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• W2043285655 abstract "In 1976, a 21-year-old woman donated her right kidney to her 24-year-old brother, who had advanced renal insufficiency secondary to chronic glomerulonephritis with diffuse glomerulosclerosis on biopsy. Her medical history was unremarkable. At the time of donation she had normal renal function, no proteinuria, and her blood pressure was normal. Her family history is notable for hypertension in her father and his brothers. Her mother has rheumatoid arthritis and her three living brothers are in good health. There is no family history of diabetes. The recipient did well during the immediate postoperative period except for a dental infection, but he died nine months after the transplantation as a result of aspiration pneumonia. The donor remained in good health. In 1981, she had a serum creatinine of 0.9 mg/dL and a creatinine clearance of 66 mL/min/1.73 m2. Two years later, a urinalysis again showed no proteinuria. An extrauterine pregnancy in 1985 was followed by recurrent urinary tract infections over the next year. During a pregnancy in 1986, she developed edema and a rapid 10-pound weight gain at term. She was hypertensive and underwent Caesarean section. The baby weighed 2500 g and was born alive but died of sepsis at the age of 5 days. In 1988, another pregnancy was complicated by premature rupture of the membranes, but she gave birth to a healthy infant. One year later, proteinuria developed. She had an uncomplicated pregnancy in 1990. Five years later, arterial hypertension required treatment with enalapril. Her serum creatinine then was 1.2 mg/dL. The serum creatinine rose to 1.3 mg/dL two years ago and to 1.5 mg/dL last year. Earlier this year, a 24-hour urine collection contained 810 mg protein; the serum creatinine was 1.6 mg/dL and the creatinine clearance was 31 mL/min/1.73 m2. Her urine sediment was benign. A further increase in her blood pressure necessitated treatment with lisinopril, 10 mg each morning, and amlodipine, 5 mg each night. She says that she has no regrets about her decision to donate despite the outcome. Five years ago, her husband's brother developed renal failure; with her encouragement, her husband donated a kidney. Her husband, now age 44, is in good health and has normal blood pressure, normal serum creatinine, and no proteinuria. Dr. Susan Hou (Section of Nephrology, Loyola University Medical Center, and Professor of Medicine, Loyola University Stritch School of Medicine, Maywood, Illinois, USA): When Joseph Murray and his colleagues performed the first successful renal transplant in 1954, they used a kidney from a living identical twin donor1.Merrill J.P. Murray J.E. Harrison J.H. Guild W.R. Successful homotransplantation of the human kidney between identical twins.JAMA. 1956; 160: 277-282Crossref PubMed Scopus (463) Google Scholar. This team demonstrated that transplantation could effectively replace renal function and save lives. As immunosuppressive therapy developed, it became clear that transplantation could be performed on a large scale2.Murray J.E. Merrill J.P. Harrison J.H. Wilson R.E. Dammin G.J. Prolonged survival of human-kidney homografts by immunosuppressive drug therapy.N Engl J Med. 1963; 268: 1315-1323Crossref PubMed Scopus (300) Google Scholar. Living donor renal transplantation has led us to ask to what extent physical injury to a healthy donor can be justified for the benefit of a sick recipient. While most transplant centers accept some living donors, the ethical issues surrounding living donor transplantation are replayed each time a new category of donors begins to be accepted. The need for cadaveric transplantation has led physicians from many countries and from major religious groups to accept brain death as a sole criterion for death. Despite widespread legal and religious acceptance of brain death, many potential donors are not recognized, and many families refuse to donate at the time of a loved one's death. The widening gap between the number of people in need of kidney transplantation and the number of organs available for transplantation is all too familiar. From 1988 to 1997, the number of people waiting for kidneys in the United States almost tripled, while the number of transplants (including kidney-pancreas transplants) increased