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LOng-term follow-up after liVE kidney donation (LOVE) study: a longitudinal comparison study protocol

LOng-term follow-up after liVE kidney donation (LOVE) study: a longitudinal comparison study protocol

Participants from the Rotterdam Study and SHIP will be restricted from analysis if they would not qualify for live kidney donation based on the following criteria: preva- lent diabetes, an eGFR < 60 ml/min/1.73m 2 , and a BMI > 40 (kg/m 2 ). To account for the fact that data for covari- ates at baseline are not complete for all subjects, a mul- tiple imputation approach will be utilized based on the method of chained equations [45]. Using this procedure 10 complete data sets will be created, and for each of the data sets the following steps will be performed: First, donors and non-donors will be 1:4 matched using pro- pensity score matching based on the baseline covariates: age, gender, year of donation/inclusion, BMI, ethnicity, kidney function, blood pressure, pre-existing co- morbidity, glucose level, smoking, alcohol use and high- est education degree. Exact matching will be required for gender, ethnicity, existing co-morbidity, and smok- ing. Progressive radius matching will be performed for age, BMI, kidney function and blood pressure. Each non-donor subject will be allowed to serve as a potential match to more than one donor. If the available data in the control group is insufficient, the target ratio of 1:4 donor:non-donor will be reduced accordingly.
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Protocol of a Randomized Controlled Trial of Culturally Sensitive Interventions to Improve African Americans' and Non-African Americans' Early, Shared, and Informed Consideration of Live Kidney Transplantation: The talking about Live Kidney Donation (TALK

Protocol of a Randomized Controlled Trial of Culturally Sensitive Interventions to Improve African Americans' and Non-African Americans' Early, Shared, and Informed Consideration of Live Kidney Transplantation: The talking about Live Kidney Donation (TALK) study

The primary outcome is change in participants’ con- sideration of LKT over time. This outcome is measured as participants’ movement through 12 possible beha- vioral ‘ stages ’ reflecting their completion of key steps toward considering LKT, including (1) preparation for and/or execution of patient-family discussions about LKT; (2) preparation for and/or execution of patient- physician discussions about LKT; (3) preparation for and/or completion of evaluation for LKT; (4) comple- tion of the LKT recipient evaluation, and (5) identifica- tion of a potential live kidney donor. To assess these behaviors, we ask participants a series of questions to which they can answer ‘yes’ or ‘no’ (e.g. “Have you already completed the testing process to get a kidney transplant?”). We categorize participants into one of the 12 stages based on their answers. Once we have categor- ized the participants, we also assess potential barriers to consideration of LKT, including the barriers to discus- sions with family and providers about LKT (e.g. diffi- culty discussing LKT with physician, competing priorities, uncertainty about desire for LKT). (Figure 1)
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Increasing the Opportunity of Live Kidney Donation by Matching for Two and Three Way Exchanges

Increasing the Opportunity of Live Kidney Donation by Matching for Two and Three Way Exchanges

Development of regional exchange programs, such as that under way in New England, are important for increasing the number of patients who can receive living donor kidney transplants, and will also help decrease the number of patients waiting for a kidney on the deceased donor wait list. Because the percentage of incompatible patient-donor pairs who can benefit from 2- way exchange increases as the population of pairs available for exchange grows, expanding local exchange programs to include regional and possibly a national exchange program should be advantageous. And since a substantial number of additional patients can receive transplants if 3- way exchanges are feasible, developing the ability to identify and perform 3-way exchanges will also be very worthwhile. Although the advantage of using 3-way exchanges cannot be confirmed without prospective studies, every successful match means that two or more recipients receive a transplant they otherwise would not have gotten, and every attempt to increase the number of transplants should be included in an exchange program.
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The TALKS study to improve communication, logistical, and financial barriers to live donor kidney transplantation in African Americans: protocol of a randomized clinical trial

The TALKS study to improve communication, logistical, and financial barriers to live donor kidney transplantation in African Americans: protocol of a randomized clinical trial

