Proposed Policy:
Directed Donation
South African Transplant Society
2010
Prepared by: Netcare Transplant Division
Approved by: ____SATS______________
Approval date: _________________
Review date: ___________________
Version: 1
POLICY STATEMENT
i.
ii.
To ensure that the South African Transplant Society and Transplant units
are compliant with the National Health Act No 61 of 2003 and the Human
Tissue Act 65 of 1983 with regards to transplantation
Provide guidelines on the ethical concerns of solicitation for organs
DIRECTED DONATION
i.
An organ that is directed to an identified recipient, either by a living donor
or at the bequest of a donor family.
THE LIVING RELATED / UNRELATED DIRECTED DONATION
i.
ii.
Genetically related donor (usually a parent, sibling, son, daughter, aunt, uncle,
nephew, niece, cousin)
Emotionally related (usually spouse, friend or someone with whom they have
a genuine close relationship)
Donation of a kidney to a genetically related recipient is a well established in
South Africa being regulated by the National Health Act No 61 of 2003.
Donation of a kidney to an emotionally related recipient is ethically acceptable
with Department of Health granting permission for the transplant in accordance to
the National health Act No 61 of 2003.
GENERAL PRINCIPLES FOR RELATED / UNRELATED LIVING
DIRECTED DONATION
i.
ii.
iii.
iv.
v.
The donor must be over 21 years of age and be able to make an informed
consent
The donor must be altruistic, free from coercion
The donor may withdraw at any time before the surgery without reason
The safety and suitability of the donor and recipient must be complied with
There should be follow up of the living donor
SOLICITATION
DEFINITION
1. “To plead or ask for something.”
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2. ‘To ask somebody for something”
3. “To draw somebody into participation in illegal or immoral acts”
Encarta Dictionary: English UK
DIRECTED LIVING DONATION WITH SOLICITATION
DEFINITION
Public media advertising appealing for a potential living donor to come forward to
donate an organ directly to the recipient.
ETHICAL CONSIDERATIONS OF SOLICITED DIRECTED LIVING
DONATION
i.
ii.
iii.
iv.
Inappropriate transplant of unsuitable or less urgent recipients
Recipients with greater resources and communication skills may have an
advantage over less resources or educated recipients
May be attempt to solicit a live donor rather then approach family or
friends
Potential for illegal payments or incentives to live donors even years later
GENRAL PRINCIPLES OF LIVING DIRECTED DONATION WITHOUT
SOLICITATION
i.
ii.
Direct media and internet appeals to direct donation directly to the
recipient are not ethically acceptable.
Assistance with raising public awareness of organ donation in general is
permitted. If a living altruistic donor should come forward, the Altruistic
Donor” policy will be complied with.
a. Currently the donor should be referred to a State hospital centre of
excellence where all preliminary evaluations should occur
b. Once the altruistic donor has been found competent to donate, cross
matching can be undertaken
c. Suitable recipients from the top of the cadaveric allocation system
should be selected as potential candidates. This benefits many as
everyone below shifts up a slot on the allocation system
d. High risk recipients should not be considered as outcome of an
altruistic donation is of great importance (MAC)
e. The selected recipient’s insurer (State or Private sector) becomes
responsible for all costs incurred in the donation process (CMS)
f. The actual donation process may then occur in either health care
sector
g. For the donation to be truly altruistic, the donor should not request one
recipient over another, and should this occur, the process should be
halted
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DECEASED DIRECTED DONATION
DEFINITION
The deceased donor family directs donor organs to a specific recipient where there
is already an established relationship; family, friends or social community members
known to the family e.g. church member.
ETHICAL CONSIDERATIONS OF SOLICITED DECEASED DIRECTED
DONATIONS
i.
ii.
iii.
iv.
Violation of a fair cadaveric allocation system by allowing recipients to
‘jump’ the queue
May allow donor families to direct donation based on conditional consent
to specific groups only
Inappropriate transplant of unsuitable or less urgent recipients
Recipients with greater resources and communication skills may have an
advantage over less resources or educated recipients
GENERAL PRINCIPLES OF DECEASED DIRECTED DONATION
i.
ii.
iii.
iv.
v.
Donor autonomy should be balanced with the rights of those on the cadaver
waiting list.
The directed donation should only be to recipients with whom the donor family
or donor have an emotional bond or a family member.
If there is no emotional bond with the recipient, and the recipient is ‘known’ to
the donor or family by media through raising awareness of organ donor,
provided that the recipient has not made a specific appeal for organs to be
directed to themselves, then this should be ethically allowed.
The donor family must be made aware that the intended recipient must be
medically suitable and matched before the transplant and if the recipient was
not, that the organ would be allocated according to the cadaver waiting list.
Other organs must be allocated according to the allocation system of the
cadaver waiting list.
LEGAL FRAMEWORK
i.
The National health Act 61 of 2003 and the Human tissue Act 65 of 1983
covers deceased donation to a specific institution or recipient.
(The Human tissue act 65 of 1983 still remains enforce until the regulations of
Chapter 8 of the National Health act 61 of 2003 have been published)
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REFRENCES:
1. Human Tissue Act No 65 of 1983 - s 3(1)
2. National Health Act No 61 of 2004 – Ch 8 s 63
3. Hanto, D.W. 2007. Ethical Challenges Posed by the Solicitation of Deceased
and Living Organ Donors. New England Journal of Medicine. 356:10. 10621066.
4. Truog, R.D. 2005. The Ethics of Organ Donation by Living Donors. New
England Journal of Medicine. 353:5. 444- 446.
5. Department of Health, New South Wales. Policy Directive. Kidney Donation –
Living (including Directed and Non- directed Donation). Available online:
http://www.health.nsw.gov.au/policies/pd/2009/pdf/PD2009_013.pdf
6. Declaration of Istanbul on Organ Trafficking and transplant Tourism. Turkey
30 April – 2 May 2008.
7. Interm Report of the OPTN/UNOS Ethics Committee. Chicago. 7 December
2009. Available on line:
http://www.unos.org/CommitteeReports/interim_main_EthicsCommittee_1_5_
2010_9_18.pdf
8. World Health Organization. Sixty Second World Health Assembly. 26 March
2009. Guiding Principle 6. pg 10. Available at:
http://apps.who.int/gb/ebwha/pdf_files/A62/A62_15-en.pdf
9. Statement on Directed Donation and Solicitation of Organs. American Society
of Transplant Surgeons. 23 October 2006. Available at:
http://www.asts.org/Tools/Download.aspx?fid=269
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