Equipoise: ethical, scientific, and clinical trial design considerations for compatible pair participation in kidney exchange programs

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
M C CuffyE S Woodle

Abstract

Compatible living donor/recipient pair participation (CPP) in kidney exchange (KE) transplantation may substantially increase transplant volumes and significantly mitigate the O blood group donor shortage in KE. Initial ethical analysis did not support CPP for two primary reasons: (1) KE would be "unbalanced," and (2) the possibility of undue influence experienced by the compatible pair living donor. Recent developments with CPP (modeling studies and small clinical experiences), have demonstrated substantial potential for increasing KE volumes. This encouraged us to reconsider initial ethical concerns, with a focus on the potential for a design of a prospective CPP clinical trial. This ethical reconsideration led us to conclude that the concept of unbalanced kidney exchanges (manifested primarily by differential benefit between compatible and incompatible pairs) is no longer as clear cut as originally conceived. In addition, application of two concepts substantially diminishes ethical concerns including: (1) "quasi-compatible" pairs, and (2) a priori definition of mitigating factors. We conclude that genuine uncertainty exists regarding whether kidney exchange is best performed with or without compatible pair participation and ...Continue Reading

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Citations

Mar 23, 2017·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·J S GillJ Gill
Jul 26, 2017·Transplantation·Krista L LentineAmit X Garg
Feb 15, 2018·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Benjamin SamsteinJean Emond
Apr 1, 2018·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Stuart M FlechnerAmy D Waterman
May 31, 2018·Transplant International : Official Journal of the European Society for Organ Transplantation·Darren LeeJoshua Y Kausman
Feb 6, 2020·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Sanjay Kulkarni, Keren Ladin
Jul 8, 2020·Transplant International : Official Journal of the European Society for Organ Transplantation·Vijay Kher, Pranaw Kumar Jha
Mar 28, 2017·Clinical Transplantation·Francis L WengMarie M Morgievich

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