Recipient Death During a Live Donor Liver Transplantation: Who Gets the Orphan Graft?

[Guest guest]

Transplantation. 2004 Nov 15;78(9):1241-1244.

Recipient Death During a Live Donor Liver Transplantation: Who Gets the

" Orphan " Graft?

Siegler J, Siegler M, Cronin DC 2nd.

Department of Surgery, University of Chicago, Chicago, Illinois.; Department

of Medicine, University of Chicago, Chicago, Illinois.; The MacLean Center

for Clinical Medical Ethics, University of Chicago, Chicago, Illinois.;

Organ Transplantation and Immunology, Yale University School of Medicine,

New Haven, Connecticut.

The limited availability of deceased organ donors, prolongation of waiting

time, and increasing number of patients dying awaiting transplantation have

contributed to the increased use of adult-to-adult living-donor liver

transplant. In the event that the intended recipient dies after the donor

graft has been procured but before it has been transplanted, what should be

done with the graft? A structured, nine-item oral survey of 26 experts in

liver transplantation was conducted in June and July 2003. Respondents were

selected primarily because of their extensive experience with liver

transplantation, especially adult-to-adult living-donor transplant. All

respondents said the surgical team should try to use the available graft for

another recipient. Twenty-one respondents believed consent from the donor or

the donor's family was required for allocation, whereas 19% believed consent

desirable but not required. Nine respondents recommended an allocation

organization place the graft, whereas 17 respondents recommended placement

within the donor hospital. Two of the respondents had previously encountered

this situation, whereas four had experienced an intraoperative recipient

death before procurement of a live donor graft. On the basis of the

responses, we offer the following recommendations for handling orphan liver

grafts: (1) obtain predonation informed consent from all donors that

indicates what the donor would want to have done with the " orphan graft " in

all cases of living-donor liver transplantation; (2) avoid the premature

removal of the donor graft until the recipient hepatectomy and survival are

likely; (3) if a live donor graft has been procured and cannot be

transplanted into the intended recipient, and if informed consent has been

obtained before the donor operation, the organ should be reallocated without

delay to minimize cold ischemia time and maximize the utility of the graft.

PMID: 15548958 [PubMed - as supplied by publisher]

[Guest guest]

Transplantation. 2004 Nov 15;78(9):1241-1244.

Recipient Death During a Live Donor Liver Transplantation: Who Gets the

" Orphan " Graft?

Siegler J, Siegler M, Cronin DC 2nd.

Department of Surgery, University of Chicago, Chicago, Illinois.; Department

of Medicine, University of Chicago, Chicago, Illinois.; The MacLean Center

for Clinical Medical Ethics, University of Chicago, Chicago, Illinois.;

Organ Transplantation and Immunology, Yale University School of Medicine,

New Haven, Connecticut.

The limited availability of deceased organ donors, prolongation of waiting

time, and increasing number of patients dying awaiting transplantation have

contributed to the increased use of adult-to-adult living-donor liver

transplant. In the event that the intended recipient dies after the donor

graft has been procured but before it has been transplanted, what should be

done with the graft? A structured, nine-item oral survey of 26 experts in

liver transplantation was conducted in June and July 2003. Respondents were

selected primarily because of their extensive experience with liver

transplantation, especially adult-to-adult living-donor transplant. All

respondents said the surgical team should try to use the available graft for

another recipient. Twenty-one respondents believed consent from the donor or

the donor's family was required for allocation, whereas 19% believed consent

desirable but not required. Nine respondents recommended an allocation

organization place the graft, whereas 17 respondents recommended placement

within the donor hospital. Two of the respondents had previously encountered

this situation, whereas four had experienced an intraoperative recipient

death before procurement of a live donor graft. On the basis of the

responses, we offer the following recommendations for handling orphan liver

grafts: (1) obtain predonation informed consent from all donors that

indicates what the donor would want to have done with the " orphan graft " in

all cases of living-donor liver transplantation; (2) avoid the premature

removal of the donor graft until the recipient hepatectomy and survival are

likely; (3) if a live donor graft has been procured and cannot be

transplanted into the intended recipient, and if informed consent has been

obtained before the donor operation, the organ should be reallocated without

delay to minimize cold ischemia time and maximize the utility of the graft.

