Argumentación ética en la donación de riñón de donante vivo y sano La autodeterminación, voluntad y generosidad superan los riesgos

el gesto altruista del donante vivo y sano de riñón, relacionado genética o sentimentalmente, se basa en autodeterminación, voluntad y generosidad. La argumentación ética alrededor de la donación de riñón de donante vivo y sano se orienta con las éticas principialista y personalista, la dignidad humana, la corporalidad, la divisibilidad del cuerpo, el mal menor y el mal mayor. Hace parte del derecho a la información amplia y suficiente que recibe el donante sobre los riesgos y posibles complicaciones físicas y morales del procedimiento, por medio del comité de bioética y el grupo de trasplantes. Con base en la argumentación ética planteada se procedió a contestar la pregunta de esta investigación: ¿se debe dejar que una persona viva y sana sea sometida a una cirugía que le dejará mononéfrico de por vida, solo por el deseo de ayudar a otro, a pesar de que existen programas activos con donante cadavérico? El objetivo de este artículo es plantear una argumentación ética sobre la donación de riñón de donante vivo y sano que contribuya a una adecuada orientación de su decisión.

the altruistic gesture of the healthy living kidney donor, genetically or sentimentally related, is based on self-determination, willingness, and generosity. The ethical argumentation around living and healthy kidney donation is guided by principled and personalistic ethics, human dignity, corporeality, divisibility of the body, the lesser evil, and the greater evil. It is part of the right to ample and sufficient information that the donor receives about the procedure's risks and possible physical and moral complications through the bioethics committee and the transplant group. Based on the ethical argumentation raised, we proceeded to answer the question of this research: should a living and healthy person be subjected to a surgery that will leave him/her mononephric for life, just because of the desire to help another, even though there are active programs with a cadaveric donor? This article aims to provide an ethical argumentation on living and healthy donor kidney donation that will contribute to an adequate orientation of their decision.

o gesto altruísta do doador de rim vivo e saudável, relacionado genética ou sentimentalmente, está baseado na autodeterminação, vontade e generosidade. A argumentação ética ao redor da doação de rim de doador vivo e saudável é orientada pelas éticas principialista e personalista, pela dignidade humana, pela corporalidade, pela divisibilidade do corpo, pelo mal menor e pelo mal maior. Faz parte do direito à informação ampla e suficiente que o doador recebe sobre os riscos e possíveis complicações físicas e morais do procedimento, por meio do comitê de bioética e do grupo de transplantes. Com base na argumentação ética proposta, procedeu-se a contestar a seguinte pergunta de pesquisa: deve-se deixar que uma pessoa viva e saudável seja submetida a uma cirurgia que a deixará mononéfrico para sempre, somente pelo desejo de ajudar o outro, apesar de existirem programas ativos com doador cadavérico? Nesse contexto, o objetivo deste artigo é apresentar uma argumentação ética sobre a doação de rim de doador vivo e saudável que contribua para uma adequada orientação de sua decisão.

The sum of kidney donor profile index and estimated post-transplant survival scale and their correlation with egfr decline in deceased donor kidney recipients

Background: The impact of donor quality on post-kidney transplant survival may vary by candidate condition. Objective: Analyzing the combined use of the Kidney Donor Profile Index (KDPI) and the estimated post-transplant survival (EPTS) scale and their correlation with the estimated glomerular filtration rate (eGFR) decline in deceased-donor kidney recipients (DDKR). Methods: This was a retrospective, observational cohort study. We included DDKRs between 2015 and 2017 at a national third-level hospital. Results: We analyzed 68 DDKR. The mean age at transplant was 41 ± 14 years, 47 (69%) had sensitization events, 18 (26%) had delayed graft function, and 16 (23%) acute rejection. The graft survival at 12 and 36 months was 98.1% (95% CI 94-100) and 83.7% (95% CI 65-100), respectively. The Pearson correlation coefficient between the percentage reduction in the annual eGFR and the sum of EPTS and KDPI scales was r = 0.61, p < 0.001. The correlation coefficient between the percentage reduction in the annual eGFR and the EPTS and KDPI scales separately was r = 0.55, p < 0.001, and r = 0.53, p < 0.001, respectively. Conclusions: The sum of EPTS and KDPI scales can provide a better donor-recipient relationship and has a moderately positive correlation with the decrease in eGFR in DDKR.

