The independent donor advocate and the independent donor advocate team

Critical shortages of deceased organ donors have resulted in the need for living donors to be utilized for solid organ transplant. Federal regulations require transplant programs to appoint an independent living donor advocate (ILDA) to ensure safe evaluation and care of live donors. Operationalizing the role of the ILDA varies across transplant programs. This includes debates regarding whether the ILDA should be an individual or a team of advocates (ILDT). If a team approach is implemented, discussions occur regarding what is the composition of the team, who appoints them, and at what part in the process do they interact with the donor. A team approach to donor advocacy has many benefits but some limitations as well. The ILDT’s involvement should not end with consent and donation but should continue through short- and long-term follow-up and management. Advocacy for the donor does not end with the appointed ILDT. Family, friends, and others may advocate for the donor throughout the donation process. Ultimately, it is the goal of this team of advocates to assist donors to advocate for themselves. Optimal outcomes begin with prepared, educated, uncoerced, and motivated donors, and it is the ILDT’s role to help donors achieve this.