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An European Multicentre Study of Transplantation of Organs from Living Donors : the Ethical and Legal Dimensions

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Globally the supply of cadaveric solid organs for transplantation is failing to meet demand, despite this the use of living donor transplantation (LDT) is highly variable and in many European states, in decline. Living donor transplantation remains the most efficient, most durable and most economical method of treating endstage renal failure. It provided the basis for the majority of successful cadaveric transplant programmes in Western Europe and for that reason is likely to be a corner stone of effective renal replacement services in the developing Central and Eastern European countries. The potential for growth in organ transplantation in Central and Eastern European states is great and the need is pressing. With limited dialysis facilities, increased annual transplantation rates are likely to be the only means of avoiding excessive mortality and morbidity. The newly formed independent territories in particular would benefit greatly from the experience of Western jurisdictions with respect of LDT. Sharing of data and experience would however be mutually beneficial to all participants and the project would for the first time generate reliable and comprehensive data for these states. The project will help establish and develop databases covering three key areas which would be accessible to all participants (1) professional and community attitudes (surveyed by questionnaires and interviews of clinical staff, patients and families) (2) Donor Health Registry, containing long-term and short-term pre-operative and postoperative morbidity data on living donors (3) Legisearch, a database of laws governing transplantation in general and LDT in particular. Experience with existing legal regimes would be of particular value to the many Central and Eastern states contemplating legislation in this area. The EUROTOLD project is an ideal vehicle for dissemination of information and the sharing of experience. In addition expansion of the project will permit a fuller evaluation of the ethics and practice of LDT generally and the use of marginal donors in particular. It is anticipated that this Central and Eastern European liaison will lead to the enhanced use of LDT within these states, leading to higher transplant rates overall. In countries with limited health care budgets and technological support, LDT offers much hope for the future.

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UNIVERSITY OF LEICESTER
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Gwendolen Road Leicester General Hospital
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