We will enroll and randomly assign 100 patient partici- pants per study arm. Few randomized controlled trials have been previously performed to establish the effect- iveness of interventions to improve rates of live kidney donation and LDKT among African Americans. In our own TALK study among chronic kidney disease patients, we identified a 28 % improvement in achievement of LDKT consideration/pursuit behaviors at 6 months. In another randomized controlled trial, home visits to Afri- can American families led to a 20 % improvement in live donor inquiries [30]. Based on these studies, we estimate the TALKS interventions will yield a 25 % improvement in live donor activation behaviors. We are not aware of studies directly studying the effect of financial interven- tions on live donor activation. We expect that potentially willing donors will be enthusiastic about participating in this intervention and estimate at least an additional 20 % incremental increase in live donor activation with the fi- nancial assistance intervention. Under usual circum- stances, we estimate approximately 25 % of African American patients in the Duke Kidney and Pancreas Transplant Program deceased donor transplant waiting list receive inquiries from live donors interested in being evaluated on waiting list registrants’ behalves each year. Under these assumptions, we estimate we will have ap- proximately 95 % power to detect a 23-30 % differ- ence between TALKS Program study arm and Usual Care study arm at follow up as well as a 21-25 % differ- ence between TALKS Plus Program study arm and the TALKS Program study arm at follow-up. We also estimate we will have 99 % power to observe a trend across the intervention arms, while accounting for multiple compari- sons, and accounting for 80 % attrition of participants.
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The practice and ethics of live kidney donationsin israel

The practice and ethics of live kidney donationsin israel

Live donations raise moral, ethical and religious questions but these must be held against the urgent necessity to increase the rate of donations, without causing harm to live donors. In discussing the shortcomings of the current live kidney donation process above we have set out several recommendations designed to make the process, including its long-term follow-up, more rigorous, more cautious and more strongly research-based. However, a recommendation of no less weight and importance is that Israel take vigorous and sustained action to multiply the number of deceased donations. Each deceased kidney donation means one less live donation, and thus a prevention of harm to a healthy individual. Not nearly enough is done in Israel to promote deceased donations with the result that 50% of potential deceased donations are not realised. The main obstacle to this change of track is that motivation is low due to Israelis’ option of buying a transplant overseas. In effect, the Ministry of Health and the public healthcare system turn a blind eye to inadequately regulated organ donation overseas for the sake of saving the cost of dialysis in Israel. However, patients returning to Israel after undergoing a transplant abroad—often performed without proper medical supervision—have their follow-up treatments in Israel, adding to the local health-centres’ workload and detracting from the level of treatment local transplantees receive.
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Hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy: HARP-trial

Hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy: HARP-trial

The donor is prehydrated with intravenous crystalloids before operation. On the morning of surgery antithrom- botic stockings are given. The anaesthetist uses a stan- dard protocol for live kidney donation anaesthesia (remifentanyl and propofol), intravenous policy, and respiration. One hour after the beginning of the opera- tion, 20 mg mannitol is infused. During the operation the research-fellow notes warm-ischemia time, blood loss, and complications. Postoperative pain medication is measured through a Patient Controlled Analgesic (PCA; morphine) device. If the patient does not use the PCA for 6 hours, the PCA is stopped. The dosage regi- men is registered. Patients can be discharged when they meet with the following criteria:
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Experiences, perspectives and values of Indigenous peoples regarding kidney transplantation: systematic review and thematic synthesis of qualitative studies

Experiences, perspectives and values of Indigenous peoples regarding kidney transplantation: systematic review and thematic synthesis of qualitative studies

Previous studies have found that targeted programs that acknowledge traditional values, include families, are supportive of well-informed health decision-making processes, and promote access to live kidney donation [31, 32] will facilitate increased kidney transplantation. Our review suggests that active incorporation of trad- itional values and beliefs into a proactive pro-donation agenda will help to build more Indigenous patient- centred and culturally appropriate programs. Trad- itional beliefs are not static; culture is dynamic and changes over time [33] and this is reflected in the prag- matic responses reported by some participants, but not necessarily the views of clinicians treating them [34]. Future programs need to promote working together with elders and other knowledge holders to develop re- sponses to the challenges and needs around transplants that both honour tradition and allow flexibility.
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<p>Modeling Lay People&rsquo;s Ethical Attitudes to Organ Donation: A Q-Methodology Study</p>

<p>Modeling Lay People&rsquo;s Ethical Attitudes to Organ Donation: A Q-Methodology Study</p>

Principlism has been criticized for neglecting emotional and personal factors 39 and for being narrow and giving autonomy the place of honor. 43 Our empirical data support such a view. “ Acceptable if motivation purely moral ” and “ Acceptable if moral motivation stronger than materialistic ” received the sixth and seventh highest ranks, respectively, and “ Acceptable with purely materialistic motivation ” and “ Acceptable with materialistic motivation stronger than moral ” the second and fourth lowest ranks, respectively. This is in line with previous results showing that judgment of an action ’ s wrongness/permissibility by lay people depends partly on the agent ’ s mental status 60 and provides some evi- dence against the argument that the four principles of princip- lism are suf fi cient for universalizable normative morality. 40–42 Organ donation has long relied on altruism, wherein the moral value of an action is focused on its bene fi cial impact to others, without regards to self-interest consequences. 16 However, certain kinds of regulated fi nancial incentives have been considered 7,9,16,22 as they may increase organ supply based on basic economics, 9 out of fairness to donors, and recognizing that even with altruism there is usually some gain such as intrinsic satisfaction, expectation of
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A Proposed Mechanism for the Iranian Model of Kidney Donation (A Comparison of the Iranian and Roth’s Models)

