Long-Term Consequences of Kidney Donation

This is an article from New England Journal of Medicine and it is published by Hassan N. Ibrahim, M.D., Robert Foley, M.B., B.S., LiPing Tan, M.D., Tyson Rogers, M.S., Robert F. Bailey, L.P.N., Hongfei Guo, Ph.D., Cynthia R. Gross, Ph.D., and Arthur J. Matas, M.D. in January 2009.

The article says the long-term renal consequences of kidney donation by a living donor are attracting increased appropriate interest. The overall evidence suggests that living kidney donors have survival similar to that of nondonors and that their risk of end-stage renal disease (ESRD) is not increased. Previous studies have included relatively small numbers of donors and a brief follow-up period.

According to other Internet sources, End-stage kidney disease (ESRD) is when the kidneys are no longer able to work at a level needed for day-to-day life. The most common causes of ESRD in the U.S. are diabetes and high blood pressure. These conditions can affect your kidneys. ESRD almost always comes after chronic kidney disease. The kidneys may slowly stop working over 10 - 20 years before end-stage disease results.

Back to the research article, they ascertained the vital status and lifetime risk of ESRD in 3698 kidney donors who donated kidneys during the period from 1963 through 2007; from 2003 through 2007. They also measured the glomerular filtration rate (GFR) and urinary albumin excretion and assessed the prevalence of hypertension, general health status, and quality of life in 255 donors.

Note that glomerular filtration rate (GFR) is a test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the tiny filters in the kidneys, called glomeruli, each minute.

The survival of kidney donors was similar to that of controls who were matched for age, sex, and race or ethnic group. ESRD developed in 11 donors, a rate of 180 cases per million persons per year, as compared with a rate of 268 per million per year in the general population. At a mean (± means standard deviation) of 12.2±9.2 years after donation, 85.5% of the subgroup of 255 donors had a GFR of 60 ml per minute per 1.73 m² of body-surface area or higher, 32.1% had hypertension, and 12.7% had albuminuria. Older age and higher body-mass index, but not a longer time since donation, were associated with both a GFR that was lower than 60 ml per minute per 1.73 m² and hypertension. Most donors had quality-of-life scores that were better than population norms, and the prevalence of coexisting conditions was similar to that among controls from the National Health and Nutrition Examination Survey (NHANES) who were matched for age, sex, race or ethnic group, and body-mass index.

As a conclusion, survival and the risk of ESRD in carefully screened kidney donors appear to be similar to those in the general population. Most donors who were studied had a preserved GFR, normal albumin excretion, and an excellent quality of life.

A New Push to Let H.I.V. Patients Accept Organs That Are Infected

In September 2008, the world's first organ transplants from a HIV-positive donor to HIV-positive recipient took place in Cape Town, South Africa.

Two kidney transplants were carried out at Cape Town's Groote Schuur hospital. The surgeon, who carried out the operations, Dr. Elmi Muller, said the operations had been highly successful and both male recipients of the kidneys had been discharged from hospital and were doing well.

Before then, the organs of HIV-positive donors were simply discarded, and HIV-positive patients were not eligible for organ transplants.

A consultant nephrologist said that while giving HIV-negative organs was better for patients, most HIV-positive patients were open to accepting an HIV-positive kidneys.
But receiving an HIV-infected organ is not without risks for the patient. In receiving donated organs, they can receive a new strain of HIV.

If the strain is a drug-resistant strain, the recipient could also develop resistance to life-prolonging anti-retroviral drugs.

In South Africa, HIV drug resistance is still ralatively low.
South Africa has the highest number of HIV-positive people in the world, meaning a large proportion of organ donors are HIV-positive.
An estimated 5.7 million, out of a total 48 million South Africans, are infected with HIV.

Even though organ transplants from an HIV-positive donor to HIV-positive recipients is still in clinical trials and has obstacles such as drug-resistant strain, it is a great news for South Africans and other HIV-positive people in the world.

5 Taiwan patients face AIDS risks after organ transplantation

Do you think a person who is AIDS virus carrier can donate his or her organs?
In August 29, 2011, there was a case related to this question in Taiwan.




The 37-year-old organ donor suffered a serious head injury due to a fall and was sent to emergency room. After he was confirmed to be brain dead, his family contacted the hopital to arrange the transplant of his organs.
A medical team removed his heart, liver, lung, and both of kidneys, then doctors checked the results of HIV tests on the organs. However, the transplant team members misheard a lab staff member saying that the HIV test result were "non-reactive" while in fact they were "reactive" and proceeded to perform four transplant procedures.
This mistake was found after the transplants had been completed and the transplant team collected the paperwork.

Five transplant patients were facing an anxious few months to find out if they have been infected with the AIDS virus. Later, each recieved an organ from the man found to have been as HIV carrier.
The hospital issued a news release saying that the mistake was due to its transplant team not following standard operating procedures or checking test results on computer before performing the operations.
They said their medical team have started relevant treatment and care including emergency anti-HIV medication for the recipients and will give the most appropriate medical care for the recipients in the future and take all responsibility.
The medical staff involved in the transplants had also started a course of anti-HIV medication.

Every hospital should draw a lesson from this incident and be more careful.

 

 

 

Celebrating 100th Kidney Transplant in Chicago

Yesterday, Oct. 23, 2012, in Chicago, Northwestern Medicine transplant surgeons and physicians have reached a significant milestone with the completion of the 100th successful kidney paired donation transplant, a strategy which has enlarged the pool of kidneys available for donation for patients with a living donor who is not compatible.

