Keeping Living Donors Safe

Keeping Living Donors Safe
LIVING DONOR COMMITTEE FOCUSES ON STANDARDIZATION

BY KAREN SOKOHL
5July–August 2007UNOS Update

I n 2001, living donation rates surpassed those of deceased
donation for the first time. Although not then under the
OPTN’s purview, living donation has become increasingly
important, and in 2007 the transplant community had
another “first.”
New federal legislation makes the OPTN responsible for
developing policies governing the equitable allocation of
living donor organs ― giving the OPTN/UNOS living donor
committee new weight in protecting living donors and in
standardizing the medical and administrative practices of
living donation.
The committee developed guidelines for the consent and
medical evaluation of living donors, and teamed with the OPTN/
UNOS membership and professional standards committee to
create living kidney and liver program certification requirements.
Committee members represent a multitude of backgrounds,
and ― in another first ― a third are themselves living donors.
What follows is a look at the committee from the
perspective of a new member and a two-year veteran.

Mary Mason, social worker and living donor
Mary Mason became aware of the OPTN/UNOS living donor
committee after reading a post from fellow social worker and
former committee member, Cheryl Jacobs. Jacobs was ending
her term and wanted to ensure that social work was still well
represented on the committee.
Mason was intimately acquainted with the needs of living
donors; she worked with donors exclusively at Seattle’s Virginia
Mason Medical Center ― and then became a living donor
herself in 2004 when she donated a kidney anonymously
through a transplant program in Seattle.
“Prior to joining the committee, I had not been involved
with UNOS,” Mason said. “I had a vested interest, of course,
but until then I had no idea how influential I could be within
the committee structure.”
Having worked in dialysis units for 12 years, Mason met
not only transplant candidates but countless donors as well.
“I had the benefit of understanding the risks and benefits
of living donation,” Mason said, “and I knew what type of
follow-up care was required. But I realized that many others in
the same situation weren’t nearly as knowledgeable.
“A lot of the time donors put their own needs behind those
of the recipient. We need a social support system in place to
help potential donors understand what they are facing.
Informed consent is paramount, and currently there isn’t a
standard.” Guidelines vary from region to region, and
sometimes even at different centers within a region.
Along with standardizing consent, the committee is
determined to develop standard medical evaluation guidelines
to follow living donors over time. Many donors aren’t aware of
what they need to do to maintain their health over the years.
Transplant centers aren’t always focused on it either.
“But now,” Mason said, “I have the opportunity to be in a
room full of people who are committed to the interests of
living donors. It’s fabulous!”

Connie Davis, medical director, kidney transplant program
As medical director of the large kidney program at the University
of Washington Medical Center in Seattle, Davis has taken care
of many living donors and was a natural for the committee.
“I was concerned about how well living donors were
represented in the transplant community, so I developed a
personal and professional interest,” Davis explained.
Becoming known as an expert, she served on the board
of the American Society of Transplantation and attended the
2004 Amsterdam international forum.
Davis’ first assignment was heading up the work group
to develop standard guidelines for the medical evaluation
of living kidney donors. No small task, the committee members
collected and evaluated existing medical evaluation protocols
from transplant centers with living donor programs. They also
reviewed the AST’s recommendations, performed an exhaustive
literature review and oversaw a focused survey of 16 large
transplant centers. They wanted to make sure the guidelines
they proposed were comprehensive and were as close to a
consensus as possible.
“There are things in the guidelines that some programs
may disagree with, but we tried to make it as cutting edge as
possible,” Davis said. “We wanted to force people to think about
it. We wanted to mention things like 24-hour blood pressure
monitors and different forms of monitoring kidney function that
aren’t the easy way out ― because it shouldn’t be easy.”
She said she would also like to see some of the other
important tests standardized, recognizing that location might
make some of the tests difficult.
“Once we got a sense of how variable things were, we knew
we had to make a change,” Davis explained. “Things need to be
constructed in a completely different way. If we’re going to do
this right we need regional evaluation centers. “This is among
the most important things UNOS is doing right now.
“We are so grateful to the living donors—these people who
are graciously stepping forward at no benefit to themselves.
Before they do that, we have to make sure that we have done
everything we can to protect them,” she added.
“That’s really what we’re here for.”

If you are a living lung, intestine or pancreas donor and are
interested in serving on the OPTN/UNOS living donor committee,
contact committee liaison Lee Bolton at (804) 782-4757 or
boltondl@unos.org.

unos.org/SharedContentDocuments/A_Focus_on_Committees_08_07_Update.pdf
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