ABSTRACT
BACKGROUND: This study aimed to compare trends in use of drug overdose (DO) donors in adult versus pediatric liver transplants and the utilization of split liver transplantation in this donor population. METHODS: The United Network for Organ Sharing database was reviewed for deceased donor liver transplants from March 2002 to December 2017. Recipients were categorized by donor mechanism of death. Donor splitting criteria was defined as age <40 y, single vasopressor or less, transaminases no >3 times the normal limit, and body mass index ≤ 28 kg/m2. RESULTS: Adult liver transplants from DO donors increased from 2% in 2002 to 15% in 2017, while pediatric liver transplants from DO donors only increased from <1% to 3% in the same time. While 28% of DO donors met splitting criteria, only 3% of those meeting splitting criteria were used as a split graft. Both pediatric and adult recipients of DO donor livers achieved excellent patient and graft survival. CONCLUSIONS: DO donors are underutilized in pediatric liver transplantation. Increased splitting of DO donor livers could significantly decrease, if not eliminate, the pediatric liver waiting list.
Subject(s)
Donor Selection/trends , Drug Overdose/mortality , End Stage Liver Disease/surgery , Liver Transplantation/trends , Opioid Epidemic/mortality , Opioid-Related Disorders/mortality , Tissue Donors/supply & distribution , Adult , Age Factors , Aged , Cause of Death , Child , Child, Preschool , Databases, Factual , End Stage Liver Disease/diagnosis , End Stage Liver Disease/mortality , Female , Humans , Infant , Infant, Newborn , Liver Transplantation/adverse effects , Male , Middle Aged , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , Waiting Lists/mortality , Young AdultSubject(s)
Allografts/physiopathology , Analgesics, Opioid/toxicity , Donor Selection/methods , Drug Overdose/mortality , Hepatitis/epidemiology , Acute Kidney Injury/blood , Acute Kidney Injury/diagnosis , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Alanine Transaminase/blood , Allografts/blood supply , Allografts/statistics & numerical data , Creatinine/blood , Donor Selection/trends , Drug Overdose/etiology , Hepatitis/blood , Hepatitis/diagnosis , Hepatitis/etiology , Humans , Ischemia/blood , Ischemia/diagnosis , Ischemia/epidemiology , Ischemia/etiology , Kidney/blood supply , Kidney/physiopathology , Liver/blood supply , Liver/pathology , Opioid-Related Disorders/complications , Opioid-Related Disorders/epidemiology , Tissue Donors/statistics & numerical dataSubject(s)
Blood Donors/legislation & jurisprudence , Donor Selection/legislation & jurisprudence , Donor Selection/standards , HIV Infections/prevention & control , Health Policy/trends , Homosexuality, Male , Prejudice , Sexual Behavior , Blood Donors/ethics , Donor Selection/ethics , Donor Selection/trends , Ethical Analysis , HIV Infections/transmission , Haiti , Health Policy/legislation & jurisprudence , Humans , Male , Power, Psychological , Risk Assessment , Risk Factors , Safety , Sexual Partners , Social Justice , Time Factors , United States , United States Food and Drug AdministrationABSTRACT
U.S. Food and Drug Administration (FDA) policy prohibits blood donation from men who have had sex with men (MSM) even one time since 1977. Growing moral criticism claims that this policy is discriminatory, a claim rejected by the FDA. An overview of U.S. blood donation, recent donor deferral policy, and the conventional ethical debate introduce the need for a different approach to analyzing discrimination claims. I draw on an institutional understanding of injustice to discern and describe five features of the MSM policy and its FDA context that contribute to its discriminatory effect. I note significant similarities in the 1980s policy of deferring Haitians, suggesting an historical pattern of discrimination in FDA deferral policy. Finally, I point to changes needed to move toward a nondiscriminatory deferral policy.