Michael Abecassis, MD, chief of the division of organ transplantation, said they are proud of this accomplishment and the diligent focus to lead the way in finding innovative techniques to provide more patients the opportunity to get the transplants they need. Many times when family members want to donate, they are not matches for their loved ones. They can, however, donate their kidney to someone else who matches, and in return, their loved one receives the gift of life according to him.

A paired exchange is a possible solution for donor and recipient pairs who have certain incompatibilities including blood type and immunological differences. Paired exchange transplants are made possible when a kidney donor, who is not compatible with their intended recipient, is paired with another donor and recipient in the same situation.

Over the last four years, Northwestern's living donor kidney transplant program has grown to become one of the largest in the country, performing 636 living donor kidney transplants. This is more than any other hospital in the United States. In 2011, surgeons performed 154 living donor kidney transplants. Kidneys from living donors tend to last longer, function better and have fewer complications than organs from deceased donors. However, approximately one third of living donors are not a match for their intended recipient.

"In addition to kidney paired donation, Northwestern offers numerous techniques to help make living kidney donation available to donors and recipients who have mismatched blood types or immune systems," said Joseph Leventhal, MD, PhD, transplant surgeon and director of the living donor kidney program.

 I thought it was amazing for a single medical team to perform 100 kidney transplant surgeries. Whether all the 100 surgeries were successful or not, I think their effort and achievement brought a great development to the field of organ transplantation and our medical area.

Organ Donation

Currently, organ donation is the safest method for both donator and receiver for organ transplantation. Organ donation can occur with:

• a deceased donor, who can give kidneys, pancreas, liver, lungs, heart, intestinal organs

• a living donor, who can give a kidney, or a portion of the liver, lung, intestine, or pancreas

In order for a person to become an organ donor, blood and oxygen must flow through the organs until the time of recovery to ensure viability. This requires that a person die under circumstances that have resulted in an irreparable neurological injury, usually from massive trauma to the brain such as aneurysm, stroke or automobile accident. Only after all efforts to save the patient's life have been exhausted, tests are performed to confirm the absence of brain or brain stem activity, and brain death has been declared, is donation a possibility. The state donor registry is searched to determine if the patient has personally consented to donation. If the potential donor is not found on the registry, his or her legally authorized representative (usually a spouse, relative or close friend) is offered the opportunity to authorize the donation. Once the donation decision is established, the family is asked to provide a medical and social history. Donation professionals determine which organs can be transplanted and to which patients on the national transplant waiting list the organs are to be allocated.

Should the Sale of Human Organs Be Legal? - No

While some believe human organ trades should be legalized, others strongly hold the opposite view on the issue. They insist if  the sales of human organs is permitted, it will be immoral, bringing more negative aspects. They believe: 

     1. It could start dangerous trends of harvesting organs without people's consent
         When it comes to the human body, there should be many laws in place to help protect
          people's safety. If selling human organs were legal, there could be many companies that
          might seize on this as a money-making opportunity. And, to do so, they might infringe 
          on the rights, and even bodily safety, of people who have not chosen to give organs.

     2. The privatization of human organizations is, for lack of a better term, inhumane
         Selling human organs to the highest bidder is a practice which many think is carried out
         only in dark alleys. In reality, some people are bumped up on organ receiving lists 
         through charitable contributions to hospitals. Practices like these are immoral and 
         akin to actually selling an organ. The outright sale of an organ should never take place, 
         and everyone is entitled to an equal opportunity for their life to be saved.

     3. No one would want to donate their organs for free anymore.
         The sale of human organs should not be legalized. The current method of obtaining
         organs for transplant is the safest method for the recipient and the donor.
         While there is a great need for donors, a black market for human organs would
         benefit no one.

  4. This would lead to a situation where only the rich could obtain an organ transplant.

      Currently, except where organs are donated by a match or by family members, organs

      go to the person who is at the top of the list when organs become available. If organs 

      could be purchased, the most needy would not be able to get a transplant unless they

      had the cash to purchase the available organ. This would result in organs going to people 

      who have no chance of actually surviving, just because the person had money to buy an 

      organ. This is a terrible outcome. If the rich pay the biggest amount of money and buy

      an organ, the patient who would be best able to survive with the organ might die since

      they can't pay as much as the rich.

      

     

Should the Sale of Human Organs Be Legal? - Yes

Organ transplantation is one of the major breakthroughs in medical area, however, human organs are scarce, and the society has unsolved ethical issues raised from the scarcity. There are people who believe that the government should legalize the organ market for the several reasons. Supporters of legalization of organ market says:

    
     1. Hospitals are always low on organ donations. If organ sales save lives, there is no reason
        why it should not be legal. This will be the only way to solve the scarcity.
        I believe that the good associated with people being able to donate
        organs for money and the lives that this will save far outweighs the downside of
        people stealing organs for sale. Human can live with partial organs. The
        ability to sell organs would make more availability for those who need them.

     2. If anything is illegal, people will still do it at any other coasts. It is the same
         condition as the alcoholic beverage prohibition law in the past. Many of us become
         desperate, especially, when we need organs to save a loved one.
         Thus, instead of making people to violate the law, it is better to legalize the organ
         market and rather regulate it under the law.

     3. Legalization of organs market will stop the predators from killing the innocent.
         Since people do businesses in organ black market, it is easy to find the crimes
         associated with organ sales. Murder or serious injuries happen because organ market
         is illegal and not controlled by government. It would be better for the society to legalize
         the market and keep eye on it.

     4. The sales of adult organs by the adult themselves should be legal, because it is a
         personal decision. Based on the principle of autonomy, the government has no
         right to prohibit people selling organs. It is a personal decision, and the government
         should not be involved in any way at all. As long as a seller is rational and healthy enough
         to live without the organ, he or she should be allowed to sell it and save someone else.
         The person who are buying the organ would agree it is worth the cost.