Trends in Kidney Donation among Kidney Stone Formers: A Survey of US Transplant Centers

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Abstract

Background: Living kidney donation is on the rise and acceptance criteria for potential donors are evolving to include more ‘complex’ patients such as kidney stone formers. Transplant centers are faced with sparse data on patient outcomes when evaluating potential donors who are stone formers; thus, attitudes and practice can differ greatly between centers. Methods: We conducted a survey of United States kidney transplant programs to assess current trends in the approach to dealing with stone formers who are evaluated for kidney donation. Results: Based on the survey results, there appears to be a tendency toward increased acceptance of donors with a history of kidney stones. 77% of responding centers allowed stone formers to donate. Nearly 40% of centers reported that their attitude towards accepting donors with kidney stones has changed over the last 5–10 years. Among these, the overwhelming majority reported that they were more likely to accept these donors. Conclusions: Such trends are likely based on organ need, as published patient outcomes and evidence-based guidelines are lacking for this unique group of patients. We propose the need for a study to formally evaluate the outcome of stone formers who donate a kidney in order to systematically examine whether appropriately selected stone formers can safely donate.

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Most cited references 17

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The quality of life of patients with end-stage renal disease.

D L Manninen, Lee Lowrie, Adam Hart … (1985)

We assessed the quality of life of 859 patients undergoing dialysis or transplantation, with the goal of ascertaining whether objective and subjective measures of the quality of life were influenced by case mix or treatment. We found that 79.1 per cent of the transplant recipients were able to function at nearly normal levels, as compared with between 47.5 and 59.1 per cent of the patients treated with dialysis (depending on the type). Nearly 75 per cent of the transplant recipients were able to work, as compared with between 24.7 and 59.3 per cent of the patients undergoing dialysis. On three subjective measures (life satisfaction, well-being, and psychological affect) transplant recipients had a higher quality of life than patients on dialysis. Among the patients treated with dialysis, those undergoing treatment at home had the highest quality of life. All quality-of-life differences were found to persist even after the patient case mix had been controlled statistically. Finally, the quality of life of transplant recipients compared well with that of the general population, but despite favorable subjective assessments, patients undergoing dialysis did not work or function at the same level as people in the general population.

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Effect of waiting time on renal transplant outcome.

S M Rudich, Lisa Hanson, Robert Port … (2000)

Numerous factors are known to impact on patient survival after renal transplantation. Recent studies have confirmed a survival advantage for renal transplant patients over those waiting on dialysis. We aimed to investigate the hypothesis that longer waiting times are more deleterious than shorter waiting times, that is, to detect a "dose effect" for waiting time. We analyzed 73,103 primary adult renal transplants registered at the United States Renal Data System Registry from 1988 to 1997 for the primary endpoints of death with functioning graft and death-censored graft failure by Cox proportional hazard models. All models were corrected for donor and recipient demographics and other factors known to affect outcome after kidney transplantation. A longer waiting time on dialysis is a significant risk factor for death-censored graft survival and patient death with functioning graft after renal transplantation (P < 0.001 each). Relative to preemptive transplants, waiting times of 6 to 12 months, 12 to 24 months, 24 to 36, 36 to 48, and over 48 months confer a 21, 28, 41, 53, and 72% increase in mortality risk after transplantation, respectively. Relative to preemptive transplants, waiting times of 0 to 6 months, 6 to 12 months, 12 to 24 months, and over 24 months confer a 17, 37, 55, and 68% increase in risk for death-censored graft loss after transplantation, respectively. Longer waiting times on dialysis negatively impact on post-transplant graft and patient survival. These data strongly support the hypothesis that patients who reach end-stage renal disease should receive a renal transplant as early as possible in order to enhance their chances of long-term survival.

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Estimating the number of potential organ donors in the United States.

Kenneth Brigham, Richard Luskin, Lawrence Schkade … (2003)

As the need for transplantable organs increases, waiting lists of patients become longer. We studied the size and composition of the national pool of brain-dead organ donors during a three-year period and, on the basis of these data, considered ways to increase the rate of donation. We reviewed hospital medical records of deaths occurring in the intensive care unit from 1997 through 1999 in the service areas of 36 organ-procurement organizations to identify brain-dead potential organ donors. We examined data on characteristics of the potential donors, the processes of referral to organ-procurement organizations and of requesting donations, and the hospitals. We identified a total of 18,524 brain-dead potential organ donors during the study period. The predicted annual number of brain-dead potential organ donors is between 10,500 and 13,800. The overall consent rate (the number of families agreeing to donate divided by the number of families asked to donate) for 1997 through 1999 was 54 percent, and the overall conversion rate (the number of actual donors divided by the number of potential donors) was 42 percent. Hospitals with 150 or more beds were more likely than smaller hospitals to have potential donors and actual donors (P<0.001); 19 percent of hospitals accounted for 80 percent of all potential donors. Calculations of the number of donors per million persons in the general population did not correlate well with the performance of organ-procurement organizations as measured by the conversion rate. Lack of consent to a request for donation was the primary cause of the gap between the number of potential donors and the number of actual donors. Since potential and actual donors are highly concentrated in larger hospitals, resources invested to improve the process of obtaining consent in larger hospitals should maximize the rate of organ recovery. The performance of organ-procurement organizations can be assessed objectively through the comparison of the number of actual donors with the number of potential donors in the given service area. Copyright 2003 Massachusetts Medical Society

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Author and article information

Journal

Journal ID (publisher-id): AJN

Journal ID (nlm-ta): Am J Nephrol

Journal ID (doi): 10.1159/issn.0250-8095

Title: American Journal of Nephrology

Publisher: S. Karger AG

ISSN (Print): 0250-8095

ISSN (Electronic): 1421-9670

Publication date Subscription-year: 2009

Publication date (Print): July 2009

Publication date (Electronic): 23 January 2009

Volume: 30

Issue: 1

Pages: 12-18

Affiliations

^aSection of Nephrology, Department of Medicine, University of Chicago Medical Center, and ^bDepartment of Health Studies, Biological Sciences Division, University of Chicago, Chicago, Ill., USA

Article

Publisher ID: 197115 Other ID: Am J Nephrol 2009;30:12–18

DOI: 10.1159/000197115

PubMed ID: 19169005

SO-VID: 89fded65-1cba-4699-978a-5aba4a63a2c3

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 03 November 2008

Date accepted : 06 December 2008

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Figures: 2, References: 31, Pages: 7

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Trends in Kidney Donation among Kidney Stone Formers: A Survey of US Transplant Centers

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Abstract

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Karger: Nephrology

Most cited references 17

The quality of life of patients with end-stage renal disease.

Effect of waiting time on renal transplant outcome.

Estimating the number of potential organ donors in the United States.

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Cited by 5

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