Position Statement Altruistic and Directed Donation 2010

Document Sample
Position Statement Altruistic and Directed Donation 2010 Powered By Docstoc
					                       Proposed Policy:

                         Directed Donation


                  South African Transplant Society
                                2010




Prepared by: Netcare Transplant Division

Approved by: ____SATS______________

Approval date: _________________
Review date: ___________________
Version: 1
POLICY STATEMENT

       i.       To ensure that the South African Transplant Society and Transplant units
                are compliant with the National Health Act No 61 of 2003 and the Human
                Tissue Act 65 of 1983 with regards to transplantation
       ii.      Provide guidelines on the ethical concerns of solicitation for organs



DIRECTED DONATION

       i.       An organ that is directed to an identified recipient, either by a living donor
                or at the bequest of a donor family.


THE LIVING RELATED / UNRELATED DIRECTED DONATION
  i.         Genetically related donor (usually a parent, sibling, son, daughter, aunt, uncle,
             nephew, niece, cousin)
 ii.         Emotionally related (usually spouse, friend or someone with whom they have
             a genuine close relationship)


       Donation of a kidney to a genetically related recipient is a well established in
       South Africa being regulated by the National Health Act No 61 of 2003.

       Donation of a kidney to an emotionally related recipient is ethically acceptable
       with Department of Health granting permission for the transplant in accordance to
       the National health Act No 61 of 2003.


GENERAL PRINCIPLES FOR RELATED / UNRELATED LIVING
DIRECTED DONATION

  i.         The donor must be over 21 years of age and be able to make an informed
             consent
 ii.         The donor must be altruistic, free from coercion
iii.         The donor may withdraw at any time before the surgery without reason
iv.          The safety and suitability of the donor and recipient must be complied with
 v.          There should be follow up of the living donor


SOLICITATION

DEFINITION

       1. “To plead or ask for something.”

                                                 2
   2. ‘To ask somebody for something”
   3. “To draw somebody into participation in illegal or immoral acts”
      Encarta Dictionary: English UK


DIRECTED LIVING DONATION WITH SOLICITATION

DEFINITION

Public media advertising appealing for a potential living donor to come forward to
donate an organ directly to the recipient.

ETHICAL CONSIDERATIONS OF SOLICITED DIRECTED LIVING
DONATION

      i.   Inappropriate transplant of unsuitable or less urgent recipients
     ii.   Recipients with greater resources and communication skills may have an
           advantage over less resources or educated recipients
    iii.   May be attempt to solicit a live donor rather then approach family or
           friends
    iv.    Potential for illegal payments or incentives to live donors even years later

GENRAL PRINCIPLES OF LIVING DIRECTED DONATION WITHOUT
SOLICITATION
     i.    Direct media and internet appeals to direct donation directly to the
           recipient are not ethically acceptable.
     ii.   Assistance with raising public awareness of organ donation in general is
           permitted. If a living altruistic donor should come forward, the Altruistic
           Donor” policy will be complied with.

           a. Currently the donor should be referred to a State hospital centre of
              excellence where all preliminary evaluations should occur
           b. Once the altruistic donor has been found competent to donate, cross
              matching can be undertaken
           c. Suitable recipients from the top of the cadaveric allocation system
              should be selected as potential candidates. This benefits many as
              everyone below shifts up a slot on the allocation system
           d. High risk recipients should not be considered as outcome of an
              altruistic donation is of great importance (MAC)
           e. The selected recipient’s insurer (State or Private sector) becomes
              responsible for all costs incurred in the donation process (CMS)
           f. The actual donation process may then occur in either health care
              sector
           g. For the donation to be truly altruistic, the donor should not request one
              recipient over another, and should this occur, the process should be
              halted




                                            3
DECEASED DIRECTED DONATION

DEFINITION

The deceased donor family directs donor organs to a specific recipient where there
is already an established relationship; family, friends or social community members
known to the family e.g. church member.


ETHICAL CONSIDERATIONS OF SOLICITED DECEASED DIRECTED
DONATIONS

          i.      Violation of a fair cadaveric allocation system by allowing recipients to
                  ‘jump’ the queue
         ii.      May allow donor families to direct donation based on conditional consent
                  to specific groups only
        iii.      Inappropriate transplant of unsuitable or less urgent recipients
        iv.       Recipients with greater resources and communication skills may have an
                  advantage over less resources or educated recipients

GENERAL PRINCIPLES OF DECEASED DIRECTED DONATION

  i.           Donor autonomy should be balanced with the rights of those on the cadaver
               waiting list.
 ii.           The directed donation should only be to recipients with whom the donor family
               or donor have an emotional bond or a family member.
 iii.          If there is no emotional bond with the recipient, and the recipient is ‘known’ to
               the donor or family by media through raising awareness of organ donor,
               provided that the recipient has not made a specific appeal for organs to be
               directed to themselves, then this should be ethically allowed.
 iv.           The donor family must be made aware that the intended recipient must be
               medically suitable and matched before the transplant and if the recipient was
               not, that the organ would be allocated according to the cadaver waiting list.
 v.            Other organs must be allocated according to the allocation system of the
               cadaver waiting list.




LEGAL FRAMEWORK

  i.           The National health Act 61 of 2003 and the Human tissue Act 65 of 1983
               covers deceased donation to a specific institution or recipient.

               (The Human tissue act 65 of 1983 still remains enforce until the regulations of
               Chapter 8 of the National Health act 61 of 2003 have been published)



                                                   4
REFRENCES:

 1. Human Tissue Act No 65 of 1983 - s 3(1)
 2. National Health Act No 61 of 2004 – Ch 8 s 63
 3. Hanto, D.W. 2007. Ethical Challenges Posed by the Solicitation of Deceased
    and Living Organ Donors. New England Journal of Medicine. 356:10. 1062-
    1066.
 4. Truog, R.D. 2005. The Ethics of Organ Donation by Living Donors. New
    England Journal of Medicine. 353:5. 444- 446.
 5. Department of Health, New South Wales. Policy Directive. Kidney Donation –
    Living (including Directed and Non- directed Donation). Available online:
    http://www.health.nsw.gov.au/policies/pd/2009/pdf/PD2009_013.pdf
 6. Declaration of Istanbul on Organ Trafficking and transplant Tourism. Turkey
    30 April – 2 May 2008.
 7. Interm Report of the OPTN/UNOS Ethics Committee. Chicago. 7 December
    2009. Available on line:
    http://www.unos.org/CommitteeReports/interim_main_EthicsCommittee_1_5_
    2010_9_18.pdf
 8. World Health Organization. Sixty Second World Health Assembly. 26 March
    2009. Guiding Principle 6. pg 10. Available at:
    http://apps.who.int/gb/ebwha/pdf_files/A62/A62_15-en.pdf
 9. Statement on Directed Donation and Solicitation of Organs. American Society
    of Transplant Surgeons. 23 October 2006. Available at:
    http://www.asts.org/Tools/Download.aspx?fid=269




                                        5

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:6
posted:5/19/2012
language:
pages:5