Tong and Company looked at ten different living donor related guidelines published from 2006-2010 from Australia, New Zealand, Europe, Canada, United Kingdom, and two International contingencies (WHO & Amsterdam Forum), analyzing their scope, quality and consistency. Here’s what they found.
– The guidelines varied in scope and lacked methodological rigor. In layperson’s terms, this means the documents were all over the place, and made up out of thin air. <- Not based on clinical data.
– Few specific guidelines on women of childbearing age, despite the renal risk of pregnancy.
– Variations in cut-offs for hypertension, obesity, diabetes, cardiovascular disease, glucose intolerance, and malignancy (cancer/tumor). In the US, this translates into different evaluation policies for every transplant center. With such variability, it’s impossible to implement quality control or gather/analyze reliable and valid data*.
– A thorough psychosocial assessment was recognized, but they didn’t offer detailed guidelines on how to suss out altruistic motives, safeguard voluntary consent, or evaluate mental suitability*. <- All jokes aside, mental health professionals are not prescient or psychic. Their training includes specific behavioral skills as well as the comprehension and implementation of psychological theory. Expecting them to 'guess' about a prospective living donor's motives or mental status constitutes neglect.
– No quality of life tool has been created specifically for living organ donors.
– Few guidelines provided recommendation for supporting donors in case of recipient death, or adverse event (transplant failure, etc). In other words, we’re on our own.
*One of OPTN‘s current proposed policies discusses living donor evaluation, but it still provides very little in the way of national standards, and does NOTHING to increase the clinical basis for those guidelines. It also disregards the importance of the psychosocial evaluation. Submit your own comment – dealing Dec. 23, 2011.
Tong A, Chapman JR, Wong G, de Bruijn J, & Craig JC (2011). Screening and follow-up of living kidney donors: a systematic review of clinical practice guidelines. Transplantation, 92 (9), 962-72 PMID: 21959214