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Marginal parent donors-Process and ethics.

Guido Filler1,2,3, Maria E Diaz-Gonzalez de Ferris4, Launa Elliott5

  • 1Departments of Paediatrics and Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.

Pediatric Transplantation
|June 2, 2021
PubMed
Summary

Pre-emptive pediatric kidney transplants may involve marginal parent donors. An independent donor advocacy team is crucial for ethical evaluation, ensuring donor well-being and informed consent in these complex cases.

Keywords:
disease recurrenceethics and medullary sponge kidneykidney transplantmarginal donoroutcomes

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Area of Science:

  • Pediatric Nephrology
  • Transplant Surgery
  • Medical Ethics

Background:

  • Pre-emptive kidney transplantation offers advantages for children with end-stage kidney disease.
  • Consideration of marginal parent donors is a potential strategy in pediatric kidney transplantation.
  • Medullary sponge disease in a parent donor presents unique ethical challenges.

Purpose of the Study:

  • To review the ethical framework for evaluating parent donors in pediatric kidney transplantation.
  • To examine the ethical considerations for using marginal donors, exemplified by a parent with medullary sponge disease.
  • To establish guidelines for risk-benefit assessment in living donor transplantation.

Main Methods:

  • Case example of a kidney transplant from a parent with medullary sponge disease to a child.
  • Review of the four core principles of health ethics: autonomy, beneficence, non-maleficence, and justice.
  • Analysis of the role of transplantation teams and independent donor advocate teams in ethical decision-making.

Main Results:

  • Potential donors may experience psychological benefits, influencing their risk tolerance.
  • The risk-benefit ratio must be carefully assessed by both the transplantation and independent donor advocate teams.
  • Informed consent and donor autonomy are paramount in the evaluation process.

Conclusions:

  • An independent donor advocacy team with multidisciplinary expertise is essential.
  • This team should prioritize donor needs, encompassing ethical, social, and psychological aspects.
  • Final donor acceptance or rejection authority should reside with the independent advocacy team.