTC – Clinical Director at Virginia Transplant Center at Henrico Doctors’ Hospital. Review her brief professional biography here. Notice that she serves on the National Kidney Foundation’s* Council of Professional Living Donor Advocates when nothing in her resume indicates a focus toward protecting or caring for living donors.

Robert Steiner, MD – Prof of Medicine, division of nephrology and hypertension, University of California, San Diego. Also the author of the 2004 book, “Educating, evaluating, and selecting living kidney donors”. Dang thing is $150 so I have no further info.

 

While non-members are invited to join the COP for one year, they are required to join the organization after that time. According to the membership definitions, the COP will then be full of no one but the same voices responsible for the current state of living donor care in the US. In other words, meet the new boss, same as the old boss.

 

 

*The National Kidney Foundation’s mission: “…dedicated to preventing kidney and urinary tract diseases, improving the health and well-being of individuals and families affected by kidney disease and increasing the availability of all organs for transplantation.”

Once again, there is an inherent conflict between increasing ‘all’ organs for transplantation and caring for living donors. Too often a choice will have to be made between obtaining a transplant for a recipient, and protecting a prospective living donor from harm. Historically NKF has always come down on the side of the recipient. See more thoughts on this here.

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