A Report of the Vancouver Forum on the Care of the Live Organ Donor: Lung, Liver, Pancreas, and Intestine Data and Medical Guidelines

Abstract

An international conference of transplant physicians, surgeons, and allied health professionals was held in Vancouver, Canada, on September 15 and 16, 2005 to address the care of the live lung, liver, pancreas, and intestine organ donor. The Vancouver Forum was convened under the auspices of the Ethics Committee of The Transplantation Society. Forum participants included over 100 leaders in organ transplantation, representing many countries from around the world, including participants from the following continents: Africa, Asia, Australia, Europe, North and South America. The objective of the Vancouver Forum was to develop an international standard of care for the live lung, liver, pancreas and intestinal organ donor. This Vancouver Forum followed a conference convened in Amsterdam on the care of the live kidney donor (1, 2). There were four organ specific work groups at the Vancouver Forum: lung, liver, pancreas and intestine. Each organ work group addressed the following topics in concert and reported their findings in a plenary presentation to all participants: The evaluation of the potential live donor Criteria of live donor medical suitability Operative events, donor morbidity and mortality Responsibility and duration of donor follow up. The Vancouver Forum also provided an opportunity for the Ethics Committee of The Transplantation Society to address issues of informed consent, the responsibilities of the transplant team, live donor selection, autonomy and satisfaction, and procedural safeguards. An ethics statement of the Vancouver Forum pertaining to these issues will be published separately by the Ethics Committee of The Transplantation Society. The transplant community has a responsibility for the care of the live organ donor. The death of a live donor is a tragedy of immeasurable proportion that brings an ethical dimension distinct from the complications that might be experienced in a recipient. Report from the Thoracic Group Live donor lung transplantation generally involves three simultaneous operations: two donor lobectomies and a recipient bilateral pneumonectomy and lobar implantation. The use of live donors is occurring in cases in which the potential recipient mortality is high while awaiting for lung allografts from a deceased donor. With increasing experience however, the practice may expand to include elective patients (3, 4). I. Donor Evaluation The goals of donor selection are to identify donors with excellent health, adequate pulmonary reserve for lobar donation and a willingness to accept the risks of donation without coercion (5, 6). A preference is given for family members or unrelated individuals with emotional attachment to recipient and/or family. A preference is also given for a spouse or donor with “significant other” relationship to the potential recipient. The necessity of two live lung donors for a single recipient also brings a consideration of both parents as donors for the potential recipient. An element of coercion can always exist between any potential donor and the recipient and/or the recipient's other siblings. “Stranger” or “Good Samaritan” donation remains controversial with caution required in the screening process to exclude active or uncontrolled psychiatric disorders or inappropriate motivation, and ensure the altruistic nature of the donation. The donor evaluation is a multi-phased process that begins with the potential recipient and family providing the names of potential donors with basic health information and height, weight, age, relationship, and smoking history. A preliminary psychosocial evaluation of selected donors is performed to assess the desire to donate. This evaluation includes a determination of the donor motivation, pain tolerance, feelings regarding the possible death of the potential recipient (and the donor) and the ability of the potential donor to be separated from family responsibilities and career obligations. Consultation with appropriate authorities regarding postlobectomy employability and insurability (life, disability insurance) is required. Prospective donors should be informed of the morbidity associated with lobectomy and the potential for mortality, as well as for potential negative recipient outcomes in regard to life expectancy and quality of life after transplantation. II. Criteria of Live Donor Medical Suitability The following are the eligibility criteria for living lobar lung donation: Age 18–60 years and able to give informed consent No active tobacco smoking or a significant smoking history No active lung disease/previous ipsilateral thoracic surgery No identifiable risk for familial lung disease (i.e. familial forms of idiopathic lung disease or pulmonary artery hypertension) No cachexia (BMI <18 kg/m2) or obesity (BMI ≥30 kg/m2) ABO blood type compatibility with recipient Donor lobe size compatible with recipient hemithorax Normal pulmonary function and arterial blood gas results No conditions that significantly in