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Donor Risk (donor + risk)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Analysis of Donor Risk in Living-Donor Hepatectomy: The Impact of Resection Type on Clinical Outcome

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2002
Ephrem Salamé
The progressive shortage of liver donors has mandated investigation of living-donor transplantation (LDT). Concerns about increasing risk to the donor are evident, but the impact of the degree of parenchymal loss has not been quantified. We analyzed clinical and biological variables in 45 LDT performed by our team over 2years to assess risks faced in adult LDT. All donors are alive and well with complete follow-up through to February 2001. When the three operations were compared, right hepatectomy (RH) was significantly longer in terms of anesthesia time and blood loss compared with left hepatectomy (LH) and left lobectomy (LL). Donor remnant liver was significantly reduced after RH compared with LH and LL. There were significant functional differences as a consequence of the remnant size, measured by an increase in peak prothrombin time after RH. RH for adults represents a markedly different insult from pediatric donations in terms of parenchymal loss and early functional impairment. Left hepatectomy donation offers modest advantage over right lobes but seems to confer substantial technical risk for a small gain in graft size. Unless novel strategies are developed to enhance liver function of the LH graft in the adult recipient, right lobe donation will be necessary for adult LDT. [source]

Acute liver failure and living donor liver transplantation

HEPATOLOGY RESEARCH, Issue 2008
Nobuhisa Akamatsu
Acute liver failure (ALF) is defined by the presence of hepatic encephalopathy due to severe liver damage in patients without pre-existing liver disease. Although the mortality of ALF without liver transplantation is over 80%, the survival rates of ALF patients have improved considerably with the advent of liver transplantation, up to 60,80% in the last decade. Living donor liver transplantation (LDLT), which has mainly evolved in Asian countries where organ availability from deceased donors is extremely scarce, has also improved the survival rate of ALF patients. According to recent reports, the overall survival rate of adult ALF patients who underwent LDLT is 60% to 90%. Although there is still controversy regarding the graft type, the optimal graft volume, and ethical issues of defining the indications for LDLT in ALF patients with respect to donor risk, LDLT has become an established treatment option for ALF in areas where the use of deceased donors organs is severely restricted. [source]

The impact of the model for end-stage liver disease on recipient selection for adult living liver donation

LIVER TRANSPLANTATION, Issue 10C 2003
Richard B. Freeman
Key points 1. The Model for End-Stage Liver Disease (MELD) system can be used to assess recipient pre-transplant risks and help select appropriate candidates for the adult to adult living donation liver transplant procedure. 2. Selection of candidates for the adult to adult living donation liver transplant procedure requires assessment of candidate risk of death without a transplant, risk of death with a transplant, and donor risk of death. 3. Understanding of the risks involved allows for development of clinical decision models to inform the risk benefit analyses. 4. MELD provides a useful, objective, and universal tool for clinicians around the world to estimate risks for clinical decision making in all forms of liver transplantation. [source]

Limiting Financial Disincentives in Live Organ Donation: A Rational Solution to the Kidney Shortage

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 11 2006
R. S. Gaston
Availability of kidney transplantation is limited by an inadequate supply of organs, with no apparent remedy on the immediate horizon and increasing reliance on living donors (LDs). While some have advocated financial remuneration to stimulate donation, the National Organ Transplant Act (NOTA) of 1984 expressly forbids the offer of ,valuable consideration.' However, recent developments indicate some fluidity in the definition of valuable consideration while evolving international standards highlight deficiencies (particularly regarding long-term care and follow-up) in the current American system. Recognizing that substantial financial and physical disincentives exist for LDs, we propose a policy change that offers the potential to enhance organ availability as well as address concerns regarding long-term care. Donors assume much greater risk than is widely acknowledged, risk that can be approximated for the purpose of determining appropriate compensation. Our proposal offsets donor risk via a package of specific benefits (life insurance, health insurance and a small amount of cash) to minimize hazard and ensure donor interests are protected after as well as before nephrectomy. It will fund medical follow-up and enable data collection so that long-term risk can be accurately assessed. The proposal should be cost effective with only a small increase in the number of LDs, and the net benefit will become greater if removal of disincentives stimulates even further growth. As importantly, by directly linking compensation to risk, we believe it preserves the essence of kidney donation as a gift, consistent with NOTA and implementable in the United States without altering current legal statutes. [source]