Nicolas Goldaracena1, Judy Jung2, Aloysious D Aravinthan3, Susan E Abbey4, Sandra Krause4, Cheryl Pritlove5, Joanna Lynch4, Linda Wright6, Nazia Selzner6, Jennifer Stunguris7, Paul Greig6, Anand Ghanekar8, Ian McGilvray6, Gonzalo Sapisochin6, Vicky Lee Ng7, Gary Levy6, Mark Cattral8, David Grant8. 1. Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Division of Transplant Surgery, University of Virginia Health System, Charlottesville, VA, United States. 2. Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Canada. Electronic address: judy.jung@sickkids.ca. 3. Multi-Organ Transplant Program, University Health Network, Toronto, Canada; NDDC, School of Medicine, University of Nottingham; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK. 4. Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Centre for Mental Health, University Health Network, Toronto, Canada. 5. Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada. 6. Multi-Organ Transplant Program, University Health Network, Toronto, Canada. 7. Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Canada. 8. Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Canada.
Abstract
BACKGROUND & AIMS: Death rates on liver transplant waiting lists range from 5%-25%. Herein, we report a unique experience with 50 anonymous individuals who volunteered to address this gap by offering to donate part of their liver to a recipient with whom they had no biological connection or prior relationship, so called anonymous live liver donation (A-LLD). METHODS: Candidates were screened to confirm excellent physical, mental, social, and financial health. Demographics and surgical outcomes were analyzed. Qualitative interviews after donation examined motivation and experiences. Validated self-reported questionnaires assessed personality traits and psychological impact. RESULTS: A total of 50 A-LLD liver transplants were performed between 2005 and 2017. Most donors had a university education, a middle-class income, and a history of prior altruism. Half were women. Median age was 38.5 years (range 20-59). Thirty-three (70%) learned about this opportunity through public or social media. Saving a life, helping others, generativity, and reciprocity for past generosity were motivators. Social, financial, healthcare, and legal support in Canada were identified as facilitators. A-LLD identified most with the personality traits of agreeableness and conscientiousness. The median hospital stay was 6 days. One donor experienced a Dindo-Clavien Grade 3 complication that completely resolved. One-year recipient survival was 91% in 22 adults and 97% in 28 children. No A-LLD reported regretting their decision. CONCLUSIONS: This is the first and only report of the characteristics, motivations and facilitators of A-LLD in a large cohort. With rigorous protocols, outcomes are excellent. A-LLD has significant potential to reduce the gap between transplant organ demand and availability. LAY SUMMARY: We report a unique experience with 50 living donors who volunteered to donate to a recipient with whom they had no biological connection or prior relationship (anonymous living donors). This report is the first to discuss motivations, strategies and facilitators that may mitigate physical, social and ethical risk factors in this patient population. With rigorous protocols, anonymous liver donation and recipient outcomes are excellent; with appropriate clinical expertise and system facilitators in place, our experience suggests that other centers may consider the procedure for its significant potential to reduce the gap between transplant organ demand and availability.
BACKGROUND & AIMS: Death rates on liver transplant waiting lists range from 5%-25%. Herein, we report a unique experience with 50 anonymous individuals who volunteered to address this gap by offering to donate part of their liver to a recipient with whom they had no biological connection or prior relationship, so called anonymous live liver donation (A-LLD). METHODS: Candidates were screened to confirm excellent physical, mental, social, and financial health. Demographics and surgical outcomes were analyzed. Qualitative interviews after donation examined motivation and experiences. Validated self-reported questionnaires assessed personality traits and psychological impact. RESULTS: A total of 50 A-LLD liver transplants were performed between 2005 and 2017. Most donors had a university education, a middle-class income, and a history of prior altruism. Half were women. Median age was 38.5 years (range 20-59). Thirty-three (70%) learned about this opportunity through public or social media. Saving a life, helping others, generativity, and reciprocity for past generosity were motivators. Social, financial, healthcare, and legal support in Canada were identified as facilitators. A-LLD identified most with the personality traits of agreeableness and conscientiousness. The median hospital stay was 6 days. One donor experienced a Dindo-Clavien Grade 3 complication that completely resolved. One-year recipient survival was 91% in 22 adults and 97% in 28 children. No A-LLD reported regretting their decision. CONCLUSIONS: This is the first and only report of the characteristics, motivations and facilitators of A-LLD in a large cohort. With rigorous protocols, outcomes are excellent. A-LLD has significant potential to reduce the gap between transplant organ demand and availability. LAY SUMMARY: We report a unique experience with 50 living donors who volunteered to donate to a recipient with whom they had no biological connection or prior relationship (anonymous living donors). This report is the first to discuss motivations, strategies and facilitators that may mitigate physical, social and ethical risk factors in this patient population. With rigorous protocols, anonymous liver donation and recipient outcomes are excellent; with appropriate clinical expertise and system facilitators in place, our experience suggests that other centers may consider the procedure for its significant potential to reduce the gap between transplant organ demand and availability.
Authors: Benjamin Samstein; Robert S Brown; Alyson Kaplan; Russell Rosenblatt; Whitney Jackson Journal: Liver Transpl Date: 2021-12-26 Impact factor: 6.112
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Authors: Juliet Emamaullee; Julie K Heimbach; Kim M Olthoff; Elizabeth A Pomfret; John P Roberts; Nazia Selzner Journal: Am J Transplant Date: 2022-04-06 Impact factor: 9.369
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Authors: Sarah Shan; Paola Vargas; Jakob Durden; Tara Seay; Tessa Williams; Emily Lyster; Anita Sites; Patrick Northup; Shawn Pelletier; Jose Oberholzer; Curtis Argo; Nicolas Goldaracena Journal: Transplant Direct Date: 2021-07-16