Emerging Ethical Challenges in Living Kidney Donation

AbstractPurpose of ReviewLiving-donor kidney transplantation (LDKT) offers the best medical outcomes in terms of graft and patient survival for end-stage renal disease (ESRD) patients. LDKT involves a medically and psychologically suitable individual willingly agreeing to donate a kidney to a loved one or stranger. It is a unique situation in which a healthy person consents to having a medical procedure for another person ’s benefit. LDKT raises numerous ethical issues, particularly with respect to voluntary consent, risks and benefits, and vulnerability.Recent FindingsIn recent years, the discovery of APOL1, a gene associated with increased risk of chronic kidney disease and ESRD in African Americans, and unique situations arising from requests to undergo living donation from persons who are not traditionally healthy or have social circumstances that may challenge influence-free, informed decision making have challenged the ethics of LDKT.SummaryIn this article, we discuss the ethical issues surrounding three emerging situations in LDKT: living kidney donors with life-limiting illness, incarcerated living kidney donors, and APOL1 genotyping in the context of living donor candidate evaluation.
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research

Related Links:

Conditions:   Chronic Kidney Disease;   Chronic Periodontitis, Generalized, Moderate Intervention:   Procedure: dental intervention Sponsor:   Augusta University Enrolling by invitation
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
AbstractNonalcoholic steatohepatitis is the fastest-growing indication for the liver transplant and a leading cause of hepatocellular carcinoma among patients listed for liver transplantation in the USA. Post-transplant nonalcoholic hepatic steatosis and steatohepatitis are frequent complications of liver transplantation. Nonalcoholic steatohepatitis poses a significant challenge in both pre- and post-transplant period due to its association with metabolic syndrome, coronary artery disease, chronic kidney disease, and obstructive sleep apnea. While optimal therapy is not yet available in the post-liver transplant setting, ...
Source: Digestive Diseases and Sciences - Category: Gastroenterology Source Type: research
Sonia Mehrotra, Raj Kumar Sharma, Manas R PatelIndian Journal of Nephrology 2019 29(4):242-247 Vitamin-D has immuno-modulatory properties besides its role in mineral and bone disorder (MBD) and could have a role in allograft outcome. Fifty-two chronic kidney disease patients on dialysis going for transplantation were prospectively studied before and after renal transplantation. FGF23, 25(OH) vitamin D, 1,25-Dihydroxyvitamin D, PTH, serum Ca, serum PO4, and e-GFR status were evaluated. Vitamin D deficiency was seen in 25.0% of recipients before transplant (26.09 ± 12.19 ng/mL) and in 48.1% at 6 months post-tra...
Source: Indian Journal of Nephrology - Category: Urology & Nephrology Authors: Source Type: research
In conclusion, we show here that sEVs are responsible for mediating paracrine senescence and speculate that they could be involved in inducing bystander senescence during therapy-induced senescence or aging. In fact, when compared to soluble factors, sEVs have different biophysical and biochemical properties as they have a longer lifespan than do soluble factors and they are more resistant to protease degradation. The idea that blocking sEV secretion could be a potential therapeutic approach to alleviate senescence "spreading" during chemotherapy-induced senescence or in aging tissues presents itself as a very at...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
President Donald Trump on Wednesday signed an executive order aimed at streamlining the overburdened kidney care and transplantation system—a move meant to “bring new hope to millions of Americans suffering from kidney disease,” Trump said. The policy is intended to improve kidney care in three major ways: by emphasizing more effective and convenient treatments; making more kidneys available for transplant; and improving preventive care and education with the goal of reducing the number of people who develop end-stage renal disease by 25% by 2030. Kidney disease tends not to attract as much attention as o...
Source: TIME: Health - Category: Consumer Health News Authors: Tags: Uncategorized medicine onetime White House Source Type: news
Purpose of review The population of kidney transplant recipients with advanced chronic kidney disease is growing but their outcomes are poor and care is not standardized. There has been wide variety of research in recent years on different aspects of care in failing allografts, and these research findings may help the providers in optimizing care. The purpose of the review is to outline the challenges and opportunities in management of failing allograft, and provide tools for improvement. Recent findings This review summarizes the recent research in field of failing allograft including outcomes, immunosuppression, ris...
Source: Current Opinion in Organ Transplantation - Category: Surgery Tags: KIDNEY PANCREAS: Edited by Matthew Cooper Source Type: research
CONCLUSIONS: Reduction of dialysate temperature may prevent IDH, but the conclusion is uncertain. Larger studies that measure important outcomes for HD patients are required to assess the effect of reduction of dialysate temperature. Six ongoing studies may provide much-needed high quality evidence in the future. PMID: 31273758 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
The management of hypertension in renal disease is best understood by classifying patients according to the stage of their chronic kidney disease (CKD). Many of the pathophysiological mechanisms are common to all patients, but in post-transplant recipients there are additional factors to be considered. The benefits of good blood pressure control in CKD are a slowing in the rate of progression of renal disease and a reduction in cardiovascular morbidity and all-cause mortality. In CKD stage 5, the aim is solely to reduce cardiovascular morbidity and mortality; the evidence of benefit here is more controversial, with several...
Source: Medicine - Category: Internal Medicine Authors: Tags: Hypertension and renal disease Source Type: research
CONCLUSION: The results support the findings of research showing that CKD has high psychiatric morbidity. It is important to include psychosocial and psychiatric assessments in the evaluation processes of different treatment modalities in CKD. PMID: 31278026 [PubMed - as supplied by publisher]
Source: Archives de Pediatrie - Category: Pediatrics Authors: Tags: Arch Pediatr Source Type: research
Conclusion: The present study revealed that hypercalcemia is a risk factor for the development of infrarenal abdominal AoC in KTRs. Furthermore, the effect of hypercalcemia was greater in patients with more severe vascular calcification.Kidney Blood Press Res
Source: Kidney and Blood Pressure Research - Category: Urology & Nephrology Source Type: research
More News: African Health | Chronic Kidney Disease | Genetics | Kidney Transplant | Kidney Transplantation | Medical Ethics | Psychology | Transplant Surgery | Transplants | Urology & Nephrology