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

Hoffman, Arika L.; Tendulkar, Ketki; Merani, Shaheed; Maskin, Alexander; Langnas, Alan Norman

doi:10.1111/ctr.13204

Cited by 7 publications

(8 citation statements)

References 11 publications

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“…Some ineligible donor candidates appreciated the opportunity to identify medical conditions during workup. It is estimated that a new diagnosis of hypertension occurs during evaluation in 25% of ineligible donor candidates and incidental diagnosis of malignancy occurs in less than 1% of ineligible donor candidates . However, other ineligible donor candidates endured prolonged uncertainty and anxiety about their health because they felt they had little opportunity to discuss their results with clinicians.…”

Section: Discussionmentioning

confidence: 99%

“…It is estimated that a new diagnosis of hypertension occurs during evaluation in 25% of ineligible donor candidates 9 and incidental diagnosis of malignancy occurs in less than 1% of ineligible donor candidates. [29][30][31] However, other ineligible donor candidates endured prolonged uncertainty and anxiety about their health because they felt they had little opportunity to discuss their results with clinicians. We recommend ensuring transmission of all new health data to referring clinicians to ensure appropriate follow up, with the establishment of clear pathways for ineligible donor candidates to access follow-up care.…”

Section: Discussionmentioning

confidence: 99%

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The experiences and impact of being deemed ineligible for living kidney donation: Semi‐structured interview study

et al. 2019

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Aim We aimed to describe the impact and experience of being deemed ineligible as a living kidney donor. Methods Semi‐structured interviews were conducted with 27 ineligible donor candidates. Transcripts were analysed thematically. Results Seven themes were identified: deriving health and relationship benefits in the process (strengthening emotional connection, identifying problematic health conditions); devastating loss and disappointment (harbouring guilt over personal failings, shattering confidence and hope, undermining relationships with extended family and friends, disrupting home dynamics); constrained within a rigid system (denied autonomy, resorting to other avenues); acknowledging as matter of fact (accepting the clinical decision, reassured by preventing a poor outcome); reluctant to relinquish the donor identity (unable to fulfil family duty, having the donor role stolen, holding onto other opportunities to donate); uncertainty in unpredictability, inconsistency and ambiguities (frustrated by inefficiencies, questioning clinician motivation, suspended donor status, unfairness in changeable eligibility criteria, unresolved concerns and questions of own health); and abandoned in despair (lacking practical support to meet eligibility criteria, ill prepared for rejection, dismissed and discarded by the system). Conclusion Being deemed unsuitable for donation took an emotional toll on ineligible donor candidates who felt immense guilt for ‘failing’ the potential recipient. Ineligible donor candidates were frustrated and angry with the perceived lack of support from clinicians and rigidity of the evaluation process. Informing potential donors of available services, including psychological support, communicating the decision sensitively and with sufficient time, and full disclosure of their health status, may contribute to improved adjustment following the ineligibility decision.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The experiences and impact of being deemed ineligible for living kidney donation: Semi‐structured interview study

et al. 2019

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“…Además, de la misma manera que se ha reportado en los datos presentados, también hay evidencia previa de que el proceso de evaluación puede diagnosticar afecciones médicas en algunos cDR contando que, de otro modo, tal vez no se hubieran reconocido 44 y que algunas de ellas pueden ser no ser malignas y comunes entre la población 45 . Esto, a pesar de las connotaciones que pueda tener, se llega a entender como un beneficio indirecto para la persona candidata a donante de riñón al ampliar el conocimiento sobre el propio estado de salud y, si es preciso, iniciar las medidas oportunas de manera más temprana 44 .…”

Section: Discussionunclassified

Necesidades asistenciales en el estudio de personas candidatas a donantes de riñón

