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Advocacy Informed Consent Living Donor Research Living Donor Risks Living Kidney Donor OPTN

63.6% of Living Kidney Donors Are Overweight

An analysis of the OPTN/UNOS database from 1999-2011 reveals that 63.6% of all living kidney donors were either overweight* or obese.

(emphasis mine):

“Overweight and mildly obese kidney donors have increased through time by 12% and 20% every 5 years, respectively “

 

Obesity is associated with numerous health risks, including Type 2 Diabetes and hypertension. According to USRDS, 44% of kidney failure is due to diabetes and another 26% is because of high blood pressure.

And:

“Having a BMI greater than 35 kg/m2 has been associated with slightly longer operative times and overall more peri-opera­tive complications, such as wound complications”

 

If obesity is such a problem, especially in regards to kidney function and health, wouldn’t OPTN have some sort of policy on the matter? (emphasis mine again)

 

According to OPTN guidelines, having a BMI greater than 35 kg/m2 is considered a relative contraindication to be a living kidney donor. Despite this, transplant centers across the United States use different criteria in determining donor exclusion based on BMI. Based on a 2007 United States Transplant Center Survey, twenty percent of the transplant centers that were surveyed excluded those with BMI greater than 40 kg/m2, fifty two percent of United States kidney transplant centers excluded donors with BMI greater than 35 kg/m2, ten percent of programs excluded those with BMI over 30 kg/m2, twelve percent had no policy for exclusion, and six percent excluded based on BMI if they had other cardiovascular risks. ”

 

In short, only 60% of U.S. transplant centers follow or exceed OPTN policy.

40% of U.S. transplant centers accept higher at-risk living kidney donors than OPTN policy dictates.

 

There’s no point in having a policy if 40% of members won’t follow it. Especially if the governing organization will do nothing to enforce it. The whole thing is nothing more than theater, engineered to make the public *believe* transplant centers care about the health and well-being of kidney donors.

Unfortunately, it’s theater that’s already put over 30,000 people at risk.

 

 

*Overweight was defined as a BMI of 25 or higher.

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
Ethical Considerations Informed Consent Living Donor Research Living Donor Risks Living Kidney Donor

The Ethics of a Pre-Diabetic Living Kidney Donor

Diabetes accounts for 44% of end-stage kidney disease in the US (per USRDS). Apparently, Mexico is no different.

What is different is that three Mexican researchers penned an article, published in a Medical Ethics journal, that criticizes the use of pre-diabetic folks as living kidney donors.

(emphasis mine)

 

In prediabetic persons there are well known metabolic alterations that may compromise the long?term outcomes of the transplant if such donors are accepted. Even so, many of them are finally included because there are not enough donor candidates. Both, families and hospitals face the need to rapidly accept prediabetic donors before the clinical conditions of the recipient and the evolution of the disease exclude him/her as a transplant candidate; however, when using a kidney potentially damaged by prediabetes, neither the donor’s nor the recipient’s long term health is usually considered.

Considering the ethical implication as well as the clinical and epidemiological evidence, we conclude that prediabetic persons are not suitable candidates for kidney donation. This recommendation should be taken into consideration by Mexican health institutions who should rewrite their transplant protocols.

 

I’m so flabbergasted by this honesty, I hardly know what to say. In six years, I’ve never run across an American article of any sort that has even hinted at the idea that *some* folks just might not be suitable living donors. Contrarily, there seems to be a contest about who can “expand” the donor pool the most.

If someone is privy to an article from U.S. authors that actually cautions against taking someone’s kidney for transplant, please let me know.

 

 

 

Ferreira-Hermosillo A, Valdez-Martínez E, & Bedolla M (2014). Ethical issues relating to renal transplantation from prediabetic living donor. BMC medical ethics, 15 (1) PMID: 24935278

Categories
Living Kidney Donor

Hospital Contaminates Donor Kidney

A wife donates her kidney to her husband* at North Shore University Hospital, and while both are under anesthesia, “an unidentified fluid” dropped from the ceiling into the basic holding the wife’s now removed kidney. The kidney was cleansed, examined and who-knows-what-else for “hours”, and by the time it was implanted in the husband, it “barely functioned”.

So sayeth the surgeon’s report.
  

Predictably, the graft failed shortly afterward. So, Mr. Johnson still needs a transplant, and Mrs. Johnson has to spend the rest of her life dealing with the risks of having one-kidney.

The hospital, remarkably enough, are denying *any* of this happened, despite the surgeon’s report and the detailed notes about the attempted recovery of the contaminated kidney. *Vehemently* denying it, I might add; as if the Johnson’s and their lawyers made up the story out of thin air.

Welcome, my friends, to the world of medical malpractice.
  

Full article: http://www.newsday.com/news/health/couple-s-lawsuit-says-hospital-error-ruined-kidney-1.6486764

*Who had Type 2 diabetes and hypertension. What are the two leading causes of kidney failure in the U.S.? Ding-Ding!