ABSTRACT
During the past decade, the number of transplantation from living kidney donors has substantially increased worldwide. The rate of increase varies from one country to another. The risk of unilateral nephrectomy to the donor includes perioperative mortality and morbidity plus the long-term risk of living with a single kidney. The rate of perioperative mortality and morbidity is about 0.03% and 10%, respectively. More attention is required to prevent serious complications of laparoscopic donor nephrectomy. A grading system in recording perioperative complications is necessary for making it available to each potential donor. The number of studies on long-term outcome of living donors is very limited. The overall evidence suggests that the risk of end-stage kidney disease is not increased in donors, however, mild renal failure, hypertension and proteinuria are not uncommon in living donors. There is also concern that the incidence of cardiovascular disease may be higher in kidney donors. Establishing living donor registry and follow-up is extremely important. Only through these registries the long-term risk of kidney donation will become more apparent. Because of severe shortage of transplantable kidneys, some transplant centers are now using donors with comorbidities and few centers are involved in transplant tourism with inadequate donor screening and follow-up. Prevention of these unacceptable practices in living kidney donors was emphasized in Amsterdam Forum in 2004 and Istanbul Summit in 2008.
ABSTRACT
Due to the severe shortage of deceased donor kidneys, the number of renal transplantation from living-related and living-unrelated donors has increased worldwide. The incidence and risk factors of delayed graft function after deceased donor renal transplantation have been extensively studied. In this analysis, the incidence and predictors of delayed graft function was investigated in 689 living-unrelated kidney recipients. In 53 recipients, dialysis was needed within the first week after renal transplantation (7.7%). The risk factors for delayed graft function upon univariate analysis models were: female gender of kidney donor (P=.027), renal allograft with multiple arteries (P=.005) and previous transplantation (P<.005). Upon multivariate analysis, the only risk factor for development of delayed graft function was retransplantation (P=.001).
Subject(s)
Kidney Transplantation/statistics & numerical data , Living Donors , Postoperative Complications/epidemiology , Adult , Female , Humans , Incidence , Male , Middle Aged , Risk Factors , Transplantation, HomologousABSTRACT
During 23 years of civil war in Afghanistan, there has been a continuous flow of more than 5 million refugees out of the country. Iran has hosted about 40% of all refugees. The majority have resided outside of camps with opportunities to integrate locally, having access to the Iranian labor market and government services, such as dialysis and transplantation. Iran also has adopted a compensated living unrelated donor renal transplantation program in which foreigners can receive transplants from living related donors or volunteer living unrelated donors of the same nationality. In June 2004, among 241 refugees with end-stage kidney disease in Iran, 179 were on hemodialysis and 62 underwent renal transplantation. Nine patients received kidneys from living related donors, 1 from a spouse, 50 from Afghani living unrelated donors, and 1 from a cadaveric donor. No refugee had been used as a kidney donor to an Iranian patient. Transplantation of all Afghan refugees in need and the absence of their use as kidney donors to Iranian patients proffer strong evidence against commercialism and a reason to believe that the Iran Model transplantation is practiced with ethical standards. In the last 2 years since the civil war has ended, returning these patients to Afghanistan has raised important ethical concerns. Repatriation of dialysis patients and transplant recipients may be tantamount to their deaths. It is expected that The Transplantation Society and the World Health Organization will establish links with the United Nations High Commissioner for Refugee Offices to provide humanitarian assistance to these patients.
Subject(s)
Kidney Transplantation/ethics , Refugees , Afghanistan/ethnology , Cadaver , Family , Humans , Iran , Kidney Failure, Chronic/surgery , Living Donors , Renal Dialysis , Tissue Donors , Tissue and Organ Procurement/standardsABSTRACT
This article reviews renal transplant (RTx) activity in USA to show that the ethics of RTx are changing, with steadily increasing numbers of living unrelated donors (LURD). In developing countries the numbers of RTx are inadequate emphasizing the need for controlled LURD RTx programs. The condemnation of all forms of compensated LURD RTx results in many patient deaths and the associated suffering is unethical. The Iran model, adopted in 1988, permits compensated and controlled LURD RTx. It has eliminated the RTx waiting list in Iran. At the end of 2002, among the 14,288 RTxs performed, 78% were from LURDs. The recipients of >50% of the kidneys from LURDs have been from the poor socioeconomic class of Iran. It has been recommended that each society should provide legally binding life-long benefits for LURDs.
Subject(s)
Kidney Transplantation/ethics , Living Donors/ethics , Humans , Iran , Kidney Transplantation/trends , Tissue Donors/supply & distribution , United StatesABSTRACT
Organ transplant (Tx) recipients are susceptible to develop various malignancies, most of which are uncommon in the general population. We present a case of post-Tx malignant fibrous histiocytoma with complete remission of tumor and excellent allograft function 3 years after cessation of cyclosporine.
