scholarly journals Alternative Living Kidney Donation Programs Boost Genetically Unrelated Donation

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Rosalie A. Poldervaart ◽  
Mirjam Laging ◽  
Tessa Royaards ◽  
Judith A. Kal-van Gestel ◽  
Madelon van Agteren ◽  
...  
Keyword(s):  
Graft Survival ◽  
Living Donor ◽  
Kidney Donation ◽  
Alternative Programs ◽  
Living Kidney Donation ◽  
Kidney Exchange ◽  
Unrelated Donors ◽  
Altruistic Donor ◽  
The Relationship ◽  
Patient And Graft Survival

Donor-recipient ABO and/or HLA incompatibility used to lead to donor decline. Development of alternative transplantation programs enabled transplantation of incompatible couples. How did that influence couple characteristics? Between 2000 and 2014, 1232 living donor transplantations have been performed. In conventional and ABO-incompatible transplantation the willing donor becomes an actual donor for the intended recipient. In kidney-exchange and domino-donation the donor donates indirectly to the intended recipient. The relationship between the donor and intended recipient was studied. There were 935 conventional and 297 alternative program transplantations. There were 66 ABO-incompatible, 68 domino-paired, 62 kidney-exchange, and 104 altruistic donor transplantations. Waiting list recipients (n=101) were excluded as they did not bring a living donor. 1131 couples remained of whom 196 participated in alternative programs.Genetically unrelateddonors (486) were primarily partners.Genetically relateddonors (645) were siblings, parents, children, and others. Compared to genetically related couples, almost three times as many genetically unrelated couples were incompatible and participated in alternative programs (P<0.001). 62% of couples were genetically related in the conventional donation program versus 32% in alternative programs (P<0.001). Patient and graft survival were not significantly different between recipient programs. Alternative donation programs increase the number of transplantations by enabling genetically unrelated donors to donate.

scholarly journals Altruistic Donor Triggered Domino-Paired Kidney Donation for Unsuccessful Couples from the Kidney-Exchange Program

2010 ◽  
Vol 10 (4) ◽  
pp. 821-827 ◽  
Author(s):  
J. I. Roodnat ◽  
W. Zuidema ◽  
J. van de Wetering ◽  
M. de Klerk ◽  
R. A. M. Erdman ◽  
...  
Keyword(s):  
Kidney Donation ◽  
Kidney Exchange ◽  
Exchange Program ◽  
Altruistic Donor

Native Americans’ Memorable Conversations About Living Kidney Donation and Transplant

2019 ◽  
Vol 30 (5) ◽  
pp. 679-692
Author(s):  
Jenn Anderson ◽  
Rebecca K. Britt ◽  
Brian C. Britt ◽  
Shana Harming ◽  
Nancy Fahrenwald
Keyword(s):  
Native Americans ◽  
Self Efficacy ◽  
Living Donor ◽  
Kidney Donation ◽  
Living Kidney Donation ◽  
Dialysis Treatment

Living kidney donation and transplant (LKDT) offers a path of hope for patients on indefinite dialysis treatment. However, identification of a living donor can be challenging; initiating these conversations is difficult. Our study analyzes memorable conversations about LKDT that occurred in response to an LKDT campaign targeted to Native Americans. Our analysis of n = 28 memorable conversations revealed that the campaign prompted conversations and increased communication efficacy about LKDT. Based on these findings, we suggest that campaign designers utilize narratives within campaigns to model communication self-efficacy and then analyze the content of postcampaign conversations as an indicator of campaign effectiveness.

scholarly journals Raising awareness of unspecified living kidney donation: an ELPAT* view

2019 ◽  
Vol 13 (2) ◽  
pp. 159-165
Author(s):  
Lisa Burnapp ◽  
Kristof Van Assche ◽  
Annette Lennerling ◽  
Dorthe Slaats ◽  
David Van Dellen ◽  
...  
Keyword(s):  
Living Donor ◽  
Kidney Donation ◽  
Public Healthcare ◽  
Living Kidney Donation ◽  
Donor Pool ◽  
Individual Country ◽  
The Public ◽  
Raising Awareness ◽  
Number Of Patients ◽  
Stage Renal Disease

