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MEP group for kidney health dinner seminar:
Chronic kidney disease-
organ donation and transplantation
Daniel Abramowicz, MD, PhD
Free University of Brussels, Belgium
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TP with LD
What are the risks for the donor?
What are the benefits for the recipient?
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HD
Renal transplantation from a living donor: recipient benefits
Pre-emptive TP possible: no need for dialysis, AVF surgery etc.
Elective, planned procedure
Reliefs the stress on the deceased donor recipient waiting list
No tt
GP
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Living donors live longer
Medical evaluation of the donor candidate
1) Assess vital/surgical risk (minimal)
2) Assess renal risk (minimal)
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• 62 servicemen who lost
a kidney due to trauma
during WW II;
• 62 matched subjects
• Mean FU: 45 y
• Creat, Creat Cl, U prot,
BP identical
One normal kidney is sufficient for life
Kidney International, 1993
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Can we accept senior living donors?
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WG on Transplantation guidelines: topic on donor evaluation
Minimal work-up (assays to be done