Risks and Outcomes of Living Donation
School of Medicine, Wayne State University, Detroit, Michigan, United States Advances in chronic kidney disease
(Impact Factor: 2.05).
07/2012; 19(4):220-8. DOI: 10.1053/j.ackd.2011.09.005
Living donors supply approximately 40% of renal allografts in the United States. Based on current data, perioperative mortality after donor nephrectomy is approximately 3 per 10,000 cases, and major and minor perioperative complications affect approximately 3% to 6% and 22% of donors, respectively. Donor nephrectomy does not appear to increase long-term mortality compared with controls, nor does it appear to increase ESRD risk among white donors. Within the donor population, the likelihood of postdonation chronic renal failure and medical comorbidities such as hypertension and diabetes appears to be relatively higher among some donor subgroups, such as African Americans and obese donors, but the impact of uninephrectomy on the lifetime risks of adverse events expected without nephrectomy in these subgroups has not yet been defined. As national follow-up of living donors in the United States is limited in scope, duration, and completeness, additional methods for quantifying risk among diverse living donors are needed. In addition to improved national collection of follow-up data, possible sources of information on donor outcomes may include focused studies with carefully defined control groups, and database integration projects that link national donor registration records to other data sources. Given the growth and evolving characteristics of the living donor population, as well as changes in surgical techniques, tracking of short- and long-term risks after living kidney donation is vital to support truly informed consent and to maintain public trust in living donation. The transplant community must persist in their efforts to accurately assess risk across demographically diverse living kidney donors.
Available from: ckj.oxfordjournals.org
- "Consequently , long-term medical risks cannot be accurately assessed. Long-term data are especially scant in certain donor subgroups , like African Americans and the obese. Given the lack of knowledge and the absence of a national registry, we echo the creation of a registry—a recommendation that has been voiced by others. "
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ABSTRACT: Kidney transplantation significantly improves patient survival, and is the most cost effective renal replacement option compared
with dialysis therapy. Living kidney donors provide a valuable societal gift, but face many formidable disincentive barriers
that include not only short- and long-term health risks, but also concerns regarding financial expenditures and health insurance.
Other than governmental coverage for their medical evaluation and surgical expenses, donors are often asked to personally
bear a significant financial responsibility due to lost work wages and travel expenses. In order to alleviate this economic
burden for donors, we advocate for the consideration of tax credits, lifelong health insurance coverage, and an outcomes registry
as societal reciprocity to reward their altruistic act of kidney donation.
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ABSTRACT: Purpose of review:
Although living donor transplantation is considered an ethically acceptable undertaking for the purpose of saving another's life, its safety remains under investigation.
Although living donors undertake considerable medical risks for no direct medical benefit, the question remains whether the risks are acceptable and should be tolerated by providers and patients or whether additional interventions and safeguards are needed to reduce and/or prevent complications. By reviewing complication risk statistics and synthesizing empirical research regarding risk-taking thresholds and attitudes, this paper examines the possibilities for determining an acceptable level of complication risk for living donors. This paper also delineates the ethical tensions surrounding protecting donors from unnecessary risk versus respecting donor autonomy to accept risks, and concludes by discussing the importance of donor follow-up and the value of donor registries.
In the absence of information on long-term donor outcomes, transplant centers should take special precautions to protect prospective donors given increasing pressures to reduce the organ shortage and concerns that donors often disregard risks to themselves to save the lives of others.
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