Abstract Background Living donor kidney transplantation (LDKT) is the preferred treatment for patients with end-stage renal disease and unspecified living kidney donation is morally justified. Despite the excellent outcomes of LDKT, unspecified kidney donation (UKD) is limited to a minority of European countries due to legal constraints and moral objections. Consequently, there are significant variations in practice and approach between countries and the contribution of UKD is undervalued. Where UKD is accepted as routine, an increasing number of patients in the kidney exchange programme are successfully transplanted when a ‘chain’ of transplants is triggered by a single unspecified donor. By expanding the shared living donor pool, the benefit of LDKT is extended to patients who do not have their own living donor because a recipient on the national transplant list always completes the chain. Is there a moral imperative to increase the scope of UKD and how could this be achieved? Methods An examination of the literature and individual country practices was performed to identify the limitations on UKD in Europe and recommend strategies to increase transplant opportunities. Results Primary limitations to UKD, key players and their roles and responsibilities were identified. Conclusions Raising awareness to encourage the public to volunteer to donate is appropriate and desirable to increase UKD. Recommendations are made to provide a framework for increasing awareness and engagement in UKD. The public, healthcare professionals, policy makers and society and religious leaders have a role to play in creating an environment for change.

scholarly journals Four hundred thirty consecutive pediatric living donor liver transplants: Variables associated with posttransplant patient and graft survival

2012 ◽  
Vol 18 (5) ◽  
pp. 577-584 ◽  
Author(s):  
Joao Seda Neto ◽  
Renata Pugliese ◽  
Eduardo A. Fonseca ◽  
Rodrigo Vincenzi ◽  
Vincenzo Pugliese ◽  
...  
Keyword(s):  
Graft Survival ◽  
Living Donor ◽  
Liver Transplants ◽  
Donor Liver ◽  
Patient And Graft Survival

scholarly journals Helping More Patients Receive a Living Donor Kidney Transplant

2018 ◽  
Vol 13 (12) ◽  
pp. 1918-1923 ◽  
Author(s):  
Amit X. Garg
Keyword(s):  
Kidney Transplant ◽  
Living Donor ◽  
Current Knowledge ◽  
Kidney Donation ◽  
Living Kidney Donation ◽  
Donor Kidney ◽  
Kidney Replacement Therapy ◽  
To Come ◽  
Living Donor Kidney Transplant ◽  
Living Donor Kidney

The best treatment option for many patients with kidney failure is a kidney transplant from a living donor. Countries that successfully increase their rate of living kidney donation will decrease their reliance on dialysis, the most expensive and high-risk form of kidney replacement therapy. Outlined here are some barriers that prevent some patients from pursuing living kidney donation and current knowledge on some potential solutions to these barriers. Also described are strategies to promote living kidney donation in a defensible system of practice. Safely increasing the rate of living kidney donation will require better programs and policies to improve the experiences of living donors and their recipients, to safeguard the practice for years to come.

Attitude of Ancillary Personnel Faced With Living Kidney Donation in a Hospital With a Living Donor Kidney Transplant Program

2007 ◽  
Vol 83 (3) ◽  
pp. 336-340 ◽  
Author(s):  
Antonio R??os ◽  
Pablo Ram??rez ◽  
Mar??a del Mar Rodr??guez ◽  
Lewa Mart??nez ◽  
Mariano Jeime Montoya ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Living Donor ◽  
Kidney Donation ◽  
Living Kidney Donation ◽  
Donor Kidney ◽  
Transplant Program ◽  
Living Donor Kidney Transplant ◽  
Living Donor Kidney

scholarly journals Use of a Processed Hematopoietic Stem Cell Product (FCRx) in Unmatched Related and Unrelated Donor — Recipient Pairs Is Associated with High Levels of Donor Chimerism and Donor-Specific Tolerance to Kidney Allografts

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 202-202
Author(s):  
Joseph R. Leventhal ◽  
John P. Galvin ◽  
James Mathew ◽  
Lorenzo Gallon ◽  
Kadiyala Ravindra ◽  
...  
Keyword(s):  
Renal Function ◽  
Stem Cell ◽  
Autoimmune Disease ◽  
Graft Survival ◽  
Graft Versus Host Disease ◽  
Living Donor ◽  
Standard Of Care ◽  
Graft Versus Host ◽  
Patient And Graft Survival

