Increasing the supply of kidneys for transplantation by making living donors the preferred source of donor kidneys (original) (raw)
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Living kidney donation: outcomes, ethics, and uncertainty
The Lancet, 2015
Since the fi rst living-donor kidney transplantation in 1954, more than half a million living kidney donations have occurred and research has advanced knowledge about long-term donor outcomes. Donors in developed countries have a similar life expectancy and quality of life as healthy non-donors. Living kidney donation is associated with an increased risk of end-stage renal disease, although this outcome is uncommon (<0•5% increase in incidence at 15 years). Kidney donation seems to elevate the risks of gestational hypertension and pre-eclampsia. Many donors incur fi nancial expenses due to factors such as lost wages, need for sick days, and travel expenses. Yet, most donors have no regrets about donation. Living kidney donation is practised ethically when informed consent incorporates information about risks, uncertainty about outcomes is acknowledged when it exists, and a donor's risks are proportional to benefi ts for the donor and recipient. Future research should determine whether outcomes are similar for donors from developing countries and donors with pre-existing conditions such as obesity. Unequal access to living-donor kidney transplantation Unlike deceased-donor organs, living-donor organs are not usually treated as a public resource. Living kidney donation generally takes place as a directed gift between individuals after careful assessment by the transplant
Ethics and living donation in renal transplantation
2017
Nevertheless, the transplant community is dealing with organ scarcity in cadaveric transplantation, and potential receptors in Portugal spend an average of 5 years on the waiting list before receiving a kidney6. The following numbers illustrate this: in Portugal, in 2016, more than 7000 patients were on the waiting list for renal transplantation; only 513 patients were transplanted, 65 of whom received a kidney from a living donor7.
Living Donor Kidney Transplant: Medicolegal and Insurance Aspects
Transplantation Proceedings, 2005
Kidney transplantation is quite a routine complex procedure, not without risks and consequences to the donor, the recipient, and the health care professionals. Kidney-related medical malpractice suits are growing rapidly, and for clinicians and surgeons, the risk of being sued can be only reduced by practicing high-quality medicine and by appropriately communicating with donors and recipients. Actually relevant guidelines are available including safety and quality assurance standards for procurements, preservation, processing, and distribution for organs to maximize their quality and thereby the rate of success of transplants and to minimize the risk of such a procedure.
Ethical Considerations on Kidney Transplantation From Living Donors
Transplantation Proceedings, 2005
our study population consisted of 402 Living Related Donors (LRD)of which 344 pairs shared I haplotype (Group A) and of 209 Living unrelated Donors (LURD) (Group B): | 75 between spouse pairs (Group C)'* t 32 from wife to husband (Group'C I) and 43 f;m husband to wife (croup C2) as well as 32 betwe€n relatives in law or emotionally related patients and 2 between members of clerg/ (Group D). 199 pairs showed 3-6 HLA A B Dr missmatches (MM) witi the donor and in i0 cases d-2 MM. Donor :nd recipient mean age was 49a 13.4 and 29t 10.3 in Group Aand resPectively 46a | 1.2 and 48:t9.6 in Group B. The post-transplant immunosuppression therapy was based on cyclosporin A (csA).12 test was usect to assess statistical significancy. Donor mortality was 096; perioperative morbidity was 15.
