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Living donor program crisis management plans: Current landscape and talking point recommendations.

Macey L Henderson1,2, Rebecca Hays3, Sarah E Van Pilsum Rasmussen1

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American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
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Summary

Living donor deaths are rare but concerning for transplant programs. Most programs lack a crisis plan, highlighting a need for guidance in managing these rare but critical events.

Keywords:
clinical research/practicedonors and donation: livingethics and public policykidney transplantation/nephrologyliver transplantation/hepatologyorgan transplantation in generalsurvey

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Area of Science:

  • Transplantation Surgery
  • Organ Donation
  • Medical Crisis Management

Background:

  • Living organ donation, while generally safe, carries an unavoidable, albeit extremely low, risk of perioperative mortality.
  • Anticipation of poor donor outcomes can cause anxiety and unpreparedness among healthcare professionals and transplant programs.
  • Systemic preparedness for living donor deaths is crucial for maintaining program integrity and supporting affected individuals.

Purpose of the Study:

  • To assess the experiences and systemic preparedness of US transplant programs regarding living donor deaths.
  • To identify the level of concern among transplant surgeons about potential living donor mortality.
  • To determine the availability of written crisis management plans within transplant institutions.

Main Methods:

  • A national survey was distributed to US transplant surgeons.
  • Respondents represented 71 kidney and 16 liver donor programs (87 unique programs).
  • The survey gathered data on experiences, concerns, and preparedness for living donor deaths.

Main Results:

  • Perioperative deaths in living donors were infrequent, aligning with expectations.
  • A significant majority of respondents (64%) expressed moderate to extreme concern about potential living donor deaths.
  • Only 33% of surveyed programs reported having a written crisis management plan, with 63% indicating a need for guidance.

Conclusions:

  • A notable gap exists in written crisis management plans for living donor deaths across US transplant programs.
  • Transplant programs frequently express concern regarding living donor mortality, underscoring the need for structured preparedness.
  • The American Society of Transplantation Live Donor Community of Practice has developed resources to aid programs in creating essential crisis management plans.