Short- and mid- term impact of tobacco smoking on donor renal function following living kidney donation at a tertiary referral hospital

Background: The negative impact of tobacco smoking on renal function has been widely studied. However, there is limited knowledge about the effect of smoking on pre-operative and post-operative renal function in living kidney donors. Objective: The objective of the study was to evaluate the short- and mid-term impact of smoking on donor renal function. Methods: This is a retrospective study of 308 patients who underwent living donor nephrectomy (LDN) at a tertiary referral hospital. We compared baseline characteristics as well as functional outcomes following LDN according to history of tobacco smoking. Estimated glomerular filtration rate (eGFR) was calculated with the modification of diet in renal disease equation in 6 time periods: pre-operative, 1 week, 1 month, 6 months, 12 months, and 24 months after surgery. We performed a Kaplan-Meier analysis for chronic kidney disease (CKD) outcome and binary logistic regression analysis to identify risk factors associated with CKD at 24 months of follow-up. Results: Among donors, 106 (34.4%) reported a smoking history before nephrectomy. Smoking donors had worse pre-operative eGFR than non-smokers (90 ± 26.3 mL/min/1.73m2 vs. 96 ± 27 mL/min/1.73 m2, respectively; p = 0.02) and lower eGFR at 1 week (p = 0.01), 1 month (p ≤ 0.01), 6 months (p = 0.01), and 12 months (p = 0.01) after LDN. Tobacco smoking (OR 3.35, p ≤ 0.01) and age ≥ 40 years at donation (OR 6.59, p ≤ 0.01) were associated with post-operative development of CKD at 24 months after LDN. Conclusions: Living kidney donors with a tobacco smoking history had an increased risk of developing chronic kidney disease following nephrectomy. Smoking-cessation strategies should be implemented.

Clinical application and progress on adult donor dual kidney transplantation / 器官移植

Full application of marginal donor organs is a critical method to expand donor pool and alleviate organ shortage. After accurate donor evaluation, allocation and recipient selection, adult donor dual kidney transplantation (DKT) can not only achieve equivalent clinical efficacy to single kidney transplantation (SKT), but also effectively reduce the discard rate of marginal donor kidney. In this article, the clinical application and progress on adult donor DKT were reviewed from the perspectives of the development situation, allocation standard, recipient selection, surgical methods and complications as well as clinical efficacy of DKT, aiming to provide reference and guidance for subsequent development of marginal donor DKT.

Why potential donors and recipients not proceed to live kidney transplantation, malatya algorithm / Por qué los donantes y receptores potenciales no proceden al trasplante de riñón vivo, algoritmo de malatya

ABSTRACT Introduction: In some countries, organ donation is not widespread enough due to medical, cultural, ethical and socioeconomic factors. Living-donor kidney transplant constitutes the main source of kidney donation. Aim: To evaluate the causes of cancellation of living-donor kidney transplant and improve the effectiveness of transplant programs. Methods: Medical records of possible donors and recipients who were evaluated for living-donor kidney transplant at a tertiary medical center between November 2010 and September 2019 were reviewed retrospectively. Results: Evaluations were performed on 364 potential donors and 338 living-donor kidney transplant recipients; 207 of the latter (61.24%) underwent living-donor kidney transplant. Immune disorders represented the majority of cancellations (38.84%). Fifty-six donors (15.38%) were rejected mainly due to renal disorders (39%). Conclusion: Timely referral of patients to transplant centers must be guaranteed in order to overcome immune problems. Transplant centers should invest in programs adequate both for their resources and for their patients: paired kidney exchange, desensitization protocols, future research, etc.

