Solid Organ Transplant Litigation at One of Europe's Largest University Hospitals.

Due to its intrinsic complexity and the principle of collective solidarity that governs it, solid organ transplantation (SOT) seems to have been spared from the increase in litigation related to medical activity. Litigation relating to solid organ transplantation that took place in the 29 units of the Assistance Publique-Hôpitaux de Paris and was the subject of a judicial decision between 2015 and 2022 was studied. A total of 52 cases of SOT were recorded, all in adults, representing 1.1% of all cases and increasing from 0.71% to 1.5% over 7 years. The organs transplanted were 25 kidneys (48%), 19 livers (37%), 5 hearts (9%) and 3 lungs (6%). For kidney transplants, 11 complaints (44%) were related to living donor procedures and 6 to donors. The main causes of complaints were early post-operative complications in 31 cases (60%) and late complications in 13 cases (25%). The verdicts were in favour of the institution in 41 cases (79%). Solid organ transplants are increasingly the subject of litigation. Although the medical institution was not held liable in almost 80% of cases, this study makes a strong case for patients, living donors and their relatives to be better informed about SOT.

Effect of revised organ transplant law in Japan on lung transplantation.

PURPOSE: To investigate how revision of the organ transplant law in Japan affected lung transplantation in this country. METHODS: Lung transplant candidates registered between January, 2000 and December, 2009 were designated as the pre-revision group (n = 396) and those registered between January, 2011 and December, 2020, as the post-revision group (n = 1326). Both groups were analyzed retrospectively using data collected by the Japanese Society of Lung and Heart-Lung Transplantation. RESULTS: The number of patients who underwent brain-dead donor lung transplantation (BDLT) increased significantly after the law amendment (32.2 vs. 13.8%, p < 0.01). The median waiting time for BDLT was significantly reduced (708 days vs. 1163 days, p < 0.01) and the mortality rate while waiting for BDLT improved significantly after the law amendment (33.1 vs. 42.6%, p < 0.01). In the post-revision group, 18 pediatric patients underwent BDLT. The 5-year survival rates after BDLT were comparable between the groups (73.5% in the pre-revision group vs. 73.2% in the post-revision group, p = 0.32). CONCLUSIONS: The organ transplant law revision shortened the waiting time for BDLT significantly and decreased the mortality rate while waiting for BDLT. The posttransplant outcomes in Japan remained favorable throughout the study period.

Update in lung transplantation 2013.

Research in pulmonary transplantation is actively evolving in quality and scope to meet the challenges of a growing population of lung allograft recipients. In 2013, research groups leveraged large publicly available datasets in addition to multicenter research networks and single-center studies to make significant contributions to our knowledge and clinical care in the areas of donor use, clinical transplant outcomes, mechanisms of rejection, infectious complications, and chronic allograft dysfunction.

Donation after cardiac death lung transplantation outcomes.

PURPOSE OF REVIEW: Lung transplantation is now a well established treatment option for several end-stage respiratory diseases. Survival after lung transplantation has significantly improved over the last decade. The primary limitation to increased utilization of lung transplantation remains donor scarcity. Suitable allografts have been procured from donors after determination of neurologic death and from donors after determination of cardiac death (DDCD or DCD). Historically, the first human lung transplantation performed, utilized an allograft procured after cardiovascular death, also referred to as nonheart-beating donor.The experience at University of Wisconsin in 1993 reintroduced DCD lung transplantation with the first successful clinical case. RECENT FINDINGS: A potential additional lung allograft source, DCD lung transplantation has been established with very acceptable outcomes observed by several centers. We provide the relevant background for the rationale of donor allograft expansion to include DCD lungs from controlled (Maastricht category III donors). SUMMARY: This review considers the available evidence for DCD lung transplantation and compares reported primary graft dysfunction rates and current survival data available.

[Lung transplantation in Hungary (1996-2011)]. / Tüdotranszplantáció Magyarországon (1996-2011).

The 15 years history of lung transplantation in Hungary shows the medical, political and social characteristics of this period. The barely determined, open-ended legal, financial and ethical framework of transplantation has stayed nowadays in the same position. The Hungarian State Audit Office has also noted these problems. Joining of Hungary to Eurotransplant will beneficially influence the whole procedure.

Public Appeals Challenging Criteria for Pediatric Organ Transplantation.

In this article, I review the ethical issues that arise in the allocation of deceased-donor organs to children and young adults. By analyzing the public media cases of Sarah Murnaghan, Amelia Rivera, and Riley Hancey, I assess whether public appeals to challenge inclusion and exclusion criteria for organ transplantation are ethical and under which circumstances. The issues of pediatric allocation with limited evidence and candidacy affected by factors such as intellectual disability and marijuana use are specifically discussed. Finally, I suggest that ethical public advocacy can coexist with well-evidenced transplant allocation if and when certain conditions (morally defensible criteria, expert evidence, nonprioritization of the poster child, and greater advocacy for organ transplantation in general) are met.

