Workload generated by a living donor programme for renal transplantation

Autor: Michael L. Nicholson, Sue Carr, T. Horsburgh, R. N. Saunders, R Elwell, Gavin J. Murphy
Rok vydání: 2000
Předmět:
Zdroj: Nephrology Dialysis Transplantation. 15:1667-1672
ISSN: 1460-2385
0931-0509
DOI: 10.1093/ndt/15.10.1667
Popis: Introduction Background. The ethical and medical implications of live kidney donation result in a comprehensive work- Renal transplant programmes throughout the UK are up process. The aim of this study was to determine suffering from an increasing shortage of cadaveric the magnitude of the workload and the yield of renal kidneys. In 1998 there were 4635 patients on the transplants generated by a live donor programme. UKTSS waiting list but only 1373 transplants were Methods. Referrals to the Leicester live donor pro- performed from cadaveric donors, a fall of 11% from gramme over the five-year period 1994–1998 were the previous year. In order to compensate for this retrospectively assessed. These were initiated by neph- shrinking pool of organ donors many units run a live rology referral and subsequently investigated in a step- donor programme and in 1998 there were 240 such wise manner. Patients were counselled and baseline renal transplants, an increase of 38% from the previous tests performed prior to consultant surgeon review and year. Recipients of these organs have consistently been assessment of donor renal function/anatomy. shown to have longer graft survival than those receivResults. One hundred and fifty referrals consisting of ing cadaveric organs [1–3]. 150 recipients with 269 potential donors were originally There are a number of principles that govern the made. This resulted in 32/120 (27%) related and 3/30 approach to live organ donation. First, to protect the (10%) unrelated recipients (P=0.06) and 32/220 (15%) donor from harm; secondly, to protect the recipient related and 3/49 (6%) unrelated donors proceeding to from harm and ensure as good an outcome as possible; live donor transplantation, with a mean work-up time whilst thirdly, avoiding unnecessary investigations and (±SD) of 9 (±7) months. One hundred and fifteen procedures. Three specific objectives stem from these recipients (77%) and 234 (87%) donors failed to pro- principles: (i) to identify contraindications early, (ii) ceed at various stages of assessment, for a variety of to identify and avoid unreasonable risks and (iii) to immunological, medical and social reasons. A large obtain good quality consent [4]. An important aspect number of expensive immunological investigations of live organ donation that has not been emphasized were required for potential donors, the majority of is that, because of these considerations, a significant which did not proceed to transplantation. However as proportion of live donor referrals will not result in a result of performing these in the early stages of transplantation. This creates a large additional workassessment the number of more invasive tests is kept load for transplant units, frequently with an unsuccessto a minimum. ful outcome. The aim of this study was to determine Conclusions. There is a relatively low yield of trans- the magnitude of this workload over a 5-year period plants from live donor referrals, particularly those and to investigate why referrals for live kidney donabetween unrelated individuals. The vast majority of tion result in a relatively low yield of renal transplants. referrals fail to proceed for legitimate reasons, but as This should allow for more efficient use of both staff a result, create a significant workload with notable and resources in the future. staffing and financial implications.
Databáze: OpenAIRE
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