RESUMEN Introducción: En algunos países la donación de órganos no es suficiente debido a factores médicos, culturales, éticos y socioeconómicos. El donante vivo de riñón constituye la principal fuente de donación de riñones. Objetivo: Evaluar las causas de cancelación de los donantes vivos de riñón y mejorar la eficacia de los programas de trasplante. Material y métodos: Se evaluaron retrospectivamente los registros médicos de posibles donantes y receptores para trasplante de riñón con donante vivo en un centro terciario, entre noviembre de 2010 y septiembre de 2019​​. Resultados: Se evaluaron 364 donantes potenciales y 338 receptores de trasplante de riñón con donante vivo; 207 receptores (61,24%) se sometieron a trasplante de riñón con donante vivo. Los problemas inmunológicos ocasionaron la mayoría de las cancelaciones (38,84%). A cincuenta y seis donantes (15,38%) se les negó la donación, principalmente debido a problemas renales (39%). Conclusión: La derivación oportuna de los pacientes a los centros de trasplante debe garantizarse para superar las barreras inmunológicas. Los centros de trasplante deberían invertir en programas adecuados, tanto por sus recursos como por los pacientes: protocolos de desensibilización, trasplante renal cruzado, investigación futura, etc.

Clinical efficacy and application criteria of single kidney transplantation from pediatric donors / 中华器官移植杂志

Objective To investigate the clinical outcome of single kidney transplantation from pediatric donors and to explore the application criteria.Methods The clinical data of 14 recipients undergoing renal transplantation from October 2006 to October 2016 were retrospectively analyzed.All the recipients received primary kidney transplantation from pediatric donor and the renal artery was anastomosed with external iliac artery.Based on the length of the kidney donor,the recipients were divided into two groups as group A (length beyond 6 cm) and group B (length 5-6 cm).The clinical effect and complications of the 14 recipients,the survival of the recipients and grafts,the recovery of renal function,the change of the renal length and the postoperative complications were compared between the two groups.Results The renal length in group A (n =7) was (7.5 ± 1.2) cm,and (5.7 ± 0.1) cm in group B (n =7).During the follow up period,all renal grafts and recipients survived.No significant difference was observed between two groups in renal graft function evaluated by serum creatinine and estimated glomerular filtration rate (eGFR) at 7th day,14th day,1st,2nd,3rd and 6th month postoperatively,P＞0.05.The length of transplanted kidney increased after operation in both groups,with results of 9.9 ± 0.6 cm in group A and 10.4 ± 1.5 cm in group B (P＞0.05),respectively,at 2nd month post-transplantation.Delayed graft function (DGF) occurred in 2 cases of group A and 1 case of group B.Seven cases developed proteinuria (50.0％),including 2 cases in group A (28.6％) and 5 cases in group B (71.4％).Four cases suffered hematuria (28.6％),including 2 cases in group A (28.6％) and 2 cases in group B (28.6％).One recipient in group B suffered acute rejection.No vascular embolization,urine leakage,pulmonary infection and other complications were observed in all the recipients.Conclusion The length beyond 5 cm is acceptable for single pediatric kidney donor for adult recipients with a promising clinical outcome in short-term.However,the high incidence of proteinuria and hematuria remains obstacle,and the long-term outcome needs further exploration.

Clinical efficacy of en-bloc kidney transplantation from pediatric donor kidneys / 器官移植

Objective To evaluate the clinical efficacy of en-bloc kidney transplantation from pediatric organ donation after death. Methods Clinical data of donors and recipients undergoing en-bloc kidney transplantation from pediatric donor kidneys were retrospectively analyzed. The 1-year survival rates of the recipient and grafted kidney were calculated. The recovery of renal function at postoperative 1 year was observed. The changes in the length of grafted kidney and incidence of postoperative adverse events were monitored. Results The 1-year survival rate of the recipients was 8/9, and 72% for the grafted kidney. During 1-year follow-up, the serum creatinine (Scr) level was down-regulated from (747± 170) μmol/L before transplantation to (83±27) μmol/L post-transplantation, the blood urea nitrogen concentration was decreased from (24.5±4.9) mmol/L to (6.8±2.0) mmol/L, and the length of transplanted kidney was increased from (61.1±9.8) mm to (100.3±1.7) mm. Two recipients suffered from delayed graft function(DGF) and restored after hemodialysis. Two cases developed acute rejection and healed after methylprednisolone shock therapy. One recipient presented with lung fungal infection at postoperative 2 weeks after transplantation, and was treated by the withdrawal of immunosuppressive agents and antibacterial treatment with poor clinical efficacy. Then the recipient died at 3rd month. One case had renal arterial thrombosis at postoperative 7 d, underwent nephrectomy at postoperative 10 d and returned to hemodialysis. At postoperative 1st month, one recipient suffered from thrombosis of unilateral renal artery. The grafted kidney in other side normally functioned and significantly grew in size at postoperative 6 months. In addition, two cases had ureterostenosis of the transplanted kidney, albuminuria in 2, abdominal aortic stenosis in 1 and urinary fistula in 1. All these symptoms were cured or alleviated after corresponding treatment. Conclusions The incidence of perioperative complications is relatively high in en-bloc kidney transplantation from pediatric organ donation after death, whereas the clinical efficacy of such kidney transplantation can be gradually increased along with the accumulation of clinical experience.