A Proposed Mechanism for the Iranian Model of Kidney Donation (A Comparison of the Iranian and Roth’s Models)

To alleviate the imbalance in the kidney market, various countries have tried to draw upon different models for kidney transplantation over the last 30 years. One of the common models used in some western countries is generally referred to as the Kidney Exchange Model, or, alternatively, the American Model. This model includes patient-donor pairs in which donors are incompatible with patients. The donors are often patients’ relatives willing to donate to their dear ones; however, they cannot do so due to blood or tissue incompatibilities. The present study aims to provide a mechanism to modify the Iranian Model of Kidney Donation (IMKD) based on market design theory and assignment algorithm. Paired kidney exchange is a solution to this problem, which was proposed in 1986 by Rapoport. (Rappaport, 1968). In 1991, the first paired kidney exchange took place in South Korea and then a few years in Europe and a year later, in 2000, the first paired kidney exchange took place in the United State. After that, the paired exchange grew rapidly and, with advanced algorithms, managed to increase the number of transplantation so that in the United States, in the third quarter of 2010, the number of paired transplantations increased to over 1,000 ( UNOS 1 , 2011). In the decade, the solution to the problem of supply shortages was the focus of a group of economists, which was the product of the emergence of market design theory.
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Longitudinal study of living kidney donor glomerular dynamics after nephrectomy

Longitudinal study of living kidney donor glomerular dynamics after nephrectomy

The presence or absence of filtration pressure equilibrium can be indirectly determined from the relation between RPF and GFR. In states of equilibrium, an acute increase in RPF leads to a proportionate elevation of the GFR, with the filtration fraction remaining constant (27). By contrast, in disequilibrium, increases in RPF associated with acute volume expansion result in a smaller or absent increase in the GFR associated with a decrease in the filtration fraction (27). We have previously demonstrated an absence of parallel increases in the GFR and a declining filtra- tion fraction, despite substantial increases in RPF during volume expansion in healthy humans, pointing to filtration pressure dis- equilibrium (31–33). Following uninephrectomy, by contrast, our healthy donors exhibited parallel increases in RPF and GFR, with constancy of the filtration fraction across our 3 time points of evaluation. We infer that in the presence of filtration pressure dis- equilibrium, the observed post-donation hyperfiltration results from a compensatory glomerular hypertrophy–induced increase in the K f , along with the associated augmentation of RPF. Were humans in filtration pressure equilibrium, the post-donation hyperfiltration seen in our living donors could be accounted for solely by the observed increase in RPF, however, we consider this scenario extremely unlikely.
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Attitudes of Parents of Schoolgoing Children in Federal Territory of Kuala Lumpur to Kidney Donation

Attitudes of Parents of Schoolgoing Children in Federal Territory of Kuala Lumpur to Kidney Donation

Attitudes of Parents of Schoolgoing Children in Federal Territory of Kuala Lumpur to Kidney Donation ORIGINAL ARTICLE I Attitudes of Parents of Schoolgoing Children in Federal Territory of Kuala Lumpu[.]

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Medical Decision making and Logics of Negotiation in Living Organ Donation

Medical Decision making and Logics of Negotiation in Living Organ Donation

understand that people refuse donating to their brother… honestly, I wouldn´t do it either… not to a brother… and it´s not because being a doctor or not… or knowing how things work… [Nephrologist, 43] Medical protocols and the legal framework, nevertheless, refer to criteria different of those mentioned. When a donor is introduced, nephrologists usually would start with checking the –biochemical- compatibility and continue by examining the health of the future donor. Apparently, these steps do not include any social dimension. In equal conditions, a male donor would be preferred due to a higher kidney volume, however this point is considered of minor importance and rarely ever up for discussion. Compatibility and health conditions, however, are very much negotiated between donors and medical professionals in order to regain the initially occupied position on our invisible axis. With the exception of “objective” biological impossibility (e.g. kidney abnormality), determined female donors try to convince of their good or, at least, acceptable health conditions. Health conditions are complex, difficult to compare and much more subjective than biomedicine would admit, so a donor might persuade by firm intention, courage, endurance and sense of responsibility. This is even the case when compatibility is not at all ideal; mothers with a different blood group than their children are not likely to give up but frequently demand a relatively recent –and expensive- blood treatment (desensitization) to make her compatible with the recipient. Whenever economic resources are available and the risk for the donor seems to be acceptable, medical professionals share the social construction of the hierarchy of ideal –and natural- donors and choose a blood-related “brave” female disregarding even poor compatibility.
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Potential for Liver and Kidney Donation After Circulatory Death in Infants and Children

