Solid Organ Transplantation: An Ethical Dilemma – Case Report

Year 2018, Volume: 5 Issue: 3, 278 - 282, 23.12.2018

Zeliha Özdemir Köken Erdal Birol Bostancı Meral Akdoğan Kayhan Nurhan Bayraktar Leyla Dinç

https://doi.org/10.31125/hunhemsire.501047

Abstract

The shortage of cadaveric organ donors continues to be a major problem for solid organ
transplantation in Turkey as well as across the world. Due to this shortage, the use of
marginal and expanded criteria donors has become a current issue to increase the number
of transplantation and to decrease waitlist mortality rates. The use of organs of marginal
donors with a history of or active central nervous system tumor has been one possible
solution to increase the number of donors in organ transplantation. While this is a lifesaving practice for waitlist patients, it constitutes a risk of malignancy originating from
donors. This is an important issue that should be discussed in the field of transplantation
and ethics. This case study aims to discuss an ethical dilemma of liver transplantation from
a donor with a history of central nervous system tumor to a patient in need of emergency
liver transplantation. It is considered that the decision-making process for the use of
marginal donor grafts in solid organ transplantation should be managed in accordance with
ethical principles.

Keywords

Donor, ethics, ethical dilemma, malignancy

References

• 1. Global Observatory on Donation and Transplantation. International Figures on Donation and Transplantation 2012: Matesanz R, editor. Newsletter Transplant 2013; 18 (1). URL:http://www. transplant-observatory.org/SiteCollectionDocuments/eurnlcoeJ.pdf September 15, 2017. 2. Turkey Organ ve Tissue Information System (TODS). Ankara: 2013. URL: https://organ.saglik.gov.tr/ web/ Temmuz 20, 2014. 3. Fiorelli AI, Stolf NAG, Pego-Fernandes PM, Oliveria Junior JL, Santos RHB, Contreras CAM, et al. Recommendations for use of marginal donors in heart transplantation: brazilian association of organs transplantation guideline. Transplantation Proceedings 2011; 43: 211-215. 4. Kashyap R, Ryan C, Sharma R, Maloo MK, Safadjou S, Graham M, et al. Liver Grafts from Donors with Central Nervous System Tumors: A Single-Center Perspective. Liver Transplantation 2009, 15: 1204- 1208. 5. Lo´ pez-Navidad A, Caballero F. Extended criteria for organ acceptance. Strategies for achieving organ safety and for increasing organ pool. Clin Transplant 2003; 17: 308–324. 6. Busittil RW, Tanaka K. The utility of marginal donors in liver transplantation. Liver Transplantation 2003; 9 (7): 651-63. 7. Finger EB, Feng S. Central nervous system tumors and organ donation: an update. Current Opinion Organ Transplantation 2006; 11:146–50. 8. Buell JF, Trofe J, Sethuraman G, Hanaway MJ, Beebe TM, Gross TG, et al. Donors with central nervous system malignancies: are they truly safe? Transplantation 2003; 76 (2): 340–3. 9. Turkey National Comission and UNESCO. Universal Declaration on Bioethics and Human Rights. 2005. URL: http://unesdoc.unesco.org/images/0014/001461/146180TUR.pdf December 15, 2017 10. Watson CJE, Roberts R, Wright KA, Greenberg DC, Rous BA, Brown CH, et al. How safe is it to transplant organs from deceased donors with primary intracranial malignancy? An analysis of UK registry data. American Journal of Transplantation 2010; 10: 1437–44. 11. Rey JW, Heister P, Wirges U, Nadalin S, Breuer R, Niehues T. Organ donor with unclear primary brain tumor, a contraindication for transplantation? – Case report of a one year old child. Klin Padiatr 2009; 221: 390 –2. 12. Warrens AN, Birch R, Collett D, Daraktchiev M, Dark J, Galea G, et al. Advising potential recipients on the use of organs from donors with primary central nervous system tumors. Transplantation 2012; 93: 348–53. 13. Felker GM, Milano CA, Yager JEE, Hernandez AF, Blue L, Higginbotham MB, et al. Outcomes with an alternate list strategy for heart transplantation. The Journal of Heart and Lung Transplantation 2005; 24: 1783-85. 14. Chen JM, Russo MJ, Hammond KM, Mancini DM, Kherani AR, Fal JM, et al. Alternate waiting list strategies for heart transplantation maximize donor organ utilization. Ann Thorac Surg 2005; 80: 224– 28. 15. United Nations, Educational, Scientific and Cultural Organization. Bioethics Core Curriculum, Section 1: Syllabus Ethics Education Programme. 2008.