The shortage of available cadaveric organs for transplantation and the growing demand has
incresed live donation. To increase the number of transplantations from living donors,
programs have been implemented to coordinate donations in direct or indirect form (crossover,
paired, and domino chain). Living donors with complex medical conditions are
accepted by several transplantation programs. In this way, the number of transplants from
living has exceeded that from cadaver donors in several European countries. No mortality
has been reported in the case of lung, pancreas, or intestinal Living donations, but the
perioperative complications range from 15% to 30% for pancreas and lung donors. In
living kidney donors, the perioperative mortality is 3 per 10,000. Their frequency of endstage
renal disease does not exceed the United States rate for the general population.
However, long-term follow-up studies of living donors for kidney transplantations have
several limitations. The frequency of complications in live donor liver transplantation is
40%, of these, 48% are possibly life-threatening according to the Clavien classification.
Residual disability, liver failure, or death has occurred in 1% of cases. The changes in live
donor acceptance criteria raise ethical issues, in particular, the physician’s role in evaluating
and accepting the risks taken by the living donor. Some workers argue to set aside
medical paternalism on behalf of the principle of donor autonomy. In this way the medical
rule “primum non nocere” is overcome. Transplantation centers should reason beyond the
shortage of organs and think in terms of the care for both donor and recipient.
- ethical evaluation
- living donor transplantation