In defense of transplantation: a reply to nancy Scheper-Hughes.
Metrolina Nephrology Associates, P.A. Charlotte, NC, USA.American Journal of Transplantation (Impact Factor: 6.19). 08/2007; 7(7):1695-7. DOI:10.1111/j.1600-6143.2007.01840.x
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ABSTRACT: Transplantation is increasingly limited by the supply of donor organs. Identifying subgroups that do not support organ donation will allow targeted efforts to increase organ donation. A total of 185 non-acutely ill outpatients visiting a community physician's office voluntarily completed a survey designed to capture views and general knowledge/misconceptions about cadaveric organ donation/transplantation. Of 185 patients, 86 were willing to donate, 42 were unwilling, and 57 were unsure. Willingness to donate was significantly associated with: having discussed the topic with family; having known a cadaveric organ donor; age 55 yr; having graduated high school; recognizing the organ shortage as the primary problem in transplantation; having received a post-high school degree; having seen public information within 30 d; and having a family member in health care (all p</=0.05). Not significant were: gender; race; religious affiliation or regular church attendance; knowing a transplant recipient or wait-listed patient; and having easy internet access. Those unwilling/unsure more often thought: organ allocation is based on race/income; organ donation is expensive for the donor family; designated donors may not receive full emergency room care; a brain-dead person can recover. Intense efforts to improve public awareness and knowledge about organ donation/transplantation are necessary to maximize donation and the overall success of transplantation.Clinical Transplantation 04/2004; 18(2):193-200. · 1.63 Impact Factor
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ABSTRACT: The size of the prevalent ESRD population in the United States increased dramatically during the 1990s, from 196,000 in 1991 to 382,000 in 2000. Incidence also increased considerably during the same period, from 53,000 to 93,000 per year. If previous trends in ESRD incidence and prevalence continue, then current levels of health care resources that are devoted to the care of these patients will eventually be unable to meet the demand. This study discusses a Markov model developed to predict ESRD incidence, prevalence, and mortality to the year 2015 and incorporating expected changes in age/race distributions, diabetes prevalence, ESRD incidence, and probability of death. The model predicted that by 2015 there will be 136,166 incident ESRD patients per year (lower/upper limits 110,989 to 164,550), 712,290 prevalent patients (595,046 to 842,761), and 107,760 ESRD deaths annually (96,068 to 118,220). Incidence and prevalence counts are expected to increase by 44 and 85%, respectively, from 2000 to 2015 and incidence and prevalence rates per million population by 32 and 70%, respectively. The financial and human resources that will be needed to care for these patients in 2015 will be considerably greater than in 2005.Journal of the American Society of Nephrology 01/2006; 16(12):3736-41. · 8.99 Impact Factor
Article: How old is old for transplantation?[show abstract] [hide abstract]
ABSTRACT: Elderly patients are the fastest growing group requiring renal transplantation. This study investigates whether transplantation is worthwhile in the elderly and whether there is evidence supporting an age limit for transplantation. One thousand ninety-five adults transplanted in Scotland between 1 January 1989 and 31 December 1999 were followed up to 11 years. Sociodemographic, comorbidity and transplant data were obtained from the national databases and patient's notes. Patient and graft survival, risk and causes of graft failure and patient death were compared between four age groups (18-49, 50-59, 60-64 and >65). All groups had similar gender, social deprivation and renal disease distribution. The incidence of comorbidity increased with age. The groups had comparable HLA matching, but patients aged 18-49 years received transplants from younger donors and with shorter cold ischaemic times. Younger patients had more acute rejection and less delayed graft function. Older patients had a higher incidence of death with functioning graft. Patients over 65 years had an almost dialysis-free remaining life, while the graft half-life was significantly shorter than patient half-life in the youngest group. Transplantation in elderly recipients is worthwhile despite a higher comorbidity. Careful selection rather than a fixed age limit should be used to ensure a satisfactory graft and patient survival.American Journal of Transplantation 01/2005; 4(12):2067-74. · 6.19 Impact Factor
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