The State of U.S. Living Kidney Donors

Davis, Connie L.; Cooper, Mathew

doi:10.2215/cjn.01510210

Cited by 92 publications

(70 citation statements)

References 56 publications

(37 reference statements)

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“…Potential financial considerations for LKDs (with limited empirical evidence) include any effect on life and health insurability (21). In addition, it is known that almost one fifth of current LKDs lack health insurance (22). At-risk donors are more likely to be black, have lower educational attainment, or not be a United States citizen (22).…”

Section: Background On Systemic Barriers To Living Kidney Donationmentioning

confidence: 99%

“…In addition, it is known that almost one fifth of current LKDs lack health insurance (22). At-risk donors are more likely to be black, have lower educational attainment, or not be a United States citizen (22). For these donors, out-of-pocket expenditures associated with medical care may be more extensive in the long term.…”

Section: Background On Systemic Barriers To Living Kidney Donationmentioning

confidence: 99%

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Living-Donor Kidney Transplantation

Tushla

Rudow

Milton

et al. 2015

Clinical Journal of the American Society of Nephrology

104

113

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Live-donor kidney transplantation (LDKT) is the best treatment for eligible people with late-stage kidney disease. Despite this, living kidney donation rates have declined in the United States in recent years. A potential source of this decline is the financial impact on potential and actual living kidney donors (LKDs). Recent evidence indicates that the economic climate may be associated with the decline in LDKT and that there are nontrivial financial ramifications for some LKDs. In June 2014, the American Society of Transplantation's Live Donor Community of Practice convened a Consensus Conference on Best Practices in Live Kidney Donation. The conference included transplant professionals, patients, and other key stakeholders (with the financial support of 10 other organizations) and sought to identify best practices, knowledge gaps, and opportunities pertaining to living kidney donation. This workgroup was tasked with exploring systemic and financial barriers to living kidney donation. The workgroup reviewed literature that assessed the financial effect of living kidney donation, analyzed employment and insurance factors, discussed international models for addressing direct and indirect costs faced by LKDs, and summarized current available resources. The workgroup developed the following series of recommendations to reduce financial and systemic barriers and achieve financial neutrality for LKDs: (1) allocate resources for standardized reimbursement of LKDs' lost wages and incidental costs; (2) pass legislation to offer employment and insurability protections to LKDs; (3) create an LKD financial toolkit to provide standardized, vetted education to donors and providers about options to maximize donor coverage and minimize financial effect within the current climate; and (4) promote further research to identify systemic barriers to living donation and LDKT to ensure the creation of mitigation strategies.

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Section: Background On Systemic Barriers To Living Kidney Donationmentioning

confidence: 99%

Section: Background On Systemic Barriers To Living Kidney Donationmentioning

confidence: 99%

Living-Donor Kidney Transplantation

Tushla

Rudow

Milton

et al. 2015

Clinical Journal of the American Society of Nephrology

104

113

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“…14 Hypertension is present in 30% of the general population, and the prevalence increases with age; some studies report that it is present in 2% of living donors at the time of donation (we observed a rate of 5%) and develops in up to 40% of donors over time. 15,16 Garg and associates reported a 10-year hypertension rate of 16% postdonation, about 5% higher than in the control population. 16 The literature suggests that transplant programs generally exclude donors with a BMI > 35 kg/m², and 10% of programs exclude donors with a BMI > 30 kg/m².…”

Section: Discussionmentioning

confidence: 96%

“…15,16 Garg and associates reported a 10-year hypertension rate of 16% postdonation, about 5% higher than in the control population. 16 The literature suggests that transplant programs generally exclude donors with a BMI > 35 kg/m², and 10% of programs exclude donors with a BMI > 30 kg/m². 17 Hassan and associates found that a higher BMI is the single predonation variable associated with every adverse postdonation outcome except for death, and each increase of 1 kg/m² is associated with a 3% to 10% higher risk of proteinuria and a reduced glomerular filtration rate.…”

Section: Discussionmentioning

confidence: 96%

Untitled

Al-Rabadi¹,

Almardini

Hajeer³

et al. 2017

Exp Clin Transplant

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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.

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“…The spectrum of health in accepted donors with isolated medical abnormalities has ranged from subtle metabolic abnormalities to early pre-clinical disease states that may portend future risk [2]. In fact, contemporary donors are older, heavier, and carry more risk factors for chronic kidney disease than donors in earlier generations [3][4][5]. Additionally, recent data suggesting that live kidney donors have higher rates of end-stage renal disease in the long-term compared with otherwise similar healthy persons [6••, 7] highlights the importance of careful predonation selection, including assessment of renal function and structure as critical components of the donor evaluation.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Kidney Function and Structure in Potential Living Kidney Donors: Implications for the Donor and Recipient

2015

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Kidney transplantation is the best treatment for patients with end-stage renal disease and recipients of living kidney donors fare better than recipients of deceased donors. In view of the shortage of organ supply and the long waiting list, expansion of the living donor pool has been sought. Importantly, donor acceptance criteria must first and foremost be grounded in concerns for donor safety. Recent studies suggesting that live kidney donors may have higher rates of end-stage renal disease in the long term compared with otherwise similar healthy persons highlights the critical importance of pre-donation evaluation of renal function and structure, and careful application in donor selection criteria. The quality of organs from living donors may also affect recipient outcomes. Because donor kidney function, histology, and anatomy pertain to the quality of the donated organ, living donor characterization of the factors associated with these features is important to the donor as well as the recipient.

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The State of U.S. Living Kidney Donors

Cited by 92 publications

References 56 publications

Living-Donor Kidney Transplantation

Living-Donor Kidney Transplantation

Untitled

Evaluation of Kidney Function and Structure in Potential Living Kidney Donors: Implications for the Donor and Recipient

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