Validation of the KDRI in Korean Deceased Donor Kidney Transplantation / 대한이식학회지

BACKGROUND: The United Network for Organ Sharing developed the continuous kidney donor risk index (KDRI) for measurement of the spectrum of risk associated with the various factors known to influence graft failure. This study was conducted in order to validate the KDRI in assessment of deceased donor kidney in Koreans. METHODS: Patients (n=404) who underwent kidney transplants performed at five transplantation centers from 2000 to 2010 were studied retrospectively. The distribution of the KDRI of donor kidneys was calculated and the distribution of kidney donors by standard criteria donor (SCD)/expanded criteria donor (ECD) and KDRI was compared. The KDRI were divided into five groups: or =1.4. Graft function and graft survival among KDRI groups were analyzed. RESULTS: The mean KDRI was 1.01 (range, 0.55~1.88). More than 90% of donors had KDRI or =1.4 were ECD. The estimated GFR at one-year in the KDRI groups was 72.2, 65.8, 63.2, 69.1, and 47.1 mg/dL, respectively. Graft function was significantly lower in those with KDRI > or =1.4 (P or =1.4 (P=0.001). CONCLUSIONS: The KDRI is a useful tool for estimation of posttransplant outcomes in the Korean population. The KDRI can be used by physicians as an additional assessment tool to assist in the decision making process regarding donor organ selection.

Health Status and Health-promoting Lifestyle for Living Donors after Kidney Donation Through Survey / 대한이식학회지

BACKGROUND: Normal renal function and health have been recognized as important factors in living donors after kidney donation. The purpose of this study was to evaluate the health status and health-promoting lifestyle in living donors after kidney donation. METHODS: A total of 678 living-kidney donors were counted in our center from January 1990 to December 2011. Only 84 donors agreed to participate in the survey by telephone. We received consent for participation in our survey from 48 donors (57.1%). Data were collected from May to August 2013 using donor characteristics, health status, and Health Promoting Lifestyle Profile I (HPLP-I). RESULTS: The donors were predominantly female (62.5%) and the average age was 48.9+/-11.8 years, and the average period after nephrectomy was 9.7+/-5.7 years. The characteristics of donors included ideal body weight (37.5%), overweight (37.5%) in body mass index, and good health status (81.3%). Most donors underwent an annual medical check-up (56.2%), no health problem (81.3%), and no disease (64.6%). However, one patient was treated with dialysis for renal failure due to diabetes. The total average score for HPLP-I was 128.3+/-13.9. Higher than average scores (116.3+/-19.1) were observed for the general middle-aged woman. There were statistically significant differences in self-realization and nutrition in subsection of HPLP-I. Self-realization showed a higher score for Christian (F=2.743, P=0.041) and good health (F=3.389, P=0.017). Nutrition showed a higher score for overweight, obesity (F=6.783, P=0.000), and older than 60 (F=3.854, P=0.009). CONCLUSIONS: Most living kidney donors were healthy after their donation and had relatively high scores for health-promoting lifestyle. However, one patient had a serious health problem. In addition, younger, longer period after donation, and the rare health examination of donors showed a lower health-promoting lifestyle. Designed and continuous health-care management after transplantation is needed for kidney donors.

