The declaration of Istanbul on organ trafficking and transplant tourism

Abboud, Omar; Abbud-Filho, Mário; Abdramanov, K; Abdulla, Sukhananazerin; Abraham, Georgi; Abueva, A. I.; Aderibigbe, A; Al-Mousawi, M; Alberú, Josefina; Rdm, Allen; Almazan-Gomez, LC; Alnono, I; Alobaidli, AA; Alrukhaimi, Mona; Alvarez, I.; Assad, Luciana Guimarães; Assounga, AG; Báez, Yadira Cabo; Alireza, Baratloo; Bakr, M. A.; Bamgboye, EA; Barbari, A; Belghiti, Jacques; Ben, Ângela Jornada; Ben, Ams; Bos, Michael; Britz, M; Britz, R; Budiani, Debra; Capron, Alexander Morgan; Castro, CR; Chapman, Jeremy R.; Chen, ZK; Codreanu, Igor; Cole, Edward; Emanuele, C; Danovitch, Gabriel M.; Davids, R.; Broe, M De; Castro, Leonardo D. de; Delmonico, Francis L.; Rania, D; Dittmer, Ian; Domínguez‐Gil, Beatriz; Valter, D-G; Ehtuish, E F; El-Shoubaki, H.; Epstein, Mark P.; Fazel, I; Fernandez, ZE; Rudolf, Gordon; Ghods, A.J; Gill, Jagbir; Glotz, Denis; Gopalakrishnan, Ganesh; Gracida, C; Grinyó, J.M.; Ha, Jinny S.; Haberel, MA; Hakim, Nadey; Harmon, William; Hasegawa, Tomonori; Hassan, A. M. Ei; David, H; Hiesse, C; Yang, Hongji; Humar, Ines; Hurtado, Ángela María Rincón; Ismail, MW; Ivanovski, N; Jha,; Kahn, Delawir; Kamel, Rami A.; Kirpalani, Amrit; Kirste, G; Kobayashi, Eiji; Koller, Ján; Kranenburg, Leonieke W.; Lameire, Norbert; Laouabdia-Sellami, Karim; Lei, Roy; Levin, Adeera; Lloveras, J; Lõhmus, Aleksander; Luciolli, Esmeralda; Lundin, Susanne; Wc, Lye; Lynch, Shaun; Maiga, Mamoudou; Mamzer, Bm-F; Marić, Nikola; Martin, Dominique; Masri, Marwan; Matamoros, MA; Matas, Arthur J.; McNeil, Andrew; Meiser, Bruno; Mesi, E; Moazam, Farhat; Mohsin, Nabil; E, Mor; Morales, J.M.; Munn, Stephen; Murphy, Margaret; Naicker, Saraladevi; Naqvi, S A. A.; Noël, Luc; Obrador, Gregorio T.; Oliveros, Y; Ona, E.T.; Oosterlee, A; Øyen, Ole; Padilla, Benita; Pratschke, Johann; Rahamimov, Ruth; Rahmel, Axel; Резник, О. Н.; Rizvi, S. A. H.; Ann, RL; Rodríguez‐Iturbe, Bernardo; Rowińskí, W; Saeed, Bassam; Sarkissian, Ashot; Mh, Sayegh; Scheper‐Hughes, Nancy; Sever,; Shaheen, F. A. M.; Sharma, Deva; Shinozaki, N; Simforoosh, Nasser; Singh, HariOm; Sok, HT; Somerville, M; Stadtler, Maria; Stephan, A; Suárez, Juan Carlos Mantilla; Suaudeau, MJ; Sumethkul,; Takahara, S; G, Thiel; Tibell, Annika; Tomadze, Gia; Tong, Mk-L; Tsai, Df-C; Uriarte, Ricardo Usategui; Vanrenterghem, Y; Vathsala, A.; Weimar, W.; Wikler, W; Young, Kimberly; Yuldashev, U; Zhao, Michael

doi:10.1038/ki.2008.388

Cited by 45 publications

(12 citation statements)