Potential for Liver and Kidney Donation After Circulatory Death in Infants and Children

those described by Durall et al, and much more stringent than those of Koogler and Costarino, which may in part explain why the proportion of eli- gible patients we observed was closer to that seen in the Durall et al report. Pleacher et al did not articulate spe- cific criteria for kidney or liver donors; rather, eligibility was “determined by size, age, diagnoses, and the PICU at- tending’s opinion on the child’s likeli- hood of expiring within 60 minutes.” Notably, when considering the propor- tional increase in donors or in number of organs per year, our criteria gave estimates for kidney donation that were similar to all 3 previous reports; it is possible our “strict” criteria were too strict and that our basic criteria are more appropriate.
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Kidney organ donation: developing family practice initiatives to reverse inertia

Kidney organ donation: developing family practice initiatives to reverse inertia

organ transplantation has led to a growing interest in liv- ing organ donation, which now makes up approximately half of all kidney transplants in the USA [8,11]. In the UK, the annual deceased donor kidney transplant rate was 23.5 and in Greece 9.2 per million population (pmp) respectively, during 2007. In the same year, the living kid- ney transplant rate was 13.4 and 7.9 pmp for the UK and Greece respectively [12]. Data from various regions sug- gest that more than half of the countries surveyed reported at least a 50% increase of the number of living kidney transplants in a ten year period [13]. Most living donors (67%) are genetically related to the recipient, but there has been a 10-fold increase in the number of trans- plants from unrelated donors in the last ten years [11,14]. This tendency to accept more unrelated donors is largely due to the finding that graft and patient survival rates are comparable between living related and living unrelated donor transplantation [14,15]. The mortality rate of donor nephrectomy has been estimated at 0.03% and of major complications 0.2%, risk rates that need to be con- sidered against the preoperative healthy status of a living donor [16]. However, in some countries with limited institutional and financial resources, issues involving organ allocation process may lead to perplexity and uncertainty in terms of equity among recipient candi- dates, donor safety and transparency about prioritisation
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Prediction model of compensation for contralateral kidney after living-donor donation

Prediction model of compensation for contralateral kidney after living-donor donation

We retrospectively analyzed 133 consecutive living kidney donors in our institution from January 2011 to December 2017. All donors were medically fit for dona- tion based on the Japanese donor selection criteria [10]. We used the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation to calculate the estimated glomerular filtration rate (eGFR) in our cohort [9, 11]. The body surface area (BSA) was calculated based on the DuBois–DuBois formula. All donors under- went a computed tomography (CT) scan, including three-dimensional CT volumetry, during their preopera- tive evaluation. Three-dimensional CT volumetry was performed using ZIOSTATION 2® (Ziosoft, Tokyo, Japan). We investigated the relationship between allograft function and donor kidney volume using CT volumetry to select the donor’s kidney (right or left) to be transplanted. We analyzed the donors’ clinical charac- teristics and outcomes and created a prediction model.
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An ethical comparison of living kidney donation and surrogacy: understanding the relational dimension

An ethical comparison of living kidney donation and surrogacy: understanding the relational dimension

Social expectations for donation are to a large extent also constituted by a reference to gendered body concepts. As it has been shown, women tend to allude to holistic body concepts. In particular, they stress the reproductive capacity of their bodies by drawing direct comparisons between birth, motherhood and the mother-child relationship [27]. In this regard, the familiar image of the self-sacrificing mother functions as a cultural mechanism that enables the transplant endeavor [55]. However, a mother’s decision to become a donor is neither to be viewed as “yet another means of gender exploitation” [55] (ibid., 7) nor as an in- fringement of her autonomy. Specifically, Crowley-Matoka and Hamdy point out that “women who defined themselves first and foremost as mothers often expressed pure elation and relief on news that they could donate their kidneys to their sick children” [55] (ibid.). The fact that mothers can benefit from donation themselves, for example, by experi- encing high social recognition and prestige within their so- cial setting, displays another argument challenging the notion of exploitation [56]. As regards the autonomy of mothers but also other family members, the latter ’ s decision to donate an organ is often framed as a matter of relational autonomy [27, 57]. As it has been noted “to be autono- mous, in a relational sense, is to be responsive and respon- sible to others, and interdependent within complex networks of relationships, which will not always easily ac- cord with the practices and expectations we have normal- ized in cultures that have elevated ‘the individual’” [58]. From this perspective then, love, affection and concern with others ’ needs are not seen as limiting autonomy but as en- abling it [17, 59]. Still, there is no inevitability of mothers becoming donors to their children. By referring to a French study which revealed that the medical staff were more likely to urge fathers to serve as living donors because “ mothers have already done their part,” Gauthier stresses the avail- ability of alternative conceptions of bodily responsibility [60].
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Altruistic kidney donation: a discourse analysis, and the client’s use of the body for unconscious communication.

