Is Living Kidney Donation Really Safe?

Azar, Sima Abedi; Nakhjavani, M.R.J.; Tarzamni, Mohammad Kazem; Faragi, A.; Bahloli, A; Badroghli, N.

doi:10.1016/j.transproceed.2007.04.017

Cited by 27 publications

(17 citation statements)

References 4 publications

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“…Renal transplantation is considered the best treatment in the case of end-stage renal disease [1], as it is associated with better quality of life and a longer life expectancy [2] and is more profitable economically [3] than dialysis. Given the shortage of renal graft from deceased persons [4, 5], the low risk involved for the donor [6, 7] and the improved quality of life likely to result for the recipient [8, 9], living kidney donation is currently being promoted and increasingly practiced in all western societies [10].…”

Section: Introductionmentioning

confidence: 99%

Donors and Recipients of Living Kidney Donation: A Qualitative Metasummary of Their Experiences

Ummel

Achille

Mekkelholt

2011

Journal of Transplantation

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With the notable growth in the qualitative investigation of living kidney donation, there is value in aggregating results from this body of research to learn from accumulated experience. The present paper aims to draw a complete portrait of living donors' and recipients' experience of donation by metasummarizing published studies. We found that donors' experience, particularly the decision-making process, has been more extensively studied than the recipients' perspective. Donors differ in their initial level of motivation to donate but on the whole report positive experiences and personal benefits. They also identify difficult periods and the need for additional resources. Recipients report an often positive but more ambivalent reaction to donation. In terms of relational issues between dyads, while the topic remains understudied, the donor-recipient relationship and gift reciprocity have received the most attention. Results are discussed in terms of their implications for future practice and research.

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Section: Introductionmentioning

confidence: 99%

Donors and Recipients of Living Kidney Donation: A Qualitative Metasummary of Their Experiences

Ummel

Achille

Mekkelholt

2011

Journal of Transplantation

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“…These changes, in the long − term, can end − up in renal failure. This was demonstrated by Azar et al (Table 1) on a study where 55% of renal donors presented complications, 7% had an increase in creatinine levels and 10% developed severe depression [15]. …”

Section: Discussionmentioning

confidence: 87%

Ethical issues relating to renal transplantation from prediabetic living donor

2014

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BackgroundIn Mexico, diabetes mellitus is the main cause of end − stage kidney disease, and some patients may be transplant candidates. Organ supply is limited because of cultural issues. And, there is a lack of standardized clinical guidelines regarding organ donation. These issues highlight the tension surrounding the fact that living donors are being selected despite being prediabetic. This article presents, examines and discusses using the principles of non-maleficience, autonomy, justice and the constitutionally guaranteed right to health, the ethical considerations that arise from considering a prediabetic person as a potential kidney donor.DiscussionDiabetes is an absolute contraindication for donating a kidney. However, the transplant protocols most frequently used in Mexico do not consider prediabetes as exclusion criteria. In prediabetic persons there are well known metabolic alterations that may compromise the long − term outcomes of the transplant if such donors are accepted. Even so, many of them are finally included because there are not enough donor candidates. Both, families and hospitals face the need to rapidly accept prediabetic donors before the clinical conditions of the recipient and the evolution of the disease exclude him/her as a transplant candidate; however, when using a kidney potentially damaged by prediabetes, neither the donor’s nor the recipient’s long term health is usually considered.Considering the ethical implication as well as the clinical and epidemiological evidence, we conclude that prediabetic persons are not suitable candidates for kidney donation. This recommendation should be taken into consideration by Mexican health institutions who should rewrite their transplant protocols.SummaryWe argue that the decision to use a kidney from a living donor known to be pre-diabetic or from those persons with family history of T2DM, obesity, hypertension, or renal failure, should be considered unethical in Mexico if the donor bases the decision to donate on socially acceptable norms rather than informed consent as understood in modern medicine.

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“…[21-25] However, even among these small studies, a few authors suggested that there may be some risk to donation and encouraged the establishment of donor registries. [26-28] That said, it has only been in the past five years that large studies over longer observation periods have had the power to show an increased risk of ESRD[3,4] and pregnancy complications in former living kidney donors. [2,29,30] These studies and our data confirm: 1) that the current OPTN requirement of two year living kidney donor follow-up is inadequate as many health complications may not appear for years or decades; and 2) that long-term living donor registries are needed.…”

Section: Discussionmentioning

confidence: 99%

Living Kidney Donors Who Develop Kidney Failure: Excerpts of Their Thoughts

et al. 2016

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Background: Psychosocial data about living kidney donors have been collected for almost 5 decades now. To date, however, no study has provided any psychosocial follow-up of donors who developed a serious health problem such as end-stage renal disease (ESRD). Methods: Donors who developed ESRD were invited to participate in a qualitative interview if they met one or both of the inclusion criteria: (1) developed ESRD within 10 years of donating and/or (2) lacked health insurance at the time of donation. We contacted 38 individuals who met these criteria, and 22 participated (58%). Two were subsequently excluded from analysis. Results: Twenty qualitative interviews were analyzed. Five findings are described: (1) donors describe the decision-making process as spontaneous and fast; (2) donors describe lack of appreciation for the need for post-donation self-care; (3) donors do not regret donating despite the adverse outcome; (4) donors advise future donors to have in place emotional and physical support post donation; and (5) donors appreciate the opportunity to tell their story from being a living donor to living with ESRD, which virtually all perceive as 2 separate unrelated events. Conclusions: Most donors are positive about their donation decision and experience and would donate again, despite developing ESRD themselves. They propose some important changes to the decision-making and informed-consent processes. Our data are reassuring regarding lack of donor regret, but highlight the need for living donor transplant programs to ensure that living donors understand their long-term risks and receive appropriate life-long follow-up care to minimize these risks.

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Is Living Kidney Donation Really Safe?

Cited by 27 publications

References 4 publications

Donors and Recipients of Living Kidney Donation: A Qualitative Metasummary of Their Experiences

Donors and Recipients of Living Kidney Donation: A Qualitative Metasummary of Their Experiences

Ethical issues relating to renal transplantation from prediabetic living donor

Living Kidney Donors Who Develop Kidney Failure: Excerpts of Their Thoughts

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