Date: Sunday, April 30, 2017
Session Time: 2:30pm-4:00pm
Presentation Time: 3:18pm-3:30pm
Advanced Donation (ADP) within Kidney Paired Donation (KDP) occurs when a donor is time-limited and chooses to donate a kidney before their intended recipient with CKD actually requires a transplant. This donation to a KPD chain may occur years or decades before the intended recipient needs a kidney. We describe four such cases our center and its potential ramifications.
Case 1: a 52-year-old man in good health whose daughter received a well functioning kidney transplant in 2007. She is now 19 and her creatinine is 0.9 mg%. The donor, anticipating that his young daughter will likely need another transplant in the future, decided to donate a kidney now, while he is still relatively young and in good health, thereby guaranteeing his daughter a live kidney transplant in the future through the KPD program.
Case 2: 60 year old aunt donating on behalf of the same recipient in Case 1.
Case 3: 38 year old father donated on behalf of his 14 year old daughter who has a maternal history of PKD.
Case 4: 62 yr old man donating on behalf of his son with H-S Purpura who is 36 years old and has a well functioning living donor transplant from 2014.
In most cases of advanced donation in a KPD program the intended recipient receives a kidney usually within weeks to months. In our cases the recipient will receive a future kidney in several years or even perhaps several decades. Our donors received informed consent beyond the usual living donor and KPD informed consents. The ADP donor had to acknowledge and consent to several possible outcomes, including these: the KPD program may never find a future match for the recipient, the recipient may be associated with a different hospital in the future that is not associated with a KPD program, the recipient may never need another kidney or may die naturally before a kidney is ever needed, the KPD program may dissolve in the future leaving no mechanism to pay the kidney back to the recipient.
Conclusion: Advanced Donation is a recently added mechanism within KPD and, while intriguing, may be fraught with ethical and legal challenges. The KPD community needs to explore the ethics and legality of donating kidneys months to years in advance of the intended recipient surgery and what resources might be made available to recipients who never receive that future kidney.
CITATION INFORMATION: Charlton M, Desrosiers F, Bretzlaff G, Serur D. Advanced Donation within a Paired Exchange Program. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Charlton M, Desrosiers F, Bretzlaff G, Serur D. Advanced Donation within a Paired Exchange Program. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/advanced-donation-within-a-paired-exchange-program/. Accessed June 5, 2020.
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