Wednesday, October 5, 2016

Young adults and kidney donation - To do or not do.

A short article was recently written on Washington Post by a medical student who donated a kidney at age 18 to his brother's stepfather and now regrets it. Worth a reading (link here).

 He questioned the informed consent and the poor quality data we have for long-term outcomes after donation, including the fact that we don't have a donor registry that captures all donors in the USA.

 Age of donation is an important factor to consider when assessing the potential long-term risk of kidney donation. Younger kidney donors have a greater chance of suffering a second-hit leading to kidney injury through their lifespan, in particular with life expectancies surpassing 80 years in many countries. Therefore, it is generally recommended to be more stringent in the selection of younger donors. But how should we as a Society respond to this? How individual centers approach younger donors below 30yo? Would love to hear our community thoughts on this.

 Figure from Kidney Transplant iBook (adapted from Mjoen et al. Kidney Int 2014)

2 comments:

Thiago Reis said...

In Kidney Hospital (São Paulo- Brazil) we use many young donors (below or around 30 yo). Many of those are not aware of the long term consequences of the donation. Moreover, this young donors are prone to miss our annual follow-up. Maybe because showing up on an medical office, means they are losing a work day or a trip from their hometowns to São Paulo, or usually both. Many will develop hypertension, proteinuria and so on, risking to evolve towards ESRD. I think that during pre-transplant appointments, donor candidates must be exposed to probabilities and numbers that illustrate not only the risks of developing ESRD, but also hypertension, proteinuria, pre-eclampsia and even death. With the nephrology fellows that are monthly doing internship training in my infirmary, I try to spread this philosophy of sparing young donor. An illustrative tool is the online calculator available on www.transplantmodels.com/esrdrisk. When the fellows calculate their own risks of developing ESRD (and usually their ages are around 30yo), the majority decline from an hypothetical donation. It is easy to sow ideas in fresh minds, than overtaking dogmas from senior nephrologists.

Thiago Reis said...

In Kidney Hospital (São Paulo- Brazil) we use many young donors (below or around 30 yo). Many of those are not aware of the long term consequences of the donation. Moreover, this young donors are prone to miss our annual follow-up. Maybe because showing up on an medical office, means they are losing a work day or a trip from their hometowns to São Paulo, or usually both. Many will develop hypertension, proteinuria and so on, risking to evolve towards ESRD. I think that during pre-transplant appointments, donor candidates must be exposed to probabilities and numbers that illustrate not only the risks of developing ESRD, but also hypertension, proteinuria, pre-eclampsia and even death. With the nephrology fellows that are monthly doing internship training in my infirmary, I try to spread this philosophy of sparing young donor. An illustrative tool is the online calculator available on www.transplantmodels.com/esrdrisk. When the fellows calculate their own risks of developing ESRD (and usually their ages are around 30yo), the majority decline from an hypothetical donation. It is easy to sow ideas in fresh minds, than overtaking dogmas from senior nephrologists.