Expanding the living related donor pool in renal transplantation: use of marginal donors

Kumar, Anant; Das, Subodh K.; Srivastava, Aneesh

doi:10.1016/s0041-1345(02)03890-3

Cited by 30 publications

(28 citation statements)

References 3 publications

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“…Srivastava et al [16] reported that 10 of 18 recipients had a serum creatinine level of <1.4 mg/dL at a median follow-up of 30 months, and the rest a value of <2.5 mg/dL within the same period. Kumar et al [44] found no change in antihypertensive medications in the recipients of grafts from hypertensive donors up to the end of their study.…”

Section: Resultsmentioning

confidence: 81%

“…Kumar et al [44] retrospectively studied 12 hypertensive donors who were controlled by one antihypertensive medication, and none of them needed any change in their antihypertensive treatment. Also, Gracida et al [26] followed 628 donors for a mean (SD) of 80.7 (32.58) months; 16 of them were hypertensive and they reported equal short-term results but with significantly lower GFR values than in the control group at the end of the follow-up.…”

Section: Resultsmentioning

confidence: 99%

“…Three of these studies were prospective [49–51] and the last was retrospective [44]. In all, 32 donors were included, with different follow-up periods.…”

Section: Resultsmentioning

confidence: 99%

“…Kumar et al [44], in a retrospective study, included 1011 donors of whom only eight were confirmed to donate a stone-bearing graft, and only one with a renal stone was admitted as an emergency for anuria 2 years after surgery. A stone in the lower ureter was diagnosed and treated by ureteroscopic removal.…”

Section: Resultsmentioning

confidence: 99%

“…In the remaining two patients the stones maintained nearly the same size, with no evidence of any other stones or complications. Kumar et al [44] retrospectively analysed the outcome of eight recipients of a stone-bearing graft, and no complications were noted. None of the eight studies evaluating the outcome of receiving a stone-bearing graft reported stone recurrence or related morbidity for the silent stone left in situ .…”

Section: Resultsmentioning

confidence: 99%

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Controversies related to living kidney donors

Kamal

Harraz

Shokeir

2011

Arab Journal of Urology

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BackgroundIncreasing the living-donor pool by accepting donors with an isolated medical abnormality (IMA) can significantly decrease the huge gap between limited supply and rising demand for organs. There is a wide range of variation among different centres in dealing with these categories of donors. We reviewed studies discussing living kidney donors with IMA, including greater age, obesity, hypertension, microscopic haematuria and nephrolithiasis, to highlight the effect of these abnormalities on both donor and recipient sides from medical and surgical perspectives.MethodsWe systematically searched MEDLINE, ISI Science Citation Index expanded, and Google scholar, from the inception of each source to January 2011, using the terms ‘kidney transplant’, ‘renal’, ‘graft’, ‘living donor’, ‘old’, ‘obesity’, ‘nephrolithiasis’, ‘haematuria’ and ‘hypertension’. In all, 58 studies were found to be relevant and were reviewed comprehensively.ResultsMost of the reviewed studies confirmed the safety of using elderly, moderately obese and well-controlled hypertensive donors. Also, under specific circumstances, donors with nephrolithiasis can be accepted. However, persistent microscopic haematuria should be considered seriously and renal biopsy is indicated to exclude underlying renal disease.ConclusionExtensive examination and cautious selection with tailored immunosuppressive protocols for these groups can provide a satisfactory short- and medium-term outcome. Highly motivated elderly, obese, controlled hypertensive and the donor with a unilateral small stone (<1.5 cm, with normal metabolic evaluation) could be accepted. Donors with dysmorphic and persistent haematuria should not be accepted. A close follow-up after donation is crucial, especially for obese donors who developed microalbuminuria.

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Section: Resultsmentioning

confidence: 81%

Section: Resultsmentioning

confidence: 99%

“…Three of these studies were prospective [49–51] and the last was retrospective [44]. In all, 32 donors were included, with different follow-up periods.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Controversies related to living kidney donors

Kamal

Harraz

Shokeir

2011

Arab Journal of Urology

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Management of Stone Disease in Renal Transplant Kidneys

Kural¹,

Öbek²

2012

Smith's Textbook of Endourology

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Respecting living kidney donor autonomy: an argument for liberalising living kidney donor acceptance criteria

Weightman

Coghlan

Clayton

2022

Monash Bioeth. Rev.

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Doctors routinely refuse donation offers from prospective living kidney donors with certain comorbidities such as diabetes or obesity out of concern for donor wellbeing. This refusal occurs despite the ongoing shortage of kidney transplants and the superior performance of living donor kidney transplants compared to those from deceased donors. In this paper, we argue that this paternalistic refusal by doctors is unjustified and that, within limits, there should be greater acceptance of such donations. We begin by describing possible weak and strong paternalistic justifications of current conservative donor acceptance guidelines and practices. We then justify our position by outlining the frequently under-recognised benefits and the routinely overestimated harms of such donation, before discussing the need to respect the autonomy of willing donors with certain comorbidities. Finally, we respond to a number of possible objections to our proposal for more liberal kidney donor acceptance criteria. We use the situation in Australia as our case study, but our argument is applicable to comparable situations around the world.

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Expanding the living related donor pool in renal transplantation: use of marginal donors

Cited by 30 publications

References 3 publications

Controversies related to living kidney donors

Controversies related to living kidney donors

Management of Stone Disease in Renal Transplant Kidneys

Respecting living kidney donor autonomy: an argument for liberalising living kidney donor acceptance criteria

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