Renal Biopsy Findings of Prospective Kidney Donors and Clinical Course of Renal Allografts / 대한이식학회지

PURPOSE: To evaluate the pathology of prospective kidney donors and assess the clinical outcomes of the renal allografts. METHODS: We reviewed the records of 12 prospective kidney donors who underwent kidney biopsy. The indications of kidney biopsy were asymptomatic microscopic hematuria (n=88, 66.7%), decreased glomerular filtration rate (GFR, n=22, 16.7%), mild proteinuria (n=11, 8.3%), history of gross hematuria (n=11, 8.3%). RESULTS: Kidney biopsy in 8 prospective donors with asymptomatic microscopic hematuria showed: 5 (62.5%) thin basement membrane disease (TBMD); 1 IgA nephropathy; 1 Alport's syndrome; 1 mild mesangial widening. Two prospective donors with decreased GFR showed IgA nephropathy and tubulointerstitial lesion. The one with mild proteinuria showed arterionephrosclerosis and the one with a history of gross hematuria showed tubulointerstitial lesion. 4 (33.3%) of the 12 who underwent kidney biopsy were accepted as kidney donors.; 3 donors with TBMD and the donor with mild mesangial widening, who all had microscopic hematuria. Among the 4 donations, there was 1 graft failure and 3 allografts (1 mild mesangial widening, 2 TBMD) have maintained graft function at latest follow up. CONCLUSION: The most common cause of asymptomatic microscopic hematuria in prospective kidney donors was TBMD. Long-term follow up is needed to assess the clinical outcomes of these allografts.

Long-term Change of Renal Function after Donor Nephrectomy for Kidney Transplantation / 대한이식학회지

PURPOSE: Occurrence of renal failure and its related complications such as hypertension are long-term problems after donor nephrectomy for living donor kidney transplantation. We retrospectively reviewed renal function of unilateral kidney donor. METHODS: From 669 living donors for kidney transplantation from December 1998 to October 2006, laboratory data related to renal function are collected from hospital medical record retrospectively in 251 (37.5%) donors who were followed-up after discharge. The selection criteria of donors were: 1) pre-nephrectomy serum creatinine level below 1.5 mg/dL, 2) no radiologic abnormality in bilateral kidney. The donor nephrectomy was performed by conventional open nephrectomy or video assisted minilaparotomy surgery. The estimated glomerular filtration rate (e-GFR) by Modification of Diet in Renal Disease (MDRD) study was used as renal function monitoring parameter. RESULTS: In immediate post-nephrectomy period, e-GFR was decreased to 67.8+/-4.6% of pre-nephrectomy level (93.8+/-9.9 mL/min/1.73 m2). The urinary protein excretion for 24 hours was increased to 255% of pre-nephrectomy level (76.4+/-4.6 mg/day), but cases with proteinuria more than 300 mg per day were only 4 cases (1.7%, 4/251). After 14.0+/-5.2 months follow-up (range: 1~80 months), two cases (0.8%, 2/251) of renal failure (chronic kidney disease stage 5) were found. Relative renal function (post-nephrectomy e-GFR ratio versus pre-nephrectomy e-GFR, %) was increased by post-nephrectomy duration. The mean scores of e-GFR ratio within post-nephrectomy 2 months, 3~11 months, 12~23 months and after 24 months were 64.8+/-10.4%, 66.4+/-9.7%, 69.5+/-10.9% and 75.8+/-17.6% respectively. The relative e-GFR ratio after 24 months was significantly different from those of within 24 months (P<0.0001 by ANOVA). In linear regression analysis, mean increment of e-GFR ratio per post-nephrectomy year was 2.88%. CONCLUSION: In spite of possibility of renal failure, our study shows the long-term compensation of residual renal function after nephrectomy.

Psychosocial Adjustment in Families with Kidney Donor or Recipient / 간호학회지

The purpose of this study was to generated a grounded theory of how families with kidney donor or recipient copel with kidney transplantations. Interview data from twelve familes involved in didney transplants was analyzed using the grounded theory method. Data analysis revealed that "protecting the family" was the main theme that represented family member experiences. In order to maintain family function and to protect the family from breaking up, family members had to adjust the family structure from the traditional style of a husband-centered family, to one that was patient health-centered. the process of this adjustment was a very long and difficult one, taking several years from the recognition of the kidney disease to the kidney transplants. Family members, especially spouses, employed nine different strategies to deal with various problems and conflicts which occurred during the process : 1) paying attention to the patient's illness and complications ; 2) accepting the patients's illness as the family's illness as well ; 3) managing the patient's illness and complications that occurred ; 4) being thrifty ; 5) supporting the kidney donor ; 6) accepting and replacing the lost roles of the patient ; 7) keeping composure and encouraging the patient ; 8) sustaining the patient's independence ; 9) self-restraining sexual desires.