by only 36% (a 19% increase in cadaver transplants and a 102% increase in living-donor transplants; Figure 1)31998 Annual Report. U.S. Scientific Registry of Transplant Recipients and the Organ Procurement and Transplantation Network. Transplant Data 1988–1997. Richmond, U.S. Department of Health and Human Services, Office of Special Programs, Division of Transplantation, UNOSGoogle Scholar. As of August 1998, 44,735 people were awaiting cadaveric kidney transplants in the United States. Waiting lists are growing in Japan, Taiwan, and all but a few European countries. The magnitude of the need worldwide is difficult to determine because most poor countries have no authoritative lists of dialysis patients waiting for kidneys. It may be less overwhelming to think of the yearly gap rather than the whole waiting list, just as thinking about the yearly budget deficit is easier than thinking about the national debt. Between 1996 and 1997, the waiting list in the United States increased by 3753. During that same year, 2129 people died waiting for kidneys. To keep up with the growing need for kidney transplants, the United States would have required an additional 5882 transplants. The magnitude of the problem, much greater in underdeveloped countries, is dramatically illustrated by the need in India, where 80,000 people reach end-stage renal disease annually. Only 2000 receive transplants; the other 78,000 die4.Thiagarajan C.M. Reddy K.C. Shunmugasundaram D. Jayachandran R. Nayer P. Thomas S. Ramachandran V. The practice of unconventional renal transplantation (UCRT) in a single centre in India.Transplant Proc. 1990; 22: 912-914PubMed Google Scholar. The first successful living related renal transplant was accomplished 45 years ago, but physicians remain ambivalent about using living donors. A dichotomy toward living donors separates the attitudes of the medical community and those of the public. For the transplant surgeon or physician, the overriding principle is to “do no harm.” For the non-medical public, the overriding principle is autonomy. The individuals believe that they have a right to donate a kidney. Multiple surveys confirm the widespread belief among the lay population (and even doctors not involved in transplantation) that the decision to take the risk should rest with the donor5.Najarian J.S. Chavers B.M. McHugh L.E. Matas A.J. 20 Years or more follow-up of living kidney donors.Lancet. 1992; 340: 807-810Abstract PubMed Scopus (525) Google Scholar. As members of a democratic society, we do not question the right of others to participate in any number of dangerous activities. But there is a difference between bungee jumping and kidney donation. To donate a kidney, the donor must enlist a transplant surgeon as an “accomplice.” A doctor's decision to reject a potential transplant donor might be viewed as an example of medical paternalism, but donor nephrectomy is one of the only occasions when a physician risks causing the death of a healthy person. The risk of death in donor nephrectomy is 1 in 32006.Bia M.J. Ramos E.L. Danovitch G.M. Gaston R.S. Harmon W.E. Leichtman A.B. Lundin P.A. Neylan J. Kasiske B.L. Evaluation of living renal donors.Transplantation. 1995; 60: 322-327Crossref PubMed Scopus (209) Google Scholar. The donor takes the 1 in 3200 risk of death once; the transplant surgeon repeatedly risks causing death. Despite the remote risk of a catastrophic outcome, most transplant surgeons and centers accept some living donors. Some centers accept only living related donors; other accept related as well as unrelated donors. These centers come to terms with the possibility of harming living donors by being highly selective in their acceptance of donors. While operationally pragmatic, there is a philosophic fallacy in this approach. The important issues regarding the donor, in addition to medical suitability, are whether the donor understands the risks of nephrectomy and whether the donor freely consents. The risk for the donor is the same regardless of the donor's relationship to the recipient and regardless of the recipient's outcome. The risk for the surgeon, that is, the death of the donor, is no less devastating for the surgeon if the patient is a close relative of the recipient than if the donor is a stranger. We have considerable information about the risks of donor nephrectomy, both immediate and over the long term. But our knowledge remains limited, and the living donor still accepts some uncertainty. The mortality rate from donor nephrectomy performed between 1987 and 1992 was 3 in 9692 (0.03%)6.Bia M.J. Ramos E.L. Danovitch G.M. Gaston R.S. Harmon W.E. Leichtman A.B. Lundin P.A. Neylan J. Kasiske B.L. Evaluation of living renal donors.Transplantation. 