Secondary Logo

Institutional members access full text with Ovid®

Share this article on:

Ethical Analysis and Policy Recommendations Regarding Domino Liver Transplantation

Schenck, David, PhD1; Mazariegos, George, V., MD2; Thistlethwaite, J., Richard, Jr, MD, PhD3,4; Ross, Lainie, Friedman, MD, PhD3,4,5

doi: 10.1097/TP.0000000000002095
Original Clinical Science—Liver

Due to the widening gap between supply and demand, patients who need a liver transplant due to metabolic disease may be asked to serve as domino liver donors—to have their native liver transplanted into another candidate. We here analyze the ethical problems surrounding informed consent for the implant and explant procedures in transplant candidates who will serve as domino donors, using the case of a child with maple syrup urine disease. We discuss the need for 2 distinct consent processes separated in time to ensure that potential domino donors (or their surrogates) give a truly voluntary consent. We propose a Domino Donor Advocate—based on the concept of the independent living donor advocate to help the patient and/or his or her surrogates consider the risks, benefits and alternatives. Finally, we evaluate the Organ Procurement and Transplantation Network policy regarding “therapeutic organ donation” and propose several modifications to ensure that the decision by the potential domino donor (and/or his or her surrogate) is voluntary and informed.

Despite the long history of clinical application of domino liver transplantation, there has been a paucity of ethical examination of the principles. The authors address multiple considerations in this timely work.

1 Department of Medicine, Medical University of South Carolina, Charleston SC.

2 Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh PA.

3 Department of Surgery, University of Chicago, Chicago IL.

4 The MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago IL.

5 Department of Pediatrics, University of Chicago, Chicago IL.

Received 30 August 2017. Revision received 3 December 2017.

Accepted 6 December 2017.

Drs. Ross and Thistlethwaite were funded in part by a Robert Wood Johnson Investigator Award in Health Policy for a book proposal entitled, “A Case-Based Approach to the Ethical and Policy Issues Raised by Living Donor Transplantation.” The authors declare no other funding sources.

The authors declare no conflict of interest.

D.S. made substantial contributions to the conception and design of the work, wrote first draft and active in multiple revisions, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. G.V.M. made substantial contributions to the analysis, reviewed multiple drafts and made critical revisions, final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. J.R.T. made substantial contributions to the analysis, reviewed multiple drafts and made critical revisions, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. L.F.R. made substantial contributions to the conception and design of the work; Involved in revising multiple drafts, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Correspondence: Lainie F. Ross, MD, PhD, Department of Pediatrics, University of Chicago, Room C-128, 5841S, Maryland Ave, MC 6082, Chicago IL 60637. (Lross@uchicago.edu).

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.