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Living Donor Misinformation Living Donor Research

Levey’s Living Kidney Donor Transplantation in the US, part II

If you haven’t, refer to Part I so you have some idea of what I’m talking about.

I want to back up for a moment and disclose that two of this paper’s authors are, in fact, kidney donors. Their statement: “2 of us have donated a kidney to an unrelated recipient“.

But ‘unrelated’ is not synonymous with ‘complete stranger’.

In one case, the author’s husband needed a kidney so the author engaged in a kidney chain. While her organ technically was transplanted into a stranger, her motivation was to obtain a kidney transplant for her husband. The very same motivation for those of us who donate directly to a family member. This does not make her any more extraordinary than any other living kidney donor, and it does not make her opinion any more valid.

In the second instance, the author donated to one of her patients. While this may seem like a lovely gesture, it is, in fact, a violation of professional ethics. The intimate nature of helping professions (therapist, physician, etc) combined with the power dynamics of people in authority (teachers, clergy, etc) make adhering to strict boundaries incredibly important. It’s the reason we judge those professionals who engage in sexual relationships with their patients/clients so harshly. It doesn’t matter that donating a kidney was a helpful and positive act, it was still a blatant disregard for her professional boundaries. After all, the author only had one kidney to give. How will it affect her relationships with her other patients who were/are denied that kidney? Will she be willing to donate bone marrow to any patient in need?

Her decision to donate to her patient is problematic enough, but the fact that NO ONE in the entire transplant facility expressed opposition or concern, and actually CONTRIBUTED to this donation makes me suspicious of the facility’s entire ethical foundation.

Now, back to the study….

Complications requiring surgical or radiologic intervention under local or general anesthesia occurred in 3% in 2 large series.

Two large series? Why didn’t the authors just request the complication rate of ALL US living donors since 2000, when one-year of follow-up was required? Instead, they referenced a study on 1022 non-US living donors over the course of a decade. Compare that to the 6000+ living donors per year in the US. Their second is a single center look at only 750 LKDs. Again, why look at a single center when OPTN has info on all centers?

After kidney donation, measured glomerular filtration rate (GFR) decreases to 70% of predonation levels, and urinary albumin excretion is minimally increased, implying glomerular hyperfiltration and some increase in glomerular permeability to albumin in the remaining kidney.

Their reference for this statement is a study from 1983. Was there seriously nothing more recent and comprehensive?

These measures are not accompanied by complications or symptoms of chronic kidney disease.

No reference for this statement. What complications or symptoms are the authors referring to? And exactly what time frame are we looking at? Because we know that some LKDs have ended up with chronic kidney disease, end stage renal disease and kidney failure. So??

Survival appears better than for control populations matched for age and the absence of comorbid conditions that are regarded as contraindications to donation.

And here we are again, referencing the b.s. Segev study.

To be continued……

Levey AS, Danovitch G, & Hou S (2011). Living donor kidney transplantation in the United States-looking back, looking forward. American journal of kidney diseases : the official journal of the National Kidney Foundation, 58 (3), 343-8 PMID: 21783290

Mjøen G, Øyen O, Holdaas H, Midtvedt K, & Line PD (2009). Morbidity and mortality in 1022 consecutive living donor nephrectomies: benefits of a living donor registry. Transplantation, 88 (11), 1273-9 PMID: 19996926

Harper JD, Breda A, Leppert JT, Veale JL, Gritsch HA, & Schulam PG (2010). Experience with 750 consecutive laparoscopic donor nephrectomies–is it time to use a standardized classification of complications? The Journal of urology, 183 (5), 1941-6 PMID: 20303114

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