Living Donor Kidney Transplantation in the United States-Looking Back, Looking Forward

Division of Nephrology, Tufts Medical Center, Boston, MA 02111, USA.
American Journal of Kidney Diseases (Impact Factor: 5.76). 09/2011; 58(3):343-8. DOI: 10.1053/j.ajkd.2011.06.007
Source: PubMed

ABSTRACT There is a desperate need for kidney donors. Twenty-five years ago, we urged more widespread acceptance of unrelated living donors for kidney transplantation. Since then, 2 of us have donated a kidney to an unrelated recipient. In our view, the major challenges for living donor transplantation today are to improve access to this extraordinary gift of life and ensure its safety. Our perspective is that altruism is the motivation for most living kidney donors and the decision to donate represents a shared responsibility among the donor, the donor's physician, and the team of professionals at the transplant center. Thus, sound knowledge of the benefits and risks to donors and recipients is required for informed decisions, and all parties share in the responsibility for the outcomes after living kidney donation. We encourage our colleagues and agencies within the US Department of Health and Human Services to accept the responsibility to do their utmost to provide access to this life-enhancing procedure and systematically evaluate the safety of kidney donation as it evolves to meet the needs of more of our patients.

  • American Journal of Kidney Diseases 05/2014; 64(3). DOI:10.1053/j.ajkd.2014.04.013 · 5.76 Impact Factor
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    ABSTRACT: African Americans (AAs) are overrepresented among those in need of a kidney transplant. Transplantation continues to be the therapy of choice for many AAs with End-Stage Renal Disease. Living donor transplant (LDT) offers numerous advantages over deceased donor transplantation; however, research consistently finds that AAs face significant barriers to LDT stemming from a lack of knowledge of LDT as a viable treatment option, distrust of the health care system, and lack of willingness to discuss LDT with family members. There is a need for culturally-sensitive interventions that addresses such patient-level barriers. Living ACTS (About Choices in Transplantation and Sharing) is a theory-based self-education intervention consisting of a DVD and educational booklet. Using a pre-post experimental research design, participants (N=296) received either Living ACTS or standardly available materials. Main outcomes explored knowledge of LDT, willingness to discuss LDT with family, and perceived benefit of LDT at both immediate and 6-month follow-up. At immediate follow-up, intervention participants demonstrated greater knowledge of LDT as a treatment option (=.16, p<.01) and reported greater perceived benefit of LDT ( =.26, p<.001) than control participants. At 6-month follow-up, intervention participants reported greater willingness to talk to family about LDT ( =.12, p<.05) than control participants. Living ACTS was successful at improving knowledge and perceived benefit of LDT in the short term. These improvements may have provided a mechanism for increasing willingness to talk to family about LDT over the subsequent 6 months during which time participants may have opportunities to experience family conversations about LDT.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Worldwide shortage of standard brain dead donors (DBD) has revived the use of kidneys donated after circulatory death (DCD). We reviewed the Belgian DCD kidney transplant (KT) experience since its reintroduction in 2000. Risk factors for delayed graft function (DGF) were identified using multivariate analysis. Five-year patient/graft survival was assessed using Kaplan–Meier curves. The evolution of the kidney donor type and the impact of DCDs on the total KT activity in Belgium were compared with the Netherlands. Between 2000 and 2009, 287 DCD KT were performed. Primary nonfunction occurred in 1% and DGF in 31%. Five-year patient and death-censored graft survival were 93% and 95%, respectively. In multivariate analysis, cold storage (versus machine perfusion), cold ischemic time, and histidine-tryptophan-ketoglutarate solution were independent risk factors for the development of DGF. Despite an increased number of DCD donations and transplantations, the total number of deceased KT did not increase significantly. This could suggest a shift from DBDs to DCDs. To increase KT activity, Belgium should further expand con- trolled DCD programs while simultaneously improve the identification of all potential DBDs and avoid their referral for donation as DCDs before brain death occurs. Furthermore, living donation remains underused.
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