Economic and ethical impact of extrarenal findings on potential living kidney donor assessment with computed tomography angiography

Abstract

Summary To determine the prevalence and spectrum of extrarenal findings in a screening population of potential living kidney donors undergoing renal Computed tomography angiography (CTA) and evaluate their impact on subsequent patient management and imaging costs. Two radiologists retrospectively reviewed 175 consecutive renal CTA's performed for assessment of potential living kidney donors. Extrarenal radiological findings were recorded and classified according to high, medium, or low importance based on clinical relevance and the need for further investigations and/or treatment. The cost of additional imaging examinations was calculated using 2002 Canadian (British Columbia) reimbursements. There were 73 extrarenal findings in 71/175 (40.6%) of the potential kidney donors in the study population. Findings were categorized as of high clinical importance in 18 (10.3%) cases, including lung lesions, bowel tumors, and liver tumors and as medium importance in 31 (17.7%). Twenty‐two (12.6%) individuals had findings categorized as low importance, probably of no clinical significance and requiring no follow‐up. Further potential evaluation of the 49 patients (28%) with highly and moderately significant extrarenal findings may require an additional $6137 (mean $35.1 per each case of all the screened patients). Transplantation of a kidney from a living donor is an excellent alternative to cadaveric allografts. Potential living kidney donors are a highly selected population of healthy individuals, screened for significant past or current medical conditions before undergoing CTA. Despite this screening, potentially significant extrarenal findings (classified as high or medium importance) were revealed in 28% of patients. These patients may require further investigations and/or treatment. The referring physician and patient should be aware of such potentially high probability, which may require further nontransplant related evaluation and treatment. This has medical, legal, economic, and ethical implications.

Incidental findings on routine thoracoabdominal computed tomography in blunt trauma patients

“…A not previously identified malignancy was found in nine patients, being 0.9% of the total trauma population. Our study population of patients with high-energy trauma had a mean age of 40 years, which can be perceived as relatively (2) Cirrhosis of liver (2) Hydronephrosis (2) Percutaneous nephrostomy (1) Urethral stricture (1) Intravenous pyelogram, after shockwave therapy (1) Pyelum stone (1) Aneurysm abdominal aorta Ͼ5 cm (1) Deceased before intervention Aneurysm thoracic aorta Ͼ6 cm (1) Endovascular repair Thoracic aneurysm Ovary cyst Ͼ3 cm (5) Uterus, adnexal extirpation (1) Cystadenoma (1) Observation, trans vaginal ultrasonography (4) Functional benign cysts (4) Irregular prostate suspect for malignancy (3) Laparoscopic prostatectomy (1) Prostatic carcinoma (1) Fine needle aspiration biopsy (2) Benign cytology (2) Pulmonary infiltrate (6) Bronchoscopy (4) Granuloma (2) Sarcoidosis (1) Pneumonia (1) Antibiotics, repeat X-rays (2) Pneumonia (2) Pericardial fluid (1) Puncture pericardium Pericarditis Pancreatitis (1) Cholecystectomy a froid Biliary pancreatitis Cardiac decompensation (2) Diuretics (2) Cardiac decompensation (2) Figure 1. A 58-yr-old male patient in whom a mediastinal tumor was found incidentally during MDCT workup.…”

“…On the other hand, incidental findings may lead to higher costs in healthcare and increased concern in patients because of additional examinations or treatment that may have to be performed to exclude or treat a diagnosis. [2][3][4] Literature is available on the workup for incidental findings on MDCTs of the thorax 5,6 and the abdomen, 7 on specific incidental findings, such as of the thyroid, 8 and on specific patient populations such as urological 9 and abdominal aneurysm 10 patients. In addition, several studies have evaluated the frequency of incidental findings in trauma populations.…”

Evaluating potential live-renal donors: Causes for rejection, deferral and planned procedure type, a single-centre experience

“…9 In their series, 49 (28%) patients required further imaging, which represented a mean increased cost of $35 for each screened patient. Our re-imaging rate was lower (11.1%), likely because our cohort received full abdominal ultrasound prior to CTA, while the comparison cohort only underwent renal ultrasound.…”

Incidental findings on total-body CT scans in trauma patients

“…It is estimated that approximately 29 000 future cancers every year could be the result of past CT scan use [21]. Furthermore, invasive diagnostic procedures following an incidental finding have their own subsequent risks for complications and might increase health care costs extensively [6,8]. In addition to the physical hazards, increased concern awaiting results of diagnostic tests might unnecessarily affect patients.…”

“…These incidental findings might be beneficial to patients in case of earlier detection of a malignancy. Conversely, it might result in increased patients' anxiety and health care costs in case of additional work-up for abnormalities that ultimately might not affect patients' health [7,8].…”