1995; 60: 322-327Crossref PubMed Scopus (209) Google Scholar. Thus donor nephrectomy is as dangerous as driving a car for two years or giving birth to two children7.Dinman B.D. The reality and the acceptance of risk.JAMA. 1980; 244: 1226-1228Crossref PubMed Scopus (39) Google Scholar. Previous nephrectomy (or the presence of a congenital solitary kidney) is not a contraindication to pregnancy8.Schaefer G. Markham S. Full-term delivery following nephrectomy.Am J Obstet Gynecol. 1968; 100: 1078-1086Abstract Full Text PDF PubMed Scopus (7) Google Scholar. It is possible that the mortality rate will change, either falling because of better surgical technique or rising because of broader criteria for accepting donors or new surgical techniques such as laparoscopic donor nephrectomy (during the “learning curve”). Because of the low mortality rate, a marked increase in donor deaths would have to occur before a single center would notice a difference, and most centers can expect to perform transplants for many years without losing a donor. It behooves us to keep track of donor complications on a large scale as criteria for donation and surgical techniques change so that we can recognize any adverse consequences of these changes. In the survey I just cited, the frequency of life-threatening or permanently disabling complications was extremely low, only 0.23%6.Bia M.J. Ramos E.L. Danovitch G.M. Gaston R.S. Harmon W.E. Leichtman A.B. Lundin P.A. Neylan J. Kasiske B.L. Evaluation of living renal donors.Transplantation. 1995; 60: 322-327Crossref PubMed Scopus (209) Google Scholar. Complications of donor nephrectomy include pulmonary embolism, pneumothorax, and myocardial infarction. Less serious complications were 8% in one series of 871 donors: wound infection (2.4%), unexplained fever (0.9%), pneumonia (0.9%), wound hematoma (0.6%), and urinary tract infection (0.3%)9.Johnson E.M. Remucal M.J. Gillingham K.J. Dahms R.A. Najarian J.S. Matas A.J. Complications and risks of living donor nephrectomy.Transplantation. 1997; 64: 1124-1128Crossref PubMed Scopus (217) Google Scholar. The immediate operative risks to the donor can be stated with some certainty, but the long-term effects are not completely understood. Follow-up of donors is reassuring but incomplete. The numbers are smaller than the tens of thousands that form the basis of our calculation of immediate surgical risk associated with donor nephrectomy. Follow-up of renal donors generally provides 20-year data and, at most, 30-year data. Since donors are accepted from 18 years of age on, ongoing studies of donors will be necessary until 50- and 60-year follow-up data become available. For predictions about 50-year outcome of nephrectomy, we have to extrapolate from a single small study of patients undergoing uninephrectomy for trauma10.Narkun-Burgess D.M. Nolan C.R. Norman J.E. Page W.F. Miller P.L. Meyer T.W. Forty-five year follow-up of uninephrectomy.Kidney Int. 1993; 43: 1110-1115Abstract Full Text PDF PubMed Scopus (167) Google Scholar. Most follow-up studies of living kidney donors find no decrease in long-term survival. A follow-up of 430 Swedish donors between 1964 and 1994 found an 85% survival 15 months to 31 years after donation compared to a predicted 66% in the general population of similar age11.Fehrmasn-Ekholm I. Elinder C.-G. Stenbeck M. Tydén G. Groth C.-G. Kidney donors live longer.Transplantation. 