PMID: 15548958 [PubMed - as supplied by publisher]

[Guest guest]

Transplantation. 2004 Nov 15;78(9):1241-1244.

Recipient Death During a Live Donor Liver Transplantation: Who Gets the

" Orphan " Graft?

Siegler J, Siegler M, Cronin DC 2nd.

Department of Surgery, University of Chicago, Chicago, Illinois.; Department

of Medicine, University of Chicago, Chicago, Illinois.; The MacLean Center

for Clinical Medical Ethics, University of Chicago, Chicago, Illinois.;

Organ Transplantation and Immunology, Yale University School of Medicine,

New Haven, Connecticut.

The limited availability of deceased organ donors, prolongation of waiting

time, and increasing number of patients dying awaiting transplantation have

contributed to the increased use of adult-to-adult living-donor liver

transplant. In the event that the intended recipient dies after the donor

graft has been procured but before it has been transplanted, what should be

done with the graft? A structured, nine-item oral survey of 26 experts in

liver transplantation was conducted in June and July 2003. Respondents were

selected primarily because of their extensive experience with liver

transplantation, especially adult-to-adult living-donor transplant. All

respondents said the surgical team should try to use the available graft for

another recipient. Twenty-one respondents believed consent from the donor or

the donor's family was required for allocation, whereas 19% believed consent

desirable but not required. Nine respondents recommended an allocation

organization place the graft, whereas 17 respondents recommended placement

within the donor hospital. Two of the respondents had previously encountered

this situation, whereas four had experienced an intraoperative recipient

death before procurement of a live donor graft. On the basis of the

responses, we offer the following recommendations for handling orphan liver

grafts: (1) obtain predonation informed consent from all donors that

indicates what the donor would want to have done with the " orphan graft " in

all cases of living-donor liver transplantation; (2) avoid the premature

removal of the donor graft until the recipient hepatectomy and survival are

likely; (3) if a live donor graft has been procured and cannot be

transplanted into the intended recipient, and if informed consent has been

obtained before the donor operation, the organ should be reallocated without

delay to minimize cold ischemia time and maximize the utility of the graft.

PMID: 15548958 [PubMed - as supplied by publisher]

[Guest guest]

Transplantation. 2004 Nov 15;78(9):1241-1244.

Recipient Death During a Live Donor Liver Transplantation: Who Gets the

" Orphan " Graft?

Siegler J, Siegler M, Cronin DC 2nd.

Department of Surgery, University of Chicago, Chicago, Illinois.; Department

of Medicine, University of Chicago, Chicago, Illinois.; The MacLean Center

for Clinical Medical Ethics, University of Chicago, Chicago, Illinois.;

Organ Transplantation and Immunology, Yale University School of Medicine,

New Haven, Connecticut.

The limited availability of deceased organ donors, prolongation of waiting

time, and increasing number of patients dying awaiting transplantation have

contributed to the increased use of adult-to-adult living-donor liver

transplant. In the event that the intended recipient dies after the donor

graft has been procured but before it has been transplanted, what should be

done with the graft? A structured, nine-item oral survey of 26 experts in

liver transplantation was conducted in June and July 2003. Respondents were

selected primarily because of their extensive experience with liver

transplantation, especially adult-to-adult living-donor transplant. All

respondents said the surgical team should try to use the available graft for

another recipient. Twenty-one respondents believed consent from the donor or

the donor's family was required for allocation, whereas 19% believed consent

desirable but not required. Nine respondents recommended an allocation

organization place the graft, whereas 17 respondents recommended placement

within the donor hospital. Two of the respondents had previously encountered

this situation, whereas four had experienced an intraoperative recipient

death before procurement of a live donor graft. On the basis of the

responses, we offer the following recommendations for handling orphan liver

grafts: (1) obtain predonation informed consent from all donors that

indicates what the donor would want to have done with the " orphan graft " in

all cases of living-donor liver transplantation; (2) avoid the premature

removal of the donor graft until the recipient hepatectomy and survival are

likely; (3) if a live donor graft has been procured and cannot be

transplanted into the intended recipient, and if informed consent has been

obtained before the donor operation, the organ should be reallocated without

delay to minimize cold ischemia time and maximize the utility of the graft.

PMID: 15548958 [PubMed - as supplied by publisher]