Living Donor Misinformation Living Kidney Donor

Weill Cornell Medical College’s Living Kidney Donor Resources, part i

Google Alerts dropped Cornell’s website into my inbox recently (which means they must’ve updated it).

First is this, the typical pro-living donor propaganda we’ve come to expect, which includes:

The majority of studies have found that:

– The risk to a donor’s physical health is minimal in both the short-term (surrounding the surgery) and long-term (in terms of kidney function, high blood pressure, and the donors lifespan).

– Kidney donors tend to have higher quality of life scores after donation, as compared to the general population.

– Donors have similar or improved psychosocial health after donation.

– The overwhelming majority of donors would choose to donate again.

Unlike every other transplant center website I’ve seen, Cornell has a link to a page they call “Living Donor Reference Center” which purports to provide references for their overly positive statements.

The first link “Consensus Statements/Guidelines for Living Kidney Donation” contains the Consensus Statement on the Live Organ Donor, an international document from 2000.

Then they list OPTN’s “Guidelines” for the medical evaluation of LKDs (Cornell erroneously contributes this document to UNOS). Unfortunately as of the beginning of 2013, those voluntary recommendations have been replaced with bondafide mandatory standards of care. Incomplete and vague standards of care, but required, nonetheless.

Finally is a 2007 article authored by Delmonico, among others, with guidelines on the psychosocial evaluation of unrelated living kidney donors.
I’m guessing Cornell wants anyone who stumbles upon this website to believe they follow these documents when dealing with prospective and current living donors?

Under “Medical Outcomes and Complications” the first two articles listed are the infamous studies by Segev and Ibrahim. Since I devoted an earlier post to how flawed these studies are, and how their results have been manipulated by those who want to promote living donation over the health of actual living donors, I’ll just leave this link here for your perusal.

(Two more of their references are also by Ibrahim. Considering his blatant bias in the NEJM article stated above, his credibility is pretty much shot everywhere else).
Next they list Connie Davis’ “Living Kidney Donors: Current State of Affairs” from 2009 – when she was a high-ranking UNOS/OPTN officer. I wrote about this when it was published, but here are the problematic highlights:

– Mortality (death) rate is underestimated/reported.
– Her statistics are not comprehensive (only cover certain portions of OPTN’s data collecting existence)
– Transplant centers have been woefully non-compliant with reporting living donor data, so all stats must be considered under-reports.

Right now I’m unable to procure the entire Najarian essay, but from the abstract I can already see a few flaws (oh and btw, it’s an opinion piece):

A. single center (This results in certain patient demographics. Also, since no standards of LD care existed prior to 2013, how patients at one center are evaluated would be different than LDs at another),

B. longevity as “proof” tha living kidney donation is safe (LKDs are *supposed* to be healthier than the general population. They *should* live longer than folks with rampant, chronic disease),

C. they compared the LKDs with their nondonor siblings (there’s no way to know if the nondonor siblings would’ve qualified as LKDs, or if they are/were as ‘healthy’ as the donors).

A nephrologist I know called the Najarian piece “self-justifying” and “unable to distinguish between causality and association”. Also, the Swedish studies he mentions don’t show casuality.

Garg et al. is a meta-analysis, meaning they grabbed all existing studies that met a certain criteria and tried to crunch them. It only looked at proteinuria, which is only one of many symptoms linked to long-term cardiovascular and/or renal problems. The studies only averaged seven years after donation, which is paltry when the average US living kidney donor is 41yoa at the time of donation.

(and btw, the meta-analysis did find increased proteinuria in LKDs)

Barri’s publications characterize him as a guy who doesn’t believe that living kidney donors, even with the required GFR (renal function), should be classified as having chronic kidney disease. This particular article simply compared LKD’s pre-donation and THREE MONTH post-donation GFR to determine how many would be less than 60, or otherwise Stage 3 CKD. I’m not sure why Cornell would link it, other than to say “We provided info that it’s ‘common’ to have Stage 3 CKD qualifying GFR post-donation!”

Hartman et al. is about the first 1600 living kidney donors recorded in the Norwegian registry. Norway has universal heath care and healthier lifestyle and longer life span than the US, so any long-term results should be viewed with caution (although this paper has no long-term statistics, despite what the abstract claims). Also, we have no way of knowing how Norwegian evaluation and care compares to that of the US.

Okamato, et al. refers only to the mortality (death) of one Japanese transplant center’s living donors over the span of 35 years. 1. We have no way of knowing how this center evaluates their LKDs, or if that evaluation has changed over the course of 35 years. 2. Japan’s lifestyle is much different than the US. 3. The study looks at 601 LKDs; the US has approximately 6000 LKDs per year.

In other words, these results (which really aren’t that significant on their face) have no comparison to the US at all.

Soneji, et al is another article that simply looked at other existing studies. It was published in 2008, so all the studies it covers are prior to that year. In other words, some of their data might be outdated. In fact, their section on LKDs with renal failure *is*, very much so.

The authors do not claim to have looked at *all* relevant studies, which means they very easily could’ve cherry-picked the ones that further their “living donation is low risk” conclusion. Also, their definition of long-term is approximately 10 years. When the average US LKD is 41 years old, 10 years only covers a percentage of their expected post-donation lifespan.

The last study cited in this section, Gossman et al, is also covered in the preceding Soneji, et al. It was published in 2005 and only covers a single German transplant center: 152 LKDs (70% female) from 1973-2001. So again, we don’t know how their LKD evaluation compares to that in the US, but we do know that Germany has universal health care, and a healthier lifestyle and a longer lifespan than the US.

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