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The Consensus Statement of the
Amsterdam
Forum
on the Care of the Live Kidney Donor
Kidney transplant physicians and surgeons met in
Amsterdam
, the
Netherlands
, from
April 1-4, 2004
for An International Forum on the Care of the Live Kidney Donor. Forum participants included over 100 experts and leaders in transplantation, representing over 40 countries from around the world, including
Africa
,
Asia
,
Australia
,
China
,
Europe
,
India
,
Israel
,
New Zealand
, North and
South America
,
Pakistan
,
Saudi Arabia
,
Singapore
,
Scandinavia
, and
Turkey
.
The objective of the Forum was to develop of an international standard of care for the live donor with a position statement regarding the responsibility of the transplant community for the live kidney donor. The international transplant community recognizes that the use of kidneys from the living donor needs to be performed in a manner that will minimize the physical, psychological and social risk to the individual donor, maximizes the benefit to the recipient and does not jeopardize the public trust of the healthcare community. The donation decision should be performed in an environment that enables the potential donor to decide in an autonomous manner.
Because of the need for more transplantable kidneys, persons with conditions that may increase the health risks to potential donor and/or recipient are currently being considered and used as donors. The international transplant community recommends that the acceptance of such individuals as kidney donors be conducted in an ethical manner, accounting for the autonomy and safety of the donor and with rigorous attention to clinical outcomes.
In view of these considerations, the following recommendations were adopted:
Prior to live kidney donation, the donor must receive a complete medical and psychosocial evaluation to include:
-
quantification (as available) and assessment of the risk of donor nephrectomy on the individualпїЅs health, subsequent renal function, psychological and social consequences (including employability);
-
the suitability of the donorпїЅs kidney for transplantation to the recipient (anatomy, function, and risk for transmissible disease).
Prior to live kidney donation, the donor must be informed of:
-
the nature of the evaluation process;
-
the results and consequences/morbidity of testing and the possibility that conditions may be discovered that will impact the healthcare, insurability and social status of the potential donor;
-
the probable risks of operative donor nephrectomy, as assessed after the complete evaluation. These should include, but not be limited to the risk of death, surgical morbidities, changes in health and renal function, impact upon insurability/ employability and unintended effects upon family and social life;
-
the responsibility of the individual and health and social system in the management of discovered conditions;
-
the expected transplant outcomes (favorable and unfavorable) for the recipient and the specific recipient conditions which may impact upon the decision to donate the kidney.
Disclosure of recipient specific information must have the assent of the recipient.
The donor should be informed of alternative renal replacement therapies available to the potential recipient.
The donor should be capable of understanding the information presented in the consent process.
The donor should make a voluntary decision:
-
be free to withdraw from the donation process at any time.
-
be assured that medical and individual reasons for not proceeding with donation will be kept confidential.
-
should not be subjected to adverse pressures to donate.
After kidney donation the transplant center is responsible to:
-
oversee and monitor the postsurgical recovery process of the donor until that individual is stable.
-
encourage and facilitate the long-term follow-up and treatment of the kidney donor with preexisting or acquired conditions (related to uni-nephrectomy) that are thought to represent a health risk (such as, but not exclusive to, hypertension, obesity, diabetes, proteinuria). In the absence of an established follow-up process for individuals with preexisting conditions that may possibly place the donor at health risk), organ donation should be avoided.
-
identify and track complications that are important for informed consent disclosure.
The center should work with the general healthcare community to provide optimal care/surveillance of the living kidney donor.
Consensus Caveats:
A donor advocate:
In order to minimize the appearance of a пїЅconflict of interestпїЅ, transplant centers should make efforts to assure that the medical and psychosocial assessment and the decision to donate incorporates health care professional(s) not involved in the care of the recipient. The concept of this recommendation is to provide a health care professional advocating the welfare of the potential donor.
Procedural safeguards should be utilized and explored to minimize coercion/ambivalence and enhance the probability of an autonomous decision, for example пїЅcooling off periodпїЅ and assessment of donor retention of information.
Medical judgment versus donor autonomy:
Donor consent and autonomy is necessary but not sufficient to proceed to kidney donation.
Medical evaluation and concurrence is essential. Donor autonomy does not overrule medical judgment and decision making.
Minors as donors:
Minors less than 18 years of age should not be used as living kidney donors.
Donor Registry:
An international registry for пїЅsentinel eventsпїЅ after living kidney donation (death, or the need for dialysis or kidney transplantation by the donor) should be established and maintained. Appropriate prospective research should be performed on the long-term outcomes of donors considered to be at potential increased risk for adverse outcomes.
Acknowledgement:
The Forum was convened by the Ethics Committee of The Transplantation Society, administered by the National Kidney Foundation U.S, and sponsored by the following: Novartis Transplantation and Immunology; Fujisawa Healthcare, Inc.; Roche Pharmaceuticals; Genzyme Corporation; Wyeth Pharmaceuticals; the International Society of Nephrology, the National Kidney Foundation of Singapore; and The Transplantation Society.
References
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2.
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