The ethics statement of the Vancouver Forum on the live lung, liver, pancreas, and intestine donor.

The use of organs from live donors is an important component of transplantation today. The Ethics Committee of the Transplantation Society (TTS) has previously published a statement on ethical considerations pertaining to the live kidney donor (1). Evolving technologies have now allowed for the successful transplantation of organs from the live lung, liver, pancreas and intestine (extrarenal) donors. The Ethics Committee of TTS was convened at the Vancouver Forum to deliberate upon the use of live donors for extrarenal transplantation. The following is a summary of the committee’s deliberations. We believe that live extrarenal donation should proceed within the context of the ethical principles established for live kidney donation. The physical and psychosocial welfare of a healthy donor must be put in context of the needs of the recipient and impact of the recipient’s illness upon the donor. In principle, the Ethics Committee of TTS recommends that live lung, liver, pancreas and intestine donation should only be performed when the aggregate benefits to the donor-recipient pair (survival, quality of life, psychological, and social well being) outweigh the risks to the donorrecipient pair (death, medical, psychological, and social morbidities). At the Vancouver Forum, emerging data pertaining to the aggregate risks and benefits of live lung, liver, pancreas and intestine transplantation provided more information regarding the factors that enter into the ethical decision to place a healthy person in harms way. It is now evident that live donors are the sole source of organs for transplantation in many societies; however the limited availability of information about outcomes for the donors and recipients mandates that live lung, liver, pancreas and intestine organ donation and transplantation must proceed with thoughtful independent oversight and transparency. As organs recovered from deceased donors offer substantial (and sometimes superior) benefits to potential recipients, with no risk to a healthy, live donor, efforts to maximize the use of organs from deceased donors must not be impeded by the development of live organ donation. This consensus statement comes from the deliberations of the Ethics Group of the Vancouver Forum which was charged with defining the essential ethical elements of the process for the transplant center performing live lung, liver, pancreas and intestine donor. Special emphasis upon elements and issues of informed consent, assurance of donor autonomy and the patient selection process is included for clarity.