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Abstract

Objectives: Living-related kidney donation is the main source of renal grafts in Jordan, since kidneys from deceased donors are scarce. Although the Jordanian community accepts the idea of kidney donation to family members, not all potential donors manage to complete the required psychologic and medical evaluations. We review the causes of kidney-donation cancellation and suggest options to increase the number of available organs. Materials and Methods: We performed a retrospective chart review of all potential living-related kidney donors at King Hussein Medical Center between January 2008 and June 2016.Results: Of 642 potential donors, 366 (57%) were male and 276 (43%) were female, ranging in age from 18 to 66 years with a mean age of 37 years. A total of 384 (59.8%) eventually donated a kidney. A donor issue was the cause of cancellation in 143 (22.3%), whereas 47 (32.9%) had a risk for renal impairment after donation (eg, hematuria, proteinuria, stones, multiple renal cysts, scarred kidney, congenital malformation, recurrent urinary tract infection), and 30 (21%) had blood group or immunologic incompatibilities. Fifteen (10.5%) withdrew during the evaluation process, 13 (9%) had hypertension, 10 (7%) had a high body mass index, 8 (5.6%) were diabetic or prediabetic, 7 (4.9%) were surgically unsuitable, 4 (2.8%) had hepatitis B virus infection, 4 (2.8%) were pregnant, 3 (2.1%) had significant cardiovascular disease, 1 (0.7%) had splenomegaly with lymph node enlargement, and 1 (0.7%) had thyroiditis. Conclusions: Cancellation of kidney donation in Jordan is mainly for medical reasons, the most common being renal issues. Paired donation between blood group and immunologically incompatible duos may increase the number of organs available, as may good psychologic assessment and counseling of those likely to change their mind. Support should be provided for donors who drop out of donation for any cause, especially for renal and vascular issues.

Addressing Kidney Transplant Shortage: The Potential of Kidney Paired Exchanges in Jordan

“…However, an Iranian study evaluated 512 kidney transplant recipients and found significant polymorphism in both class 1 and 2 antigens [ 29 ]. In a study done retrospectively at the King Hussein Cancer Centre (KHCC) to evaluate the cause of cancellation of potential kidney transplants, out of 642 possible donations, 143 were cancelled due to donor issue; out of those, 16 (11.2%) potential kidney transplants were cancelled due to ABO incompatibility, 10 (7.1%) other potential donors were positive for cytotoxic antibodies, only 3 (2.1%) had 0% HLA match, and only one (0.7%) potential donor had both cytotoxin antibodies and HLA incompatibility [ 3 ]. While desensitization has been proposed as one approach, it is associated with complications and risks [ 30 ].…”

“…The Jordanian parliament then took proactive action in 1977 by enacting laws governing organ donation and transplantation, becoming one of the first Arab nations to regulate such procedures [ 2 ]. Nevertheless, despite these early advances in living donor transplantation, the organ donation after brain death program in Jordan is not active, and the absence of an active brain death donation program significantly contributes to the difficulty of meeting the demand for organs, leaving many patients on long waiting lists with little hope of receiving a life-saving transplant [ 3 – 5 ].…”