Article

Living kidney donation and hypertension risk

Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
The Lancet (Impact Factor: 39.21). 02/2007; 369(9556):87-8. DOI: 10.1016/S0140-6736(07)60046-4
Source: PubMed
0 Followers
 · 
61 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In Chapter One we described the development of live kidney donation. Currently, live donor kidney transplantation is the best solution to attack the persistent organ shortage in the Western World. Because of this shortage live kidney donation is still interesting over fifty years after Joseph Murray and Rene Kuss performed the first live kidney donor transplantations. The revival of live kidney donation in the 1990s still continues. Developments in immunosuppressive therapy, crossing the blood barrier, intelligent logistic solutions, improvements of peri-operative care and last but not least less invasive surgical techniques all attribute to the successes of live kidney donor transplantations. In this thesis we focused on the latter aspect, but one have to keep in mind that improvements in surgical and peri-operative care of the donor can only exist within a solid system providing screening of potential donors, selection of transplant candidates and accurate medical treatment of the recipients. In the United States Ratner and colleagues introduced laparoscopic donor nephrectomy in 1995. This technique has greatly revolutionized live kidney donation. Presently the majority of live kidney donors is operated on using a (modified) laparoscopic approach. However, the introduction of minimally invasive surgery has also encouraged refinement of open techniques. Most studies up to now aimed to prove the feasibility of a new surgical technique for live kidney donation. In this thesis, we compared these novel techniques, therewith addressing short term surgical outcomes, quality of life, costs and transplant outcome.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The disparity between available and needed organs is rapidly increasing, and the number of patients dying while still on the waiting list is growing exponentially. As a partial solution to this disparity, living unrelated transplantation is being performed more frequently, and some have proposed providing financial incentives to donors. The aim of this discussion is to illustrate that with an ever-increasing number of living unrelated transplantations, society and the transplant community should adopt a more active role in developing specificstrategies to scrutinize the process. The current paper will also examine the viewpoint that medical ethics is not separable from the prevailing needs of society and involves a constant balancing of often opposinggoods. Issues surrounding living unrelated donor transplantation illustrate ethics as a dynamically evolving field, which is often influenced by necessity and which evolves with progression of science and society. As part of this evolution, it is the collective responsibility of society and the transplant community to devise safeguards to guarantee adherence to basic principles of ethics and to avoid “situational ethics.”
    05/2010; 1(2).
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: There is a large treatment gap with few community services for people with schizophrenia in low income countries largely due to the shortage of specialist mental healthcare human resources. Community based rehabilitation (CBR), involving lay health workers, has been shown to be feasible, acceptable and more effective than routine care for people with schizophrenia in observational studies. The aim of this study is to evaluate whether a lay health worker led, Collaborative Community Based Care (CCBC) intervention, combined with usual Facility Based Care (FBC), is superior to FBC alone in improving outcomes for people with schizophrenia and their caregivers in India. This trial is a multi-site, parallel group randomised controlled trial design in India.The trial will be conducted concurrently at three sites in India where persons with schizophrenia will be screened for eligibility and recruited after providing informed consent. Trial participants will be randomly allocated in a 2:1 ratio to the CCBC+FBC and FBC arms respectively using an allocation sequence pre-prepared through the use of permuted blocks, stratified within site. The structured CCBC intervention will be delivered by trained lay community health workers (CHWs) working together with the treating Psychiatrist. We aim to recruit 282 persons with schizophrenia. The primary outcomes are reduction in severity of symptoms of schizophrenia and disability at 12 months. The study will be conducted according to good ethical practice, data analysis and reporting guidelines. If the additional CCBC intervention delivered by front line CHWs is demonstrated to be effective and cost-effective in comparison to usually available care, this intervention can be scaled up to expand coverage and improve outcomes for persons with schizophrenia and their caregivers in low income countries. The trial is registered with the International Society for the Registration of Clinical Trials and the allocated unique ID number is ISRCTN 56877013.
    Trials 01/2011; 12:12. DOI:10.1186/1745-6215-12-12 · 2.12 Impact Factor