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Ethical Considerations Follow-Up Informed Consent Living Donor Research Living Kidney Donor Organ Markets

More Bad News For Iranian Kidney Donors – er – Sellers

From Transplant Proceedings:

 

With assistance of the Iranian Kidney Foundation, we accessed the contact information of living donors through the years 2001–2012. We tried to contact donors who have donated at least 2 years before the survey. We interviewed these donors according to a questionnaire that was approved by the ethics committee of the research deputy of Tehran University of Medical Sciences. The collected data were analyzed using the SPSS software version 20.

Results

The contact data of 388 donors were available but we were able to contact only 60 donors. We found that 40% of donors had been informed about the risks and benefits of donation. Also, 11% of donors had not had a full physical examination and in 5% even blood pressure was not measured before donation by the transplantation team. The donors reported that 34% of them had not been educated on how they should follow up their health status and 50% of the donors did not have any follow-up after donation.

 

The most understated conclusion in the history of conclusions:

 

In the Iranian model of transplantation the donors are the neglected victims of renal transplantation and this model should be revised immediately, concerning both the medical and ethical issues.

 

Khatami, M., Nikravan, N., & Alimohammadi, F. (2015). Quality and Quantity of Health Evaluation and the Follow-up of Iranian Living Donors Transplantation Proceedings, 47 (4), 1092-1095 DOI: 10.1016/j.transproceed.2014.11.059

Categories
Organ Markets

The Latest on Iran’s Kidney Market

In short:

Iranian paid unrelated donors have lower quality of life and higher incidence of microalbuminuria compared with related [unpaid] donors.
  

From an editorial in the same journal issue:

…their identification of a difference in microalbuminuria postnephrectomy between paid and unpaid donors fuels
concerns that the clinical evaluation of donors may be compromised when donor payments are allowed. Although the absence of prenephrectomy information precludes definitive conclusions, the short time since donation suggests that abnormalities may have been present prior to nephrectomy and accordingly, that the donor clinical evaluation may not have been as thorough as necessary.

The most plausible alternative explanation for the findings is that the proteinuria was in some way related to the higher level of poverty in the paid donors.

  
So – either paid living kidney donors are receiving an adequate evaluation OR paid living kidney donors are overwhelmingly poor which causes great kidney-related health problems.

Note that each of these possible explanations fall neatly into the offered objections to implementing a paid kidney market.
  

From one of the article’s references, aka a study on whether Iran’s living kidney donors (100 in this case) were knowledgeable about complications and risk:

Seventy-nine donors were men and 21 women. Mean age was 27 ± 4.4 years. Ninety-seven donors were unrelated to the recipient and three were related (LRD). The motivation for donation was altruistic in nine (three LRD and six LURD) and financial in 89. Eighty donors were not aware of the possible short- or long-term complications of nephrectomy. Six donors mentioned the possibility of potential intraoperative complications, and 16 mentioned the risk of renal failure. Only 44 donors knew that they should visit doctors regularly after donation, most of them (61%) from the postoperative group.
  

And my favorite (from the op-ed again), the reminder that after nearly 60 years, we still don’t have any comprehensive reliable data on living donors’ health and well-being:

Sadly, the risk factors for and clinical significance of proteinuria in living kidney donors remain unclear. The existing literature on this subject is hampered by use of nonstandardized definitions, a paucity of controlled studies, and virtually no information regarding progression over time.
   

Abstract (full not available without subscription): http://onlinelibrary.wiley.com/doi/10.1111/ajt.12488/abstract
Full article: http://onlinelibrary.wiley.com/doi/10.1111/ajt.12486/full