1997; 64: 976-978Crossref PubMed Scopus (302) Google Scholar. The survival advantage was attributed to the selection bias of only healthy individuals as renal donors. Two concerns have emerged regarding the possibility that donors will develop end-stage renal disease (ESRD). One is that hyperfiltration in the remaining kidney will lead to focal segmental glomerulosclerosis and renal failure, that is, donation per se will cause renal failure. The second concern is that donors who develop primary renal disease will progress to renal failure more quickly because they have lower-than-normal renal mass at the onset of the primary renal disease. The latter concern applies particularly to patients with a family history that puts them at risk for renal disease, for example, family members of patients with type II diabetes. These concerns are illustrated by the current case: the donor has lost one-half of her renal function over 23 years without any clear explanation for her renal insufficiency. A report by Bia and colleagues of 9692 living donors identified 11 (0.1%) who at follow-up had ESRD and 4 (0.04%) with renal insufficiency6.Bia M.J. Ramos E.L. Danovitch G.M. Gaston R.S. Harmon W.E. Leichtman A.B. Lundin P.A. Neylan J. Kasiske B.L. Evaluation of living renal donors.Transplantation. 1995; 60: 322-327Crossref PubMed Scopus (209) Google Scholar. Two donors were from families with a strong family history of renal disease. The other 9 had nothing to distinguish them from other donors. The renal disease was different from the recipient's disease in 5 and was unrelated to hyperfiltration per se. In addition to these 11, the literature contains at least 6 case reports of renal failure after donation12.Said R. Soyannwo M. Renal failure in a living-related kidney donor: Case report and review of the literature.Am J Nephrol. 1996; 16: 334-338Crossref PubMed Scopus (6) Google Scholar. Focal sclerosis developed between 5 and 13 years after transplantation, although in one report, cocaine and heroin abuse as well as uninephrectomy might have played a role12.Said R. Soyannwo M. Renal failure in a living-related kidney donor: Case report and review of the literature.Am J Nephrol. 1996; 16: 334-338Crossref PubMed Scopus (6) Google Scholar. If we accept the mortality rate of 0.03%, we would be inconsistent not to accept the frequency of ESRD of 0.1%. The longest follow-up of people after uninephrectomy is a 45-year follow-up of 62 World War II veterans who had undergone nephrectomy following trauma at ages 19 to 3710.Narkun-Burgess D.M. Nolan C.R. Norman J.E. Page W.F. Miller P.L. Meyer T.W. Forty-five year follow-up of uninephrectomy.Kidney Int. 1993; 43: 1110-1115Abstract Full Text PDF PubMed Scopus (167) Google Scholar. The survival rate was similar to that of other World War II veterans. Serum creatinine, proteinuria, and the frequency of hypertension among the survivors whose renal function was studied was similar to that of aged-matched controls. Mild renal insufficiency was found in 5 men, 4 of whom had diabetes. Evidence of primary renal disease was found in 6 of 28 kidneys of deceased men. Renal failure was listed as a cause of death in one patient with type II diabetes. Many follow-up studies of renal donors have noted an increase in hypertension and proteinuria, as well as a statistically but not clinically significant increase in serum creatinine. A compilation of data from 4 studies including 212 patients more than 10 years after donor nephrectomy found hypertension in 25% (15% to 48%)13.Bay W.H. Hebert L.A. The living donor in kidney transplantation.Ann Intern Med. 1987; 106: 719-727Crossref PubMed Scopus (156) Google Scholar. It is not clear whether hypertension is more common in this group than in the general population. One report of 57 donors more than 20 years after nephrectomy found 32% taking antihypertensive medications and 23% having proteinuria, compared to 44% and 22%, respectively, for 65 sibling controls5.Najarian J.S. Chavers B.M. McHugh L.E. Matas A.J. 20 Years or more follow-up of living kidney donors.Lancet. 1992; 340: 807-810Abstract PubMed Scopus (525) Google Scholar. Although the donor can have nearly normal renal function, the GFR is maintained by hyperfiltration. Renal donors have a significantly lower increase in creatinine clearance in response to a protein load than do normal subjects14.Rodriguez-Iturbe B. Herrera J. Garcia R. Response to acute protein load in kidney donors and apparently normal post acute glomerulonephritis patients: Evidence for glomerular hyperfiltration.Lancet. 1985; 2: 461-464Abstract PubMed Scopus (93) Google Scholar. The ultimate clinical consequence of this observation is not known. Many follow-up studies conclude that the majority of donors derive a tremendous degree of satisfaction and an increase in self-esteem from their donation. Most donors interviewed viewed their donation as an act of heroism and generosity with which nothing else in their lives compared15.Fellner C.H. Marshall J.R. Kidney donors—the myth of informed consent.Am Psychiatr. 