How to improve organ donation: results of the ISHLT/FACT poll.

BACKGROUND: Worldwide organ shortages remain a long-standing problem. Efforts to address this have ranged from attempts to improve public awareness to modified mandated choice systems; most have been unsuccessful. In the face of this intractable problem, increased consideration has been given to direct and indirect compensation, and in certain countries, black markets for organs have developed. To examine the attitudes of the transplant medical community regarding these issues, we surveyed members of the International Society for Heart and Lung Transplantation (ISHLT) in conjunction with the Foundation for the Advancement of Cardiac Therapies (FACT). METHODS/RESULTS: We asked for opinions about how to improve organ donation. Of 739 respondents, 75% supported presumed consent, and 39% identified it as the single best way to increase donation; improved public education was a distant second (18%). Seventy percent supported indirect compensation (e.g., payment of funeral expenses, donation to a charity of the family's choice), and 66% opposed direct compensation (e.g., tax credit, life insurance benefit). When asked whether next of kin should be consulted regarding organ donation, and 84.2% responded affirmatively. However, of these individuals, 77.2% did not think that consultation should be required if the potential donor already had signed a donor card. MEMBERSHIP: Our membership dramatically favors indirect over direct compensation as a way of increasing organ donation. The majority also favors the wishes of the individual over the family in determining donor status. However, presumed consent is the single best way to significantly improve organ donation, according to the majority of our respondents. More effort should be directed toward policy in these areas as opposed to improving public education, which has failed to yield satisfactory results.

Current status and future of lung transplantation.

Lung transplantation has been performed successfully outside Japan since 1983 in patients with end-stage lung disease. More than 9,000 lung transplants have been reported in The Registry of the International Society for Heart and Lung Transplantation. In contrast, a transplant law became effective in Japan only recently, and four universities were designated as official lung transplant centers (Okayama, Osaka, Kyoto and Tohoku Universities). In October 1998, the first successful living-donor lobar lung transplantation was performed at Okayama University. Since then, seven lung transplants (four from living donors and three from cadaveric donors) have been successfully performed in Japan. Although lung transplantation offers acceptable prospects for 5-year survival, chronic rejection and donor shortage remain to be major problems. In an effort to address the donor shortage issue, living-donor lobar lung transplantations have been performed with satisfactory intermediate survival and functional results.

Single lung transplantation from a brain-dead donor for a patient with idiopathic pulmonary fibrosis. A breakthrough after new legislation in Japan.

Two single lung transplants from a single cadaveric donor were successfully conducted at 2 institutions on March 29, 2000, the first such procedure in Japan under newly introduced legislation. Our patient was a 48-year-old woman with idiopathic pulmonary fibrosis who underwent left single-lung transplantation under cardiopulmonary support. The donor lung was preserved in 4 degrees C modified Euro-Collins solution. Total ischemic time was 5 hours and 37 minutes. The postoperative course was uneventful. The patient was discharged on postoperative day 62 with satisfactory respiratory function.

[Current aspects of lung transplantation in eastern countries and Japan].

Approximately 1,500 lung transplantations are performed as an established treatment for progressive benign pulmonary diseases in Eastern countries. In Japan, however, lung transplantation has just started after a long dark period since the transplant law had become effective in October, 1997. Until today, 33 patients underwent lung transplantation, of whom 13 were received from brain death donors and 20 from living donors. For the patients in Kyushu, this therapeutic modality would be also expected in this district.

Was Sarah Murnaghan treated justly?

Lung transplantation is a potentially life-saving procedure for patients with irreversible lung failure. Five-year survival rates after lung transplantation are >50% for children and young adults. But there are not enough lungs to save everyone who could benefit. In 2005, the United Network for Organ Sharing developed a scoring system to prioritize patients for transplantation. That system considered transplant urgency as well as time on the waiting list and the likelihood that the patient would benefit from the transplant. At the time, there were so few pediatric lung transplants that the data that were used to develop the Lung Allocation Score were inadequate to analyze and prioritize children, so they were left out of the Lung Allocation Score system. In 2013, the family of a 10-year-old challenged this system, claiming that it was unjust to children. In the article, we asked experts in health policy, bioethics, and transplantation to discuss the issues in the Murnaghan case.

Temporal trends in lung transplant center volume and outcomes in the United States.

Publicly available program-specific data from the scientific registry of transplant recipients were used to determine the association between adult lung transplant center volume and 1-year recipient mortality from 2000 to 2007. We found a significant inverse association between the center volume of adult lung transplants and 1-year recipient mortality that is growing more pronounced over time. We conclude that procedure volume is an increasingly important determinant of lung transplant center volume and that policies that improve the performance of low-volume centers or reduce the number of patients who use such centers may be warranted.