Altruistic kidney donation: a discourse analysis, and the client’s use of the body for unconscious communication.

Having constructed donation in terms of being valued, Peter now denies that there is an “emotional” reason to donate, seeming to contradict himself. At this point, I would like to analyse my own emotional investment in the discourse, and ask myself the question I was asking Peter. Why was I interested in altruistic kidney donation and what was my initial response on learning of its existence? My response to it reflects my own unconscious process and from an inter-subjective framework, in which meaning is co-created, this can be used to gain a more nuanced understanding of Peter’s experience. When I reflect on my own response to the idea of living organ donation, the first thing I notice is also conflict; a distinct yet unfocused sense of uneasiness, even queasiness around the intimacy and the violation of bodily integrity that it involves. I feel that there is a sacrificial element to it, the donor is submitting to something and not trying to resist any longer, as though they are offering themselves up. Peter describes the process as “like a snowball”, suggesting that he is allowing himself to be taken along by it. This might be interpreted as a way for him to avoid having to think anymore about the feelings that go with it, feelings that might be either unavailable to conscious evaluation because they need to be defended against, guilt or shame for instance. There does seem to be evidence in the text to support the suggestion that Peter is reluctant to experience the unpleasant feelings that go with his attempt to increase his sense of self-value, for instance, when he denies that his decision to donate is not “heavily emotional”.
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Uterus transplantation: current progress and future prospects

Uterus transplantation: current progress and future prospects

Uterus transplantation was a breakthrough in the field of reproductive medicine and has so far showed a remarkable successful outcome. Bearing this in mind, this procedure is still only proof of concept for uterus transplantation as a treatment for uterine factor infertility in a live related donor setting by laparotomic technique. Before introducing uterus transplantation in a wider general setting, several more care- fully monitored pregnancies are required to evaluate major obstetrical risks, including miscarriage, preeclampsia, pre- term birth, and fetal growth restriction. The concept of uterus transplantation will though surely be expanded to be dem- onstrated in other settings in the near future. All the current successful cases have been performed at a single institution, after years of meticulous research in several animal models. The years of extensive collaboration between gynecological and transplant surgeons, pathologists, and anesthesiologists is the single most important factor in achieving such a remark- able good outcome of this novel procedure. With more cases being performed in the near future, by new surgical teams and centers, one can expect a wider and more extensive variety of different complications and this might come to affect the overall outcome. Prior to the clinical introduction of uterus transplantation, it was debated whether it was ethically and morally defendable to perform the procedure. Now that it is proven to be successful in a controlled setting, the question might instead be whether it will be defendable or not to develop the uterus transplantation procedure further.
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Identifying Potential Kidney Donors Among Newborns Undergoing Circulatory Determination of Death

Identifying Potential Kidney Donors Among Newborns Undergoing Circulatory Determination of Death

help another child. However, because DCDD grafts are primarily being cur- rently used for adult recipients, this situation may affect the willingness of the family to consent to donation and their overall view of the experience. We understand that identifying DCDD donors is just the fi rst step. The accep- tance of this alternative category of donors may be slow and vary across centers, depending on program volume and experience with DCDD kidney trans- plantation. Some ICU physicians still have con fl icting opinions about the practice of DCDD from an ethical point of view, which may slow the establish- ment of NICU DCDD programs. 31 – 34
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Utilizing List Exchange and Non directed Donation through “Chain” Paired Kidney Donations

Utilizing List Exchange and Non directed Donation through “Chain” Paired Kidney Donations

A chain exchange involves at least one additional pair besides the original LE pair or ND-D. In a chain exchange, instead of the first donor (LE-D or ND-D) directly donating to a waitlist candidate, the kidney is donated to a KPD-IR and in return the KPD-D donates to the DD-waitlist. Longer chain exchanges involving more pairs can also be feasible. We conducted simulations using both local data and OPTN/SRTR data to see the potential benefits of chain exchanges. The benefits of this integration with KPD are largest for ABO-O blood-type donors (ND-D or LE-D), but are also significant with ABO-A or B donors (although in the small local sample, an ABO-B or AB donor did not help any IRs).
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