References 3 publications

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“…This is to ensure that commercialism is prevented and that there is strict adherence to the Declaration of Istanbul. 23, 24 Suitability for donation is determined by the results of HLA typing and crossmatching, and assessment of donor-specific antibody or panel-reactive antibodies as well as serological screening. Tissue typing was outsourced abroad and was initially by ELISA, but has since been replaced by molecular techniques (PCR).…”

Section: Discussionmentioning

confidence: 99%

“…KT is recognized globally as the gold standard treatment modality for ESRD patients because of its overall cost effectiveness, guaranteeing of an almost normal quality of life, as it affects different domains and reduced frequency of hospital visits and hospitalizations. 1, 2, 3, 4, 13 It however has its constraints, which include the huge financial outlay at the outset, shortage of donor organs, challenges of immunosuppression and, very recently, organ trafficking 13, 21, 22, 23, 24, 25, 26, 27, 28 , This current review is aimed at assessing kidney transplant activities in Nigeria from the years 2000–2010 with the objective of highlighting the outcomes and challenges. This is to be able to proffer ethically and culturally acceptable solutions to the identified challenges without compromising standards.…”

Section: Introductionmentioning

confidence: 99%

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Kidney transplantation in a low-resource setting: Nigeria experience

Arogundade

2013

Kidney International Supplements

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The incidence and prevalence of chronic kidney disease and end-stage renal disease (ESRD) have continued to increase exponentially all over the world in both developed and developing countries. While the majority of patients in developed countries benefit from various modalities of renal replacement therapies, those from developing economies suffer untimely deaths from uremia and cardiovascular disease. Kidney transplantation (KT) leads to improvement in both the quantity and quality of life. Unfortunately, it is not exploited to its full potential in most countries and this is particularly the case in developing economies. Only a very small fraction of the ESRD population in emerging countries ever gets transplanted because of the many constraints. This review focuses on KT in Nigeria between 2000 and 2010 and assessed particular challenges that need be addressed for KT potential to be fully harnessed in such resource-constrained settings. A total of 143 KTs were performed in 5 transplant centers, some of which have only recently opened. One-year graft and patient survival was 83.2% and 90.2%, respectively, while the 5-year graft and patient survival was 58.7% and 73.4%, respectively. Mortality was reported in 38 (27%) of recipients. The complications recorded included acute rejection episodes in 15–30%, chronic allograft nephropathy in 21(14.7%) and malignancies, particularly Kaposi Sarcoma, which was reported in 8 (5.6%) recipients. It was concluded that KT has led to an improved survival but is bedevilled with unaffordability, inaccessibility, a shortage of donor organs and poor legislative support. Enactment of relevant organ transplant legislation, subsidization of renal care, and further development of local capacities would improve KT utilization and thus lead to better outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Kidney transplantation in a low-resource setting: Nigeria experience

Arogundade

2013

Kidney International Supplements

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“…For in- and exclusion criteria, refer to Table S1 in Supplementary Material. All procedures were in accordance with the ethical standards of the Declaration of Istanbul (35). In short, both groups received basiliximab induction therapy (Simulect ® , Novartis, Basel, Switzerland), followed by maintenance therapy with MMF and prednisolone, which was tapered to 5 mg by month 3 after transplantation.…”

Section: Methodsmentioning

confidence: 99%

Belatacept Does Not Inhibit Follicular T Cell-Dependent B-Cell Differentiation in Kidney Transplantation

