Addiction, Pain, Transplant
Medical and surgical advances in living organ donation can help increase kidney and liver transplantation and improve morbidity and mortality for recipients waiting for transplant. With improved outcomes for both recipient and donor, more volunteers may be encouraged to come forward in order to fill this need. Non directed donation (NDD), paired exchange and donor hepatectomy has continued to increase over the past 10 years. Around the world, nearly 30,000 people receive an organ from a living donor each year. Transplant physicians and surgeons will need to consider the psychosocial and ethical implications of this advancing field. Psychiatrists knowledgeable in the psychosocial care of donors and ethics can begin these conversations in transplant programs. How can we apply an ethical framework to challenging new situations in this changing field?
Dr. Appel, a bioethicist, will moderate 4 separate ethical inquiries surrounding autonomy, informed consent, decision making, and declining donors for psychosocial reasons. The audience will be encouraged to ask questions of their own to stimulate the discussion through each of these 4 cases.
1) Dr. Adler will present a rare case illustrating the tensions between paternalism and autonomy with recipient confidentiality further impacting donor informed consent (10 min). What happens when the recipient can no longer use the organ and the donor is incapacitated. Who makes the decision about where the organ goes? (10 min)
2) Dr. Shenoy will present a case and data from the LDAT study to illustrate donor motivation through the psychology of expectation and management of risks (10 min). Can we assess donor informed consent in the setting of heroic attitude or anxious mood? Should we allow donation from those individuals who have mood problems to proceed as long as they can recite all the risks? (10 min)
3) Dr. Wiener will present a challenging case that illustrates external pressure through longstanding family dynamics and culture and share ways to assess for signs of coercion (10 minutes). Can donor independent decision making include aspects of shared decision making? Should we allow donation from those individuals who want family involvement in their decision even though there may be signs of co-dependency and other family members have a strong wish for the donor to proceed? (10 min).
4) Dr. Zimbrean will present her case and discuss altruism as it is conceived for the purpose of donor assessment and discuss general concepts of altruism through genetics, neuroscience, psychological, sociological and philosophical constructs. How do we assess altruism and other possible psychological factors in the motivations for this type of double donor? (10 min). What are the limits of altruism? Can a non-directed donor who previously donated a kidney now donate part of his liver? (10 min).