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Living Kidney Donors (live + kidney_donor)
Selected AbstractsPersistent Glomerular Hematuria in Living Kidney Donors Confers a Risk of Progressive Kidney Disease in Donors After HeminephrectomyAMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2010R. Kido Although glomerular hematuria is likely a sign of chronic kidney disease that will develop into overt nephropathy after donation, it remains unclear whether prospective donors with hematuria should be excluded. We reviewed the medical records of 242 donors who donated at our institution from 2001 to 2007 and surveyed the prevalence of hematuria pre- and postdonation. We then investigated the association of hematuria with proteinuria postdonation and trends in glomerular filtration rate. Before donation, 8.3% of 242 donors presented with persistent hematuria, a finding that was significantly associated with dysmorphic hematuria before donation. Most cases of predonation persistent hematuria persisted after donation, and the overall prevalence increased to 15.3%. During a median follow-up period of 2.3 years after donation, 8.3% developed persistent proteinuria, with incidence being significantly higher in donors having persistent hematuria with dysmorphic red blood cells (d-RBC) both before and after donation. Postdonation persistent hematuria with d-RBC was also associated with a progressive decline in renal function. These results indicate that persistent glomerular hematuria is strongly associated with a higher incidence of postdonation progressive kidney disease. Potential donors with persistent glomerular hematuria should be excluded, while those with isolated hematuria need to be evaluated with heightened caution. [source] ,Normal for Now' or ,At Future Risk': A Double Standard for Selecting Young and Older Living Kidney DonorsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2010R. W. Steiner Transplant centers medically evaluate potential living kidney donors in part to determine their baseline remaining lifetime risk for end stage renal disease (ESRD). If baseline risk is increased by the presence of a risk factor for ESRD, donation is often refused. However, as only about 13% of ESRD occurs in the general population by age 44, a normal medical evaluation cannot be expected to significantly reduce the 7% lifetime risk for a ,normal' 25-year-old black donor or the 2,3% risk for a similar white donor. About half of newly diagnosed ESRD in the United States occurs by age 65, and about half of that is from diabetic nephropathy, which takes about 25 years to develop. Therefore, the remaining baseline lifetime risk for ESRD is significantly lower in the normal, nondiabetic 55-year-old donor candidate. Some older donors with an isolated medical abnormality such as mild hypertension will be at lower or about the same overall baseline lifetime risk for ESRD as are young ,normal' donor candidates. Transplant centers use a ,normal for now' standard for accepting young donors, in place of the long-term risk estimates that must guide selection of all donors. [source] Life Insurance for Living Kidney Donors: A Canadian Undercover InvestigationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2009R. C. Yang Some living kidney donors encounter difficulties obtaining life insurance, despite previous surveys of insurance companies reporting otherwise. To better understand the effect of donation on insurability, we contacted offices of life insurance companies in five major cities in Canada to obtain $100 000 of life insurance (20-year term) for 40 fictitious living kidney donors and 40 paired controls. These profiles were matched on age, gender, family history of kidney disease and presence of hypertension. The companies were blinded to data collection. The study protocol was reviewed by the Office of Research Ethics. The main study outcomes were the annual premium quoted and total time spent on the phone with the insurance agent. All donor and control profiles received a quote, with no significant difference in the premium quoted (medians $190 vs. $209, p = 0.89). More time was spent on the phone for donor compared to control profiles, but the absolute difference was small (medians 9.5 vs. 7.0 min, p = 0.046). Age, gender, family history of kidney disease and new-onset hypertension had no further effect on donor insurability in regression analysis. We found no evidence that kidney donors were disadvantaged in the first step of applying for life insurance. The effect donation has on subsequent phases of insurance underwriting remains to be studied. [source] Ensuring the Safety of Living Kidney Donors and Recipients in China Through Ethics Committee Oversight: An Early ExperienceAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2008Z. Lei In 2007, the Regulation on Human Organ Transplantation was enacted in China requiring the establishment of ethics committees to oversee living donor organ transplantation and establishing specific requirements that must be met. We established an Ethics Committee on Organ Transplantation at Peking University Third Hospital, and described its composition, its methods and operating procedures in the examination and approval of living-related donor kidney transplantation (LRDKT) and our initial experience. All 60 proposed cases of LRDKT were presented to the Ethics Committee for discussion, among which 53 cases were approved and seven cases were disapproved due to a variety of reasons that are discussed. The Ethics Committee on Organ Transplantation plays an important role in the ethical oversight of living-related donor organ transplantation in order to ensure to the greatest extent possible the safety, rights and interests of donors and recipients. [source] Direction of the Organ Procurement and Transplantation Network and United Network for Organ Sharing Regarding the Oversight of Live Donor Transplantation and Solicitation for OrgansAMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2006F. L. Delmonico The Organ Procurement and Transplantation Network (OPTN) operated by United Network for Organ Sharing (UNOS) has taken recent steps to address public solicitation for organ donors and its oversight of live donor transplantation. This report provides the direction of the OPTN regarding deceased donor solicitation. The OPTN has authority under federal law to equitably allocate deceased donor organs within a single national network based upon medical criteria, not upon one's social or economic ability to utilize resources not available to all on the waiting list. The OPTN makes a distinction between solicitations for a live donor organ versus solicitations for directed donation of deceased organs. As to live donor solicitation, the OPTN cannot regulate or restrict ways relationships are developed in our society, nor does it seek to do so. OPTN members have a responsibility of helping protect potential recipients from hazards that can arise from public appeals for live donor organs. Oversight and support of the OPTN for live donor transplantation is now detailed by improving the reporting of live donor follow-up, by providing a mechanism for facilitating anonymous live kidney donation, and by providing information for potential live kidney donors via the UNOS Transplant LivingSM website. [source] Short-term renal outcomes in African American and Caucasian donors following live kidney donationCLINICAL TRANSPLANTATION, Issue 5 2010A. Reeves-Daniel Reeves-Daniel A, Freedman BI, Assimos D, Hartmann EL, Bleyer A, Adams PL, Westcott C, Stratta RJ, Rogers J, Farney AC, Daniel KR. Short-term renal outcomes in African American and Caucasian donors following live kidney donation. Clin Transplant 2009 DOI: 10.1111/j.1399-0012.2009.01170.x © 2009 John Wiley & Sons A/S. Abstract:, Introduction:, Although African Americans (AA) are considered higher risk kidney donors than Caucasians, limited data are available regarding outcomes of AA donors. Methods:, We performed a single-center retrospective review of all kidney donors from 1993 to 2007 and evaluated race/ethnic differences in post-donation changes in renal function, incident proteinuria, and systolic blood pressure (SBP) using linear mixed models. Results:, A total of 336 kidney donors (63 AA, 263 Caucasian, 10 other) were evaluated. Before donation, AA had higher serum creatinine concentrations, estimated glomerular filtration rate (GFR) values, and SBP levels than Caucasians. No significant changes in SBP or renal function were observed between the two groups within the first year after donation, although results were limited by incomplete follow-up. Conclusion:, AA had higher pre-donation serum creatinine, GFR, and SBP values compared to Caucasians; however, the degree of change in renal function and blood pressure did not differ between groups following kidney donation. Although long-term studies are needed, our study suggests that AA and Caucasians experience similar short-term consequences after donation. The incomplete data available on donor outcomes in our center and in prior publications also indicates a global need to implement systems for structured follow-up of live kidney donors. [source] | ||||||||||