Transplantation Proceedings, 2018
Background. Living donor kidney transplantation (LDKT) is the best therapy for patients with chronic renal failure. Its advantages, compared with cadaveric transplantation, include the possibility of avoiding dialysis, the likelihood of best outcome, and donor pool expansion. Careful assessment of potential donors is important to minimize the risks and ensure success. However, the proportion of donors disqualified has been poorly investigated. The aim of this work is to describe our experience and present the main reasons for missed donation. Methods. This was a single-center, retrospective study of all potential donors and recipients evaluated for LDKT between January 2008 and December 2017. Results. During the period of study, 81 donor-recipient pairs were evaluated. Of these, 45.7% were disqualified and 37 LDKTs were carried out. LDKT was the first choice in 68% of cases and preemptive in 20%; 60% of transplants were among family members. Sex distribution revealed a prevalence of females in the donor group (69%) and males in the recipient group (70%). The mean living donor age was 53 AE 9.5 years; the mean recipient age was lower in recipients listed in the living transplant program than those listed for cadaver transplantation (45.8 AE 13.4 vs 54.2 AE 11.08; P < .0001). Reasons for denial included hypertension (18.9%), deceased donor transplant performed during the study period (16.2%), urologic pathology (13.5%), incompatibility (13.5%), withdrawal of consent by donor or recipient (13.5%), psychological unsuitability (8.1%), donor cancer (5.4%), and reduced renal clearance (2.7%). Conclusion. LDKT is considered an option especially for younger recipients. Of the potential kidney living donors, 45.7% were disqualified during the evaluation, with medical reasons being the primary cause.
Living donor kidney transplants: the difficult decisions
Transplantation Reviews, 2003
At our center, candidates for kidney transplantation are usually encouraged to undergo living donor transplantation. The evaluation of both prospective donors and recipients has been standardized. Yet, even after full medical evaluation, the decision to proceed with living donation is often difficult. We herein discuss some of these difficult decisions and our approach to them. 2003 Elsevier Inc. All rights reserved. From the Departments of Surge O, and Medicine, University of Minne.mta, Minnealmlis. MN. SupIx~rted 41' National htstitutes of Health grant DKI3083. Address reprint requests to Arthur.L Matas, MD, Universi O, oJ'Mimwsota, Department of Surgeo,. MMC 328, ,190 Delaware St. ,bE, Minneapolis, MN 55.t55. © '-)003 EL~'evier btc. All rights rmen,ed. 0955-470.\703/1701-0009530.00/0
Ethical Evaluation of Risks Related to Living Donor Transplantation Programs
Transplantation Proceedings, 2013
The shortage of available cadaveric organs for transplantation and the growing demand has incresed live donation. To increase the number of transplantations from living donors, programs have been implemented to coordinate donations in direct or indirect form (crossover, paired, and domino chain). Living donors with complex medical conditions are accepted by several transplantation programs. In this way, the number of transplants from living has exceeded that from cadaver donors in several European countries. No mortality has been reported in the case of lung, pancreas, or intestinal Living donations, but the perioperative complications range from 15% to 30% for pancreas and lung donors. In living kidney donors, the perioperative mortality is 3 per 10,000. Their frequency of endstage renal disease does not exceed the United States rate for the general population. However, long-term follow-up studies of living donors for kidney transplantations have several limitations. The frequency of complications in live donor liver transplantation is 40%, of these, 48% are possibly life-threatening according to the Clavien classification. Residual disability, liver failure, or death has occurred in 1% of cases. The changes in live donor acceptance criteria raise ethical issues, in particular, the physician's role in evaluating and accepting the risks taken by the living donor. Some workers argue to set aside medical paternalism on behalf of the principle of donor autonomy. In this way the medical rule "primum non nocere" is overcome. Transplantation centers should reason beyond the shortage of organs and think in terms of the care for both donor and recipient.
Frontiers in Public Health, 2022
Living kidney donation is the most common type of living-donor transplant. Italian guidelines allow the living donations from emotionally related donors only after clear and voluntary consent expressed by both the donor and the recipient involved. Living donation raises ethical and legal issues because donors voluntarily undergo a surgical procedure to remove a healthy kidney in order to help another person. According to the Italian standards, the assessment of living donor-recipient pair has to be conducted by a medical “third party”, completely independent from both the patients involved and the medical team treating the recipient. Starting from the Hospital “Città della Salute e della Scienza” of Turin (Italy) experience, including 116 living kidney donations, the Authors divided the evaluation process performed by the “Third-Party” Commission into four stages, with a particular attention to the potential donor. Living donation procedures should reflect fiduciary duties that heal...