Abstract The prospect of eliminating the long term costs and side effects of drug-based immunosuppression (IS) is a compelling reason to pursue the establishment of transplant tolerance. Tolerance in kidney transplant (KTx) recipients has been achieved through the infusion of donor HSC under some form of conditioning. The increased upfront cost and intensive treatment required by tolerance induction protocols demands that the long term outcomes be superior to that achieved with SOC IS regimens. Since 2009 we have conducted a Phase 2 trial of combined stem cell/living donor kidney transplantation in mismatched and unrelated subjects where the stated goal has been the establishment of durable donor macrochimerism. Our protocol is based upon tolerogenic CD8+/TCR-facilitating cells (FCRx) and 200 cGy TBI-based nonmyeloablative conditioning. Recipients were conditioned with fludarabine (30mg/m2/dose, days -5,-4,-3), cyclophosphamide (50mg/kg/dose, day-3 and+3), 200 cGy TBI (day-1) followed by a living donor KTx (day0). A G-CSF mobilized peripheral blood mononuclear cell product was apheresed from the donor >2 weeks pre-KTx, processed to remove graft-versus-host disease (GVHD)-producing cells yet retain CD34 + cells and FC, and cryopreserved until administration day+1 post-KTx. MMF and tacrolimus-based immunosuppression (IS) was weaned and discontinued at 1 year if chimerism, normal renal function and normal KTx biopsy were noted. 37 subjects were transplanted between 2009 and 2016. 17 of 37 subjects were transplanted from 0-2 of 6 HLA matched unrelated donors. 26 of 37 subjects achieved high levels of durable donor chimerism and have been removed from all immunosuppression (7-95 months). Durably chimeric subjects show normal yearly protocol biopsies at 6 months, 12 months, and yearly thereafter, while standard of care patients begin to show abnormal biopsies and deterioration of renal function as early as 24 months post-transplant. Among the 26 subjects who were removed from immunosuppression, none have experienced biopsy proven acute rejection, none have lost chimerism, and none have had to have immunosuppression resumed. Patient and graft survival at 5 years post-transplant are similar to standard of care (SOC) subjects. Two cases of graft-versus-host disease (GVHD) have occurred (6% incidence). One subject experienced grade 2 GVHD that responded to therapy and was successfully removed from all immunosuppression. One subject experienced steroid unresponsive grade 3-4 GVHD resulting in death. Among 7 durably chimeric subjects who had an underlying autoimmune disease that caused their renal failure, none have experienced recurrence of the autoimmune disease (expected rate of recurrence 40-60%). In summary, patient and graft survival at five years was comparable between FCRx and SOC pts. Tolerant FCRx subjects had significantly better renal function than SOC. Medical therapy for hypertension and hyperlipidemia was more common in SOC than tolerant FCRx pts. We conclude there are significant long-term medical benefits to establishing tolerance in KTx recipients using the FCRx approach that become apparent within < 5 years. Disclosures Horwitz: Gamida Cell: Research Funding. Ildstad:Regenerex, LLC: Equity Ownership, Other: CEO.

Fortuitous benefits of living kidney donation: Diagnosis of serious medical conditions during the living donor evaluation

2018 ◽  
Vol 32 (3) ◽  
pp. e13204 ◽  
Author(s):  
Arika Hoffman ◽  
Ketki Tendulkar ◽  
Shaheed Merani ◽  
Alexander Maskin ◽  
Alan Langnas
Keyword(s):  
Living Donor ◽  
Kidney Donation ◽  
Medical Conditions ◽  
Living Kidney Donation ◽  
Donor Evaluation

One Organ Donation, Three Perspectives: Experiences of Donors, Recipients, and Third Parties with Living Kidney Donation

2003 ◽  
Vol 13 (2) ◽  
pp. 142-150 ◽  
Author(s):  
Thomas E. Burroughs ◽  
Amy D. Waterman ◽  
Barry A. Hong
Keyword(s):  
Social Support ◽  
Retrospective Studies ◽  
Third Parties ◽  
Third Party ◽  
Kidney Donation ◽  
Potential Bias ◽  
Living Kidney Donation ◽  
Memory Biases ◽  
Living Kidney Donors ◽  
The Relationship

Although living kidney donors' experiences with donation have been studied, questions of potential bias in retrospective donor reports remain. This study examined the experience of living kidney donation from 3 perspectives: those of the donor, the recipient, and a third party involved with the donation (ie, a donor triad). Surveys were completed with 174 donor triads to examine triad members' perceptions of donors' concerns before transplantation, whether these concerns came true after transplantation, the donors' experiences with surgery and recovery, and whether they would make the same decision again today. Triad members all agreed that donors were highly satisfied with their donation experience and that the relationship between recipient and donor improved after transplantation. Although recipients and third parties correctly identified the donors' primary concerns, they underestimated the prevalence of 16 of 18 donor concerns, including the donors' willingness to make the same decision again. Recipients also overestimated how painful and difficult the surgery and recovery were for donors. The results suggest that retrospective studies of donors may not be marred by significant misreporting or memory biases and that better education about the donation experience for the entire donor triad might provide better social support for donors, reduce recipients' guilt about donors' pain, and increase donation rates overall.

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