TY - JOUR
T1 - Development of a Donor-Centered Approach to Risk Assessment
T2 - Rebalancing Nonmaleficence and Autonomy
AU - Thiessen, C.
AU - Gordon, E. J.
AU - Reese, P. P.
AU - Kulkarni, S.
N1 - Publisher Copyright:
© Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.
Copyright:
Copyright 2016 Elsevier B.V., All rights reserved.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - Living kidney donors are often excluded from the shared decision making and patient-centered models that are advocated in medical practice. Thresholds for acceptable risk vary between transplant centers, and between clinicians and donors. Although donor selection committees commonly focus on medical risks, potential donors also consider nonmedical risks and burdens, which may alter their assessment of an acceptable level of medical risk. Thus, transplant centers may encounter ethical tensions between nonmaleficence and respect for donor autonomy. A donor-centered model of risk assessment and risk reconciliation would integrate the donor's values and preferences in a shared decision about their eligibility to donate. This paper argues for shifting to a donor-centered model of risk assessment, and presents a research agenda to facilitate the greater participation of donors in their own evaluation and approval processes. This viewpoint advocates for the adoption of a donor-centered approach to living kidney donor evaluation, thereby enhancing donor autonomy and involvement in determining acceptable levels of donation-related medical risk.
AB - Living kidney donors are often excluded from the shared decision making and patient-centered models that are advocated in medical practice. Thresholds for acceptable risk vary between transplant centers, and between clinicians and donors. Although donor selection committees commonly focus on medical risks, potential donors also consider nonmedical risks and burdens, which may alter their assessment of an acceptable level of medical risk. Thus, transplant centers may encounter ethical tensions between nonmaleficence and respect for donor autonomy. A donor-centered model of risk assessment and risk reconciliation would integrate the donor's values and preferences in a shared decision about their eligibility to donate. This paper argues for shifting to a donor-centered model of risk assessment, and presents a research agenda to facilitate the greater participation of donors in their own evaluation and approval processes. This viewpoint advocates for the adoption of a donor-centered approach to living kidney donor evaluation, thereby enhancing donor autonomy and involvement in determining acceptable levels of donation-related medical risk.
KW - Donors and donation: donor evaluation
KW - donors and donation: living
KW - editorial/personal viewpoint
KW - ethics
KW - ethics and public policy
KW - kidney transplantation/nephrology
KW - kidney transplantation: living donor
KW - risk assessment/risk stratification
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U2 - 10.1111/ajt.13272
DO - 10.1111/ajt.13272
M3 - Review article
C2 - 25868787
AN - SCOPUS:84939574728
VL - 15
SP - 2314
EP - 2323
JO - American Journal of Transplantation
JF - American Journal of Transplantation
SN - 1600-6135
IS - 9
ER -