Living donors in kidney transplantation: five-year follow-up

Living Kidney Donors Who Develop Kidney Failure: Excerpts of Their Thoughts

BACKGROUND

Psychosocial data about living kidney donors have been collected for almost 5 decades now. To date, however, no study has provided any psychosocial follow-up of donors who developed a serious health problem such as end-stage renal disease (ESRD).

METHODS

Donors who developed ESRD were invited to participate in a qualitative interview if they met one or both of the inclusion criteria: (1) developed ESRD within 10 years of donating and/or (2) lacked health insurance at the time of donation. We contacted 38 individuals who met these criteria, and 22 participated (58%). Two were subsequently excluded from analysis.

RESULTS

Twenty qualitative interviews were analyzed. Five findings are described: (1) donors describe the decision-making process as spontaneous and fast; (2) donors describe lack of appreciation for the need for post-donation self-care; (3) donors do not regret donating despite the adverse outcome; (4) donors advise future donors to have in place emotional and physical support post donation; and (5) donors appreciate the opportunity to tell their story from being a living donor to living with ESRD, which virtually all perceive as 2 separate unrelated events.

CONCLUSIONS

Most donors are positive about their donation decision and experience and would donate again, despite developing ESRD themselves. They propose some important changes to the decision-making and informed-consent processes. Our data are reassuring regarding lack of donor regret, but highlight the need for living donor transplant programs to ensure that living donors understand their long-term risks and receive appropriate life-long follow-up care to minimize these risks.

Medical risk analysis of renal transplant donors

AIM

The aim of this study was to evaluate the long-term medical risks of living-related donors in our center.

PATIENTS AND METHODS

185 living-related donors participated in the study. The factors assessed were creatinine clearance rate (CrCl), serum creatinine (SCr), BUN, hematocrit levels, proteinuria, microalbuminuria and hypertension rates, and renal parenchyma thickness and kidney dimensions predonation as well as at the last follow-up. In addition, we examined postoperative complications. A lombotomy incision was the choice for donor nephrectomy procedure routinely.

RESULTS

The mean length of hospital stay after donor nephrectomy was 3.2 +/- 0.6 days (range, 2-5 days). Seven donors readmitted during the first month after operation with surgical site infection were treated successfully. Four donors were reoperated for incisional hernia repairs and discharged without complication. The mean follow-up period was 61.6 +/- 50.4 months (range, 2-180 months). Mean ages of the donors at operation and at the last follow-up were 50.9 +/- 12.7 years (range, 20-81 years) and 56.5 +/- 11.9 years (range, 29-77 years), respectively. The male-to-female ratio was 0.69. Mean SCr levels and CrCl rates predonation and at the last follow-up were 0.83 +/- 0.22 mg/dL versus 1.1 +/- 0.2 mg/dL (P < .001), and 103.9 +/- 28.8 mL/min versus 88.3 +/- 25.9 mL/min (P = .03), respectively. SCr levels were within normal limits in all donors at predonation and at the last follow-up. At the last follow-up, CrCl was also within expected normal limits in all donors. Hypertension was detected in 13 donors. Mean predonation and at the last follow-up renal parenchymal thickness, BUN, and hematocrit levels were similar. Kidney dimensions were significantly different at the last follow-up after donation (P = .001). Eleven donors displayed proteinuria and 19 had microalbuminuria at the last follow-up, which had been negative for all donors predonation. There were seven surgical site infections and 4 incisional herniae.

CONCLUSION

Donor nephrectomy was performed with low surgical morbidity and comparable results of clinical and laboratory data to the age-matched general population.

"They don't have to suffer for me": why dialysis patients refuse offers of living donor kidneys

In the present climate of organ shortage, high demand for kidney transplants, and better clinical outcomes from living donors, health care professionals expect and encourage patients to accept offers of living related donor (LRD) kidneys. When patients decide not to adhere to this course of treatment, scholars and policy makers may question why, given that it delays their chances of receiving a transplant. This article reports on patients' decisions to refuse LRD kidney offers. An 18-month study was conducted of treatment decisions by hemodialysis patients (N = 79). Fewer than half of those offered an LRD kidney (N = 64) were willing to accept it, suggesting that sociocultural factors inform decisions. Patients expressed concerns about the potential donors' well-being over their own and about compromising their relationships with the donors. This article concludes that social relations, emotions, and ethnomedical beliefs play an important role in patients' treatment decisions and thus contributes to the anthropology of decision making.