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Deceased donor-initiated Chains: first report of a successful deliberate case and its ethical implications
- Source :
- Nicolo, A 2019, ' Deceased donor-initiated Chains: first report of a successful deliberate case and its ethical implications ', Transplantation . https://doi.org/10.1097/TP.0000000000002645
- Publication Year :
- 2019
-
Abstract
- Background: The utilization of deceased donor kidneys to initiate chains of living donor kidney paired donation (KPD) has been proposed, although the potential gain of this practice needs to be quantified and the ethical implications must be addressed before starting its application.Methods: The gain of implementing deceased donor-initiated chains has been measured through a mathematical algorithm, using retrospective data on the pool of donor/recipient incompatible pairs at a single Center. Allocation rules of chain ending kidneys and characteristics/quality of the chain initiating kidney (CIK) are described.Results: the quantification of benefit analysis showed that with a pool of 69 kidneys from deceased donors and 16 pairs enrolled in the KPD program, over a period of 3 years it is possible to transplant 8/16 recipients (50%). Following the approval of the Bioethical Committee of the Veneto Region and the revision of the allocation policies by the Italian National Transplant Center, the first successful case has been performed. The waiting time of the recipient (male, 53 yo) after entering the program for the CIK with a kidney donor risk index (KDRI) equal to 0.61 and a kidney donor profile index (KDPI) of 3%, was 4 days. His willing donor (female, 53 yo) with a living kidney donor profile index (LKDPI) of 2, donated 2 days later to a chain ending recipient (male, 47 yo,) who had been on dialysis for 5 years. Conclusions: This is the first report of a deliberate deceased donor-initiated chain, which has been successfully performed. This has been made possible thanks to an extensive phase of evaluation of the ethical issues and allocation policy impact. This paper includes a preliminary efficacy assessment and the development a dedicated algorithm.
- Subjects :
- Adult
Male
medicine.medical_specialty
Waiting Lists
Kidney Paired Donation
medicine.medical_treatment
030230 surgery
Kidney
Single Center
Living donor
Resource Allocation
03 medical and health sciences
0302 clinical medicine
Directed Tissue Donation
Living Donors
medicine
Humans
Dialysis
Kidney transplantation
Retrospective Studies
Transplantation
Deceased donor
business.industry
Retrospective cohort study
Bioethics
Middle Aged
Allografts
medicine.disease
Kidney Transplantation
Treatment Outcome
Italy
Child, Preschool
Family medicine
Kidney Failure, Chronic
Female
030211 gastroenterology & hepatology
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Nicolo, A 2019, ' Deceased donor-initiated Chains: first report of a successful deliberate case and its ethical implications ', Transplantation . https://doi.org/10.1097/TP.0000000000002645
- Accession number :
- edsair.doi.dedup.....de0cf368de2cb71583a7b0bb3b25b7ac