1970; 126: 1245-1251Crossref PubMed Scopus (92) Google Scholar. More than 90% said that they would donate if they had it to do over again9.Johnson E.M. Remucal M.J. Gillingham K.J. Dahms R.A. Najarian J.S. Matas A.J. Complications and risks of living donor nephrectomy.Transplantation. 1997; 64: 1124-1128Crossref PubMed Scopus (217) Google Scholar,16.Eisendrath R.M. Guttmann R.D. Murray J.E. Psychological considerations in the selection of kidney transplant donors.Surg Gynecol Obstet. 1969; 129: 243-248PubMed Google Scholar and fewer than 10% expressed any regret about donating17.Johnson E.M. Anderson J.K. Jacobs C. Suh G. Humar A. Suhr B.D. Kerr S.R. Matas A.J. Long-term follow-up of living kidney donors: Quality of life after donation.Transplantation. 1999; 67: 717-721Crossref PubMed Scopus (258) Google Scholar. These findings apply to only a slightly smaller majority of donors when the kidney is rejected or even when the recipient dies. Kidney donation is not without a financial burden, however. Although the medical expenses associated with renal donation are covered by the recipient's insurance, 23.2% of donors in one series of 536 reported financial hardship and 8% had more than $1000 in unreimbursed expenses18.Smith M.D. Kappell D.F. Province M.A. Hong B.A. Robson A.M. Dutton S. Guzman T. Hoff J. Shelton L. Cameron E. Emerson W. Glass N.R. Hopkins J. Peterson C. Living-related kidney donors: A multicentered study of donor education, socioeconomic adjustment and rehabilitation.Am J Kidney Dis. 1986; 8: 223-233Abstract Full Text PDF PubMed Scopus (95) Google Scholar. Renal donors are not at a disadvantage when trying to obtain life insurance or health insurance. Through the efforts of transplant surgeons and physicians, most insurance companies accept renal donors as having the same risk as the general population19.Spital A.T. Health insurance for kidney donors: How easy is it to obtain?.Transplantation. 1996; 62: 1356-1358Crossref PubMed Scopus (29) Google Scholar. Even if one argues that because of hypertension, the donor's life is shorter than it might have been, survival is still as good or better than that of the general population. Insurance companies recognize that most renal donors have been more carefully screened for diseases that affect health and longevity than clients receiving a routine insurance physical. Early in the history of renal transplantation, living donors could be either related or unrelated. Through 1966, living unrelated donors accounted for 10% of all kidneys donated20.Advisory Committee to the Renal Transplant Registry The Ninth Report of the Human Renal Transplant Registry.JAMA. 1972; 220: 253-260Crossref PubMed Scopus (45) Google Scholar. Two factors resulted in the abandonment of living unrelated donors: the results of living unrelated donor transplantation were similar to the results of cadaveric transplantation, and with Medicare funding of dialysis, the patient could afford to wait for a kidney. Congressional legislation in 1972 mandating payment for renal replacement therapy through Medicare meant that dialysis, not death, was the alternative to renal transplantation. But living unrelated donor transplants now yield better results than cadaveric transplants, while patients in much of the world have no means of paying for dialysis. The growth of transplant waiting lists makes it certain that some patients will never receive a transplant. In 1997, 2129 patients in the United States died while waiting for a kidney31998 Annual Report. U.S. Scientific Registry of Transplant Recipients and the Organ Procurement and Transplantation Network. Transplant Data 1988–1997. Richmond, U.S. Department of Health and Human Services, Office of Special Programs, Division of Transplantation, UNOSGoogle Scholar. As the outcome of cadaveric transplant improved in the 1970s and 1980s, transplant surgeons and nephrologists had two notable responses. Some believed that this improvement meant that living donors need never be used; others believed that it was no longer necessary to limit living donors to genetically