Robles

Fraile²,

Bach-Pascual

et al. 2022

Enferm Nefrol

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Objetivos: Describir las necesidades asistenciales del candidato a donante de riñón; sus características sociodemográficas y clínicas; y analizar los resultados desde una perspectiva de género.Material y Método: Estudio observacional descriptivo transversal. Se recogieron datos clínicos; sociodemográficos; y el número y tipo de visitas y pruebas realizadas durante el año 2020.Resultados: Se incluyeron 60 candidatos a donantes de riñón (n=37 mujeres; 61,67%) con una media de 51,98±14,50 años y una mediana de 2,5 [RIQ (0,69-5,29)] meses de estudio. 16 (26,67%) fueron aptos para la donación, correspondiendo al 14,16% de la actividad en Trasplante Renal (TR) del centro de referencia. Se requirieron 757 visitas (20,60% de la actividad) de las que 341 (45,05%) fueron visitas con la enfermera. Se requirieron 423 pruebas (19,60% de la actividad) durante el estudio. Se identificó una media de 1,87±1,35 factores de riesgo cardiovascular en la muestra analizada, siendo de 1,56±0,81 en los que finalmente fueron donantes. Más mujeres (n=12; 75%) que hombres (n=4; 25%) fueron finalmente donantes renales.Conclusiones: El estudio del candidato a donante de riñón es complejo e implica el doble de actividad que en el de los candidatos a receptores de trasplante renal. El proceso finaliza en donación en el 27% de los candidatos estudiados. La enfermera concentra el 45% de las visitas que se requieren. Es necesario explorar estrategias para optimizar el proceso de estudio. Hay diferencias de género en cuanto a la predisposición para estudiarse voluntariamente como candidata a donante renal.

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“…This is slightly higher than previously published rates of 42%-54%. 7,10 The evaluation process revealed a medical condition requiring timely medical attention in 33.1% of the refused donor candidates and in 18.6% of all evaluated. The first study to describe unknown medical conditions in donors in 1993 has demonstrated an incidence of 8.4%, which is markedly lower.…”

Section: Discussionmentioning

confidence: 99%

Living kidney donor evaluation is associated with early identification of life‐changing diagnoses in potentially healthy donor candidates

Mühlbacher

Nadalin

Althaus

et al. 2022

Clinical Transplantation

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Background In order to ensure eligibility for living kidney donation, donor candidates undergo a thorough medical evaluation. This process might reveal hitherto undetected medical conditions, leading to refusal of the kidney donor candidate. Detection of such conditions may, however, also have a lifesaving effect. We report on 13 years of data from our living donor transplantation program on kidney donor candidates who were diagnosed with major medical conditions during evaluation. Materials and methods We performed a retrospective analysis of living kidney donor candidates who attended our transplant center between January, 2007 and December, 2019. The main focus was on newly diagnosed medical conditions that required immediate medical attention and their prognostic significance. Results Of the 436 donor candidates who were evaluated for living kidney donation at our transplant center, 192 (44%) were accepted, while 244 (56%) were excluded from donation. Interestingly, 81 (33.1%) of the ineligible donor candidates were newly diagnosed as having a medical condition that required immediate attention. While 45 (18.5%) candidates were newly diagnosed with diabetes or prediabetes, 12 (4.9%) candidates had hitherto undetected malignancies, 10 candidates (4.1%) cardiac disease, five (2.0%) hypertension with end‐organ damage, and four (1.6%) suffered from kidney disease. The remaining four candidates (1.6%) were diagnosed with gastrointestinal diseases, and one candidate (.4%) had an endocrine disorder. Conclusion A comprehensive evaluation process for living kidney donation facilitates the identification of life‐changing diagnoses in a significant proportion of candidates and secures immediate medical attention.

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

Abstract: The evaluation process can diagnose serious medical conditions in a significant minority of donors that would have otherwise been unrecognized. The benefit associated with the donor evaluation should be considered an important part of the consent process.

Cited by 7 publications

References 11 publications

The experiences and impact of being deemed ineligible for living kidney donation: Semi‐structured interview study

The experiences and impact of being deemed ineligible for living kidney donation: Semi‐structured interview study

Necesidades asistenciales en el estudio de personas candidatas a donantes de riñón

Living kidney donor evaluation is associated with early identification of life‐changing diagnoses in potentially healthy donor candidates

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