et al. 2017

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Humoral alloreactivity has been recognized as a common cause of kidney transplant dysfunction. B-cell activation, differentiation, and antibody production are dependent on IL-21+CXCR5+follicular T-helper (Tfh) cells. Here, we studied whether belatacept, an inhibitor of the costimulatory CD28-CD80/86-pathway, interrupts the crosstalk between Tfh- and B-cells more efficiently than the calcineurin inhibitor tacrolimus. The suppressive effects of belatacept and tacrolimus on donor antigen-driven Tfh–B-cell interaction were functionally studied in peripheral blood mononuclear cells from 40 kidney transplant patients randomized to a belatacept- or tacrolimus-based immunosuppressive regimen. No significant differences in uncultured cells or donor antigen-stimulated cells were found between belatacept- and tacrolimus-treated patients in the CXCR5+Tfh cell generation and activation (upregulation of PD-1). Belatacept and tacrolimus in vitro minimally inhibited Tfh-cell generation (by ~6–7%) and partially prevented Tfh-cell activation (by ~30–50%). The proportion of IL-21+-activated Tfh-cells was partially decreased by in vitro addition of belatacept or tacrolimus (by ~60%). Baseline expressions and proportions of activated CD86+ B-cells, plasmablasts, and transitional B-cells after donor antigen stimulation did not differ between belatacept- and tacrolimus-treated patients. Donor antigen-driven CD86 upregulation on memory B-cells was not fully prevented by adding belatacept in vitro (~35%), even in supratherapeutic doses. In contrast to tacrolimus, belatacept failed to inhibit donor antigen-driven plasmablast formation (~50% inhibition vs. no inhibition, respectively, p < 0.0001). In summary, donor antigen-driven Tfh-B-cell crosstalk is similar in cells obtained from belatacept- and tacrolimus-treated patients. Belatacept is, however, less potent in vitro than tacrolimus in inhibiting Tfh-cell-dependent plasmablast formation.

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“…Kidney donation is free and voluntary since commercial organ donation is considered unethical and is prohibited in most parts of the world [11]. In Kenya the transplant program is relatively new facing numerous challenges ranging from shortage of transplant surgeons, reliance on living related donors, cultural barriers as regards organ donation and the cost of transplant surgery that is out of reach for most people.…”

Section: Introductionmentioning

confidence: 99%

A retrospective study to assess the evaluation of living related kidney donors and their outcomes following nephrectomy at Kenyatta National Hospital

2017

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BackgroundKidney transplantation is the renal replacement therapy of choice for end stage renal disease. To ensure safety regular audit of the donation process is necessary. The aim of this study was to assess the evaluation of potential living related kidney donors and document their outcomes following nephrectomy.MethodsThis was a retrospective descriptive study involving all living related kidney donors seen at Kenyatta National Hospital (KNH) renal unit from 2010 to 2014.Upon approval by KNH/ERC, the records of all kidney donors were retrieved. Demographic characteristics, number of potential and actual donors, their clinical, laboratory and radiological data as well as documented complications and deaths were recorded. SPSS version 17(Chicago, Ilinois) was used for data entry and analysis. Chi square test and Mann Whitney U test were used as tests of association for categorical and continuous data respectively, with P value set at <0.05.ResultsMedian age of the donors was 34 years (IQR 31–39). First-degree relatives were majority(84.5%). Renal function assessment was done using mean glomerular filtration rate (GFR) from the radionuclide scan (DTPA) and serum creatinine levels. The donors had a mean GFR of 99.2 ± SD 6.6. All the haematological and biochemical tests were within normal. Majority(42.9%) were HLA compatible, but data on HLA typing was missing for 22% of the patients records. On CT angiogram, single renal artery and single renal vein were found in 94 and 88% respectively. Immediate complications included excessive bleeding(2%) and breach of other cavities (4%). Paralytic ileus (32%) and atelectasis (27%) were the most common early postoperative complications. There was no mortality.ConclusionOur study reports no fatality but significant post-operative complications. These are significant findings that may be used to review and improve care and to educate potential kidney donors on the safety of this procedure in our centre, in a bid to widen the pool of potential living kidney donors.

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The declaration of Istanbul on organ trafficking and transplant tourism

Cited by 45 publications

References 3 publications

Kidney transplantation in a low-resource setting: Nigeria experience

Kidney transplantation in a low-resource setting: Nigeria experience

Belatacept Does Not Inhibit Follicular T Cell-Dependent B-Cell Differentiation in Kidney Transplantation

A retrospective study to assess the evaluation of living related kidney donors and their outcomes following nephrectomy at Kenyatta National Hospital

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