Section of Legal Medicine, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy.
Clinical Risk Management Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy.
Front Public Health. 2022 Mar 17;10:824048. doi: 10.3389/fpubh.2022.824048. eCollection 2022.
Living kidney donation is the most common type of living-donor transplant. Italian guidelines allow the living donations from emotionally related donors only after clear and voluntary consent expressed by both the donor and the recipient involved. Living donation raises ethical and legal issues because donors voluntarily undergo a surgical procedure to remove a healthy kidney in order to help another person. According to the Italian standards, the assessment of living donor-recipient pair has to be conducted by a medical "third party", completely independent from both the patients involved and the medical team treating the recipient. Starting from the Hospital "Città della Salute e della Scienza" of Turin (Italy) experience, including 116 living kidney donations, the Authors divided the evaluation process performed by the "Third-Party" Commission into four stages, with a particular attention to the potential donor. Living donation procedures should reflect fiduciary duties that healthcare providers have toward their patients, originating from the relationship of trust between physician and patient. In addition to that, the social implications are enormous if one considers the worldwide campaigns to promote public awareness about organ donation and transplantation, and to encourage people to register their organ donation decisions. The systematic process proposed here can be a tool that proactively reduces and controls the risks of coercion, organ trafficking, vitiated consent, insufficient weighting of donative choice, that could arise especially in donors involved in living kidney donation.
活体肾捐赠是最常见的活体供肾移植类型。意大利的指导方针仅允许在有情感关系的供者在供者和受者双方明确和自愿表示同意的情况下进行活体捐赠。活体捐赠引发了伦理和法律问题，因为供者自愿接受手术以切除健康的肾脏来帮助他人。根据意大利的标准，对活体供受者配对的评估必须由医疗“第三方”进行，该第三方完全独立于涉及的患者和治疗受者的医疗团队。从意大利都灵的“Città della Salute e della Scienza”医院的经验开始，包括 116 例活体肾脏捐赠，作者将“第三方”委员会进行的评估过程分为四个阶段，特别关注潜在供者。活体捐赠程序应反映医疗保健提供者对其患者的信托责任，这种责任源于医生和患者之间的信任关系。此外，如果考虑到全球范围内宣传器官捐赠和移植的公众意识，并鼓励人们登记他们的器官捐赠决定的宣传活动，那么社会影响是巨大的。这里提出的系统过程可以是一种工具，可以主动减少和控制胁迫、器官贩卖、同意被篡改、捐赠选择权重不足等风险，这些风险尤其可能出现在参与活体肾脏捐赠的供者中。
