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Living Donor Protections Living Donor Research Living Donor Risks

Latest KDIGO Guidelines for Living Kidney Donors

Before reading the linked article, remember that many aspects of living donor evaluation, care and consequences have never been adequately documented or studied. So, those very real issues won’t be included or considered (the authors admit as much in their abstract), which results in yet *another* incomplete and tragically flawed guidance document.

 

Why bother posting it? Well, because it’s important to see if any progress has been made at all. Plus, prospective living donors should be aware of what to expect from their transplant centers.

Here you go: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540357/

 

Keep in mind that transplant centers, essentially, make up their own rules in terms of what is, and isn’t, an acceptable living donor. Theoretically, a potential LKD could receive a much higher standard of care at one center as opposed to another. Frankly, I find that scary as hell.

 

 

Categories
Living Donor Research Living Donor Risks Living Kidney Donor

How Many Living Kidney Donors Were Obese Pre-Donation?

47,705 adult living kidney donors as reported to OPTN from 1999 to 2011 were analyzed using their pre-donation BMI (body mass index)

  • 35.6% were normal weight.
  • 40.5% were overweight
  • 18.9% were mildly obese
  • 4.2% were moderate to morbidly obese
  • Overweight and mildly obese kidney donors have increased through time by 12% and 20% every 5 years, respectively
  • 63.6% of living kidney donors over the past thirteen years have spanned the overweight to obese categories

 

According to OPTN guidelines, having a BMI greater than 35 kg/m2 is considered a relative contraindication to be a living kidney donor. However, based on a 2007 survey, 20% of transplant centers surveyed excluded those with BMI greater than 40 kg/m2 , 52% excluded donors with BMI greater than 35 kg/m2 , 10% excluded those with BMI over 30 kg/m2 , 12% percent had no policy for exclusion, and 6% excluded based on BMI if they had other cardiovascular risks.

  • Short term outcomes of obese living kidney donors have shown increased wound related complications and longer operative times
  • At five year follow up, Kramer et al found that overweight and obese individuals had 20% and 40% risk of developing chronic kidney disease.
  • Having a higher baseline BMI can serve as an independent risk factor for end stage kidney disease.
  • The long term effects of obesity on the solitary kidney of a kidney donor are still uncertain. This risk factor increases the risk of developing other co-morbid conditions such as diabetes mellitus, hypertension, or even proteinuria which can together compromise the function of their solitary kidney
  • At a mean of 11 year follow up, obese donors had an increased risk of developing hypertension and dyslipidemia.

 

Read the entire article at the link (above). Take care of yourselves.

 
Sachdeva, M. (2015). Weight trends in United States living kidney donors: Analysis of the UNOS database World Journal of Transplantation, 5 (3) DOI: 10.5500/wjt.v5.i3.137

Categories
Advocacy Living Kidney Donor

Not Easy to Sue For Malpractice

Propublica’s long-term investigation into patient harm has produced an article about the difficulties in obtaining a malpractice attorney. The story revolves around living kidney donor Ernie Ciccotelli.

 

“Ciccotelli, 58, donated his kidney in 2006 at Beth Israel Deaconess Medical Center in Boston…within days he suffered nausea and intense pain in his gut, then chills and a steady greenish drainage that soaked his bandages and shirts.

He had an infection plus an additional complication: His intestines had knuckled under beneath his skin. Ten days after the transplant, doctors operated again, removing 15 inches of dying intestine from Ciccotelli’s gut and scraping out the infection…’

Over the course of his complications and recovery, Ernie “estimates he lost $45,000 in earnings.

Ciccotelli said he paid a few thousand dollars out-of-pocket traveling back and forth to the hospital for treatments. For about a year he was unable to carry any weight, and he said he still can’t exercise the way he did before the surgery, which has caused his weight to balloon.

Ciccotelli figured another lawyer would jump to take his case. He’d been fine before the surgery and clearly had suffered harm. But one by one, lawyers turned him away.

After about a half-dozen rejections, he asked one why no one would take his case. You can win, the attorney told him, but it won’t be enough money to be worth it.”

 

It’s not about justice; it’s not about holding the doctors and hospitals responsible; it’s about MONEY. The article, which you should read in full, discusses the too-common practice of malpractice attorneys rejecting clients because there simply isn’t enough profit in it.

This is why we need to push for public policies and laws that protect living donors, and go public about the harm we’ve experienced. We simply can’t rely on the civil courts to make us whole.

 

Categories
Advocacy Living Donor Protections Living Donor Research Living Donor Risks Living Kidney Donor OPTN

OPTN Standards For Transplant Surgeons Are Too Low

This excerpt pretty much says it all:

The learning curve [of a surgeon specializing in laparoscopic donor nephrectomy], defined by decreased operating time, averaged 35 cases.

Improved intra-operative, patient, and recipient outcomes were observed for centers performing ?50 LDNs annually.

The United Network of Organ Sharing [UNOS; in this case used as a synonym for OPTN] requires 15 cases as surgeon or assistant to be certified as the primary LDN surgeon. This falls below the described learning curve for LDN.

 

 

Raque, J., Billeter, A., Lucich, E., Marvin, M., & Sutton, E. (2015). Training techniques in laparoscopic donor nephrectomy: a systematic review Clinical Transplantation, 29 (10), 893-903 DOI: 10.1111/ctr.12592

Categories
OPTN

Proposed OPTN Policies Living Donors Should Care About

I encourage everyone who’s invested in the way the US transplant system functions to review *all* the proposed policies and submit informed comments.

The following are the policies which affect living donors:

  • Revise Data Release Policy
  • Revise KPD Priority Points
  • Requirements for Therapeutic Organ Donation

All policies and the means to submit a public comment are available here.