Living Donor Practices in the United States

Mandelbrot, Didier A.; Pavlakis, Martha

doi:10.1053/j.ackd.2012.04.010

Cited by 54 publications

(58 citation statements)

References 40 publications

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“…As in other areas of medicine, an individual's freedom to undergo a procedure or medical treatment must be circumscribed by the physician's judgment of risk and what constitutes reasonable clinical practice (22). With regard to determining donor eligibility, the limited quality and quantity of data about outcomes after live organ donation (particularly for medically complex donors) creates a situation in which decisions about whether to allow an individual to donate a kidney will likely always require the judgment of the individual transplant team (16). Such considerations should include the possible impact of turning down a donor while also remaining attentive to the donor's medical interests.…”

Section: Nonmaleficence In Living Kidney Donationmentioning

confidence: 99%

What Are the Harms of Refusing to Allow Living Kidney Donation? An Expanded View of Risks and Benefits

Allen

Abt

Reese

2014

American Journal of Transplantation

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Recent Organ Procurement and Transplantation Network policies relating to living kidney donation (LKD) warrant renewed attention to the ethics of transplantation from living donors. These policies focus on risks related to potential donor evaluation, informed consent and follow‐up. The ethical basis of living donation is a favorable risk/benefit ratio for the donor, but regulations and research have given less attention to the benefits of donation. Relatedly, the transplant field has also failed to consider potential harms from denying patients the opportunity to donate. These harms may be substantial in the setting of directed kidney donation to a spouse/partner, sibling or child. We argue that complete assessment of donor risks and benefits demands consideration of not only the risks and benefits of donation, but also those of refusing a donor. In contrast to the ever‐expanding literature on risks of donation, there are no data describing outcomes for individuals who were turned down as kidney donors. We consider factors contributing to this omission in the transplant literature, argue that current regulations may perpetuate a narrow understanding of relevant risks and benefits in LKD, and identify areas for improvement in research and clinical practice.

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Section: Nonmaleficence In Living Kidney Donationmentioning

confidence: 99%

What Are the Harms of Refusing to Allow Living Kidney Donation? An Expanded View of Risks and Benefits

Allen

Abt

Reese

2014

American Journal of Transplantation

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“…Criteria for acceptance include having two kidneys, normal kidney function, no identifiable risk of disease transmission (e.g., hepatitis C), and ability to tolerate the procedure with no (or minimal) increased risk (versus age-matched healthy general population). However, transplant centers' criteria for the minimal accepted GFR vary widely (39). Most centers insist on a minimal GFR of 80 ml/min per 1.73 m 2 .…”

Section: Kidney Donor Evaluation Selection Criteria and Kidney Funcmentioning

confidence: 99%

The Unjustified Classification of Kidney Donors as Patients with CKD

Matas

Ibrahim

2013

Clinical Journal of the American Society of Nephrology

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SummaryUnilateral nephrectomy for kidney donation results in loss of about 30% of baseline GFR, leaving some donors with GFR <60 ml/min per 1.73 m 2 , the threshold for the diagnosis CKD. This has resulted in insurability problems for some donors. This article reviews the definition of CKD, risks associated with CKD, and large follow-up studies on the vital status and risk of ESRD in kidney donors. It also provides evidence that kidney donors, despite having reduced GFR, are not at increased risk for CKD-associated morbidity and mortality. Epidemiologic studies, most with follow-up <10 years, have shown an association between GFR <60 ml/min per 1.73 m 2 and higher mortality and progression to ESRD. Low GFR in the absence of any other markers for kidney disease, however, conveys attenuated or minimal risk. Of note, studies of long-term kidney donor outcomes (6-45 years) have not shown excess mortality or ESRD. The limitation of the collective evidence is that the increased risks associated with GFR <60 ml/min per 1.73 m 2 were demonstrated in much larger cohorts than those reported for kidney donor outcomes, but donor outcome studies have substantially longer follow-up. On the basis of current findings, kidney donors with low GFR and no other signs of kidney disease should not be classified as having CKD. This is definitely not the reward they deserve, and, more important, the implications of reduced GFR in donors are not associated with unfavorable outcomes. In addition, the increasing number of patients who are interested in and are eligible for a kidney transplant has not been associated with a commensurate increase in the number of DD organs. This has resulted in a markedly longer waiting time on the list. The increasing waiting time for a DD transplant and the poor shortand mid-term results with dialysis have put increased emphasis on living donation. The major disadvantage of an LD transplant is the risk to the donor. Studies over the last three decades have noted a perioperative donor mortality rate of 3 in 10,000 (0.03%) and a major complication rate of ,1% (3-5). Laparoscopic nephrectomy is associated with quicker recovery than open nephrectomy but carries similar risk. To date, long-term follow-up studies report that donors, compared with controls, have similar or better survival rates, and perhaps lower rates of development of . In addition, donor quality of life after donation is excellent (15). Of concern, however, is that recent studies in the nondonor general population have suggested that reduced renal function is associated with increased cardiovascular and all-cause mortality; consequently, some former donors have had problems obtaining life and health insurance or are being forced to pay higher premiums (16,17). At the same time, some former donors with stable renal function have been labeled as having CKD. Herein, we review level of renal function after donation and the data on long-term survival and risk of ESRD after kidney donation. Definition of CKDMany observation studies have shown the a...

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“…Guidelines specify a value of GFR above or below a threshold as a main criterion to accept or decline candidate donors, although there is variation in both the recommended threshold to permit donation and the method by which GFR should be assessed (1)(2)(3)(4)(5)(6)(7). Some guidelines recommend that GFR be measured by clearance of an exogenous filtration marker (measured GFR [mGFR]) using urinary, plasma or radionuclide imaging clearance protocols; other guidelines accept urinary creatinine clearance (CrCl), although it is less accurate than clearance of exogenous filtration markers (1,2,6).…”

Section: Introductionmentioning

confidence: 99%