close relatives. Supporters of the former response have repeatedly argued that enough potential cadaver kidneys are available to meet patients' needs, but that we have an ineffective method of procuring the organs. Supporters of the latter argument seem to have won in that living donors accounted for 57% of the increase in kidneys transplanted between 1988 and 1997, a substantial fraction of which came from non-genetically-related donors, for example, spouses31998 Annual Report. U.S. Scientific Registry of Transplant Recipients and the Organ Procurement and Transplantation Network. Transplant Data 1988–1997. Richmond, U.S. Department of Health and Human Services, Office of Special Programs, Division of Transplantation, UNOSGoogle Scholar. Unrelated donors, particularly spouses, began to be used again in the late 1980s and in the early 1990s. In 1987, spouses accounted for 2% of the living donors (40 spouses); by 1997, they accounted for almost 10% (318 spouses; Figure 2). Experience has shown that the success rate for living unrelated donor kidneys is significantly better than that for cadaveric kidneys, despite the simultaneous improved outcome for the recipients of cadaveric kidneys now receiving cyclosporine. Data from the United Network for Organ Sharing (UNOS) registry published in 1995 showed an 85% 3-year survival rate for kidneys from 368 spousal donors, 82% for kidneys from 3368 parental donors, and 70% for 43,341 cadaveric kidneys21.Lowell J.A. Brennan D.C. Shenoy S. Hagerty D. Miller S. Ceriotti C. Cole B. Howard T.K. Living-unrelated renal transplantation provides comparable results to living-related renal transplantation: A 12-year single center experience.Surgery. 1996; 11: 538-543Abstract Full Text PDF Scopus (58) Google Scholar. Similar good results were seen in the 844 spousal donor transplants between 1994 and 1997 (92% 1-year and 87% 3-year graft survival)31998 Annual Report. U.S. Scientific Registry of Transplant Recipients and the Organ Procurement and Transplantation Network. Transplant Data 1988–1997. Richmond, U.S. Department of Health and Human Services, Office of Special Programs, Division of Transplantation, UNOSGoogle Scholar. Some physicians have argued that this short-term advantage (at three years) for living unrelated donor renal transplants will disappear over the long run as the effects of poor tissue matching contribute to chronic rejection. Although three-year follow-up for the UNOS data represent only short-term success, at least four centers have used unrelated donors since 1983 and 1984. These centers (University of Wisconsin; Washington University Medical Center; National Hospital, University of Oslo; and II Clinical Chirurgica, Università di Roma) have performed a total of 425 living unrelated donor transplants21.Lowell J.A. Brennan D.C. Shenoy S. Hagerty D. Miller S. Ceriotti C. Cole B. Howard T.K. Living-unrelated renal transplantation provides comparable results to living-related renal transplantation: A 12-year single center experience.Surgery. 1996; 11: 538-543Abstract Full Text PDF Scopus (58) Google Scholar, 22.Foss A. Leivestad T. Brekke I.B. Fauchald P. Bentdal O. Lien B. Pfeffer P. Sødal G. Albrechtsen D. Søreide O. Flatmark A. Unrelated living donors in 141 kidney transplantations.Transplantation. 1998; 66: 49-52Crossref PubMed Scopus (54) Google Scholar, 23.Alfani D. Pretagostini R. Rossi M. Poli P. De Simone P. Colonnello M. Novelli G. Urbano D. Venettoni S. Persijn G. Smits J. Coresini R. Analysis of 160 consecutive unrelated kidney transplants: 1983–1997.Transplant Proc. 1997; 29: 3399-3401Abstract Full Text PDF PubMed Scopus (14) Google Scholar, 24.D'alessandro A.M. Sollinger H.W. Knechtle S.J. Kalayoglu M. Kisken W.A. Uehling D.T. Moon T.D. Messing E.M. Bruskewitz R.C. Pirsch J.D. Belzer F.O. Living related and unrelated donors for kidney transplantation.Ann Surg. 1995; 22: 353-364Crossref Scopus (94) Google Scholar. The advantage over cadaveric transplants persisted at 5- and 12-year follow-up. The results are not surprising, as the number of mismatches in cadaveric (3.6) and living unrelated donor kidneys (4.1) in the UNOS data was not dramatically different, and the number of well-matched cadavers was relatively small25.Terasaki P.I. Cecka J.M. Gjertson D.W. Takemoto S. High survival rates of kidney transplants from spousal and living unrelated donors.N Engl J Med. 1995; 333: 333-336Crossref PubMed Scopus (1013) Google Scholar. With these encouraging outcomes, 90% of transplant centers reported in 1994 that they accepted “emotionally related” donors, primarily spouses26.Spital A. Do US transplant centers encourage emotionally related kidney donation?.Transplantation. 1996; 61: 374-377Crossref PubMed Scopus (36) Google Scholar. It is not clear to what extent spousal donors can help close the gap between the number of available donors and the number of needed kidneys. It is worth noting that Norway, where 40% of transplants use living donors, is one of the few countries in Europe with a stable transplant list23.Alfani D. Pretagostini R. Rossi M. Poli P. De Simone P. Colonnello M. Novelli G. Urbano D. Venettoni S. Persijn G. Smits J. Coresini R. Analysis of 160 consecutive unrelated kidney transplants: 1983–1997.Transplant Proc. 1997; 29: 3399-3401Abstract Full Text PDF PubMed Scopus (14) Google Scholar. Friends as donors usually have been accepted with more reluctance than spouses. But the reluctance of physicians to accept or even encourage friends as donors does not take into account that friends would be less likely to feel pressured to donate than would a family member. A greater acceptance of friends as donors is reflected in an increase in unrelated donors from 31 in 1988 to 184 in 1997 Figure 2. Unrelated donors other than spouses now account for almost 6% of all living donors. In the United States, transplant centers accepted 816 kidneys from donors other than spouses over the 10-year period. In his fourth survey on the subject, Aaron Spital noted that among the 154 transplant centers responding to a 1994 survey (74% of total), only 21% preferred friends to cadaveric donors26.Spital A. Do US transplant centers encourage emotionally related kidney donation?.Transplantation. 1996; 61: 374-377Crossref PubMed Scopus (36) Google Scholar. Transplant centers regard the altruistic donor with suspicion. A 1968 survey of 54 transplant centers reported that 50% disapproved of the use of living unrelated donors and only 20% had used them28.Fellner C.H. Schwartz S.H. Altruism in disrepute.N Engl J Med. 1971; 284: 582-585Crossref PubMed Scopus (69) Google Scholar. The transplant centers believed that there was a high likelihood that an altruistic donor suffered from a psychiatric disorder that might be exacerbated by organ donation. In contrast, in a survey of public attitudes toward donation, 54% of respondents said that they would probably or definitely donate to a stranger29.Spital A. Spital M. Living kidney donation: Attitudes outside the transplant center.Arch Intern Med. 1988; 148: 1077-1080Crossref PubMed Scopus (45) Google Scholar. Eighty-two percent of physicians not involved in transplantation and 94% of the non-medical public supported allowing donations to strangers29.Spital A. Spital M. Living kidney donation: Attitudes outside the transplant center.Arch Intern Med. 1988; 148: 1077-1080Crossref PubMed Scopus (45) Google Scholar. As recently as 1994, only 15% of 126 transplant centers responding to a survey said that they would accept strangers as donors, and none had used a stranger as a donor in the year preceding the survey27.Spital A. Unrelated living kidney donors: An update of attitudes and use among US transplant centers.Transplantation. 1994; 57: 1722-1726Crossref PubMed Scopus (67) Google Scholar. The concern about psychopathology played a role in the reluctance to use altruistic donors. But the fear that altruistic donors harbor psychopathology has not been substantiated. A follow-up of 18 unrelated donors, including 9 strangers, found no psychological complications or regrets after donation30.Sadler H.H. Davison L. Carroll C. Kountz S.L. The living genetically unrelated, kidney donor.Semin Pyschiatr. 1971; 3: 86-101PubMed Google Scholar. The same report described 22 potential donors answering an appeal for donors who" @default.
• W2043285655 created "2016-06-24" @default.
• W2043285655 creator A5080178594 @default.
• W2043285655 date "2000-10-01" @default.
• W2043285655 modified "2023-09-29" @default.
• W2043285655 title "Expanding the kidney donor pool: Ethical and medical considerations" @default.
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