Donatie - P58 - Inclusion of compatible donor-recipient pairs in the Dutch kidney exchange programme: a new challenge

M. de Klerk, W. Zuidema, J. van de Wetering, E.K. Massey, W. Weimar, M.G.H. Betjes

Chair(s): drs. Tineke Wind, transplantatiecoördinator, Maastricht UMC

Thursday 10 march 2016

13:00 - 13:30h at Foyer

Categories: Postersessie

Parallel session: Postersessies XI - Opgesplitst in 3 tijdblokken en 3 categoriëen (klinisch, basaal, donatie)

Background:
Since 2004 incompatible donor-recipients pairs have participated in the Dutch kidney exchange program. However, also compatible couples could be enrolled in this programme. One kidney donation can then result in multiple transplant procedures. However, such a programme is not widely implemented and the willingness to participate is unknown. Initial results from our own center showed that five compatible couples participated successfully in the Dutch kidney exchange programme, which resulted in fourteen transplant procedures. Further development of such a programme necessitates a structured process and identification of possible barriers, including an understanding of the motivation and willingness of both recipients and donors.

Methods:
A literature search was performed for relevant data regarding logistical issues and ethical concerns. Discussion meetings with our transplant team were held and the commission of medical ethical issues of our hospital was consulted for their opinion on the protocol of this programme.

Results:
The most important topics mentioned within the literature are: 1.undue influence, 2.organisational issues as wait time, who should travel and the item on anonymity, 3.equivalence of organs, 4.empathy or altruism and 5.financial compensation. These issues were discussed and the importance of avoiding undue influence and maintaining anonymity were recognized. In addition, no financial compensation should be offered. The organisational issues will always be discussed with the compatible pairs and their wishes should be facilitated as much as possible. The possibility of equivalence of the quality of the kidneys will be discussed within the committee of the Dutch kidney exchange programme. These conclusions formed the basis of the development of a structured enrolment procedure and a neutral information leaflet for compatible donor-recipient pairs. This protocol was discussed and approved by the commission of medical ethical issues of our hospital. In addition, different research instruments are under development to gain more insight in motivation and possible barriers, covering important subjects such as emotional and rational considerations and moral obligations.

Conclusion:
A protocol has been developed at the Erasmus MC to include compatible pairs in the Dutch kidney exchange programme. The motivations and possible barriers for the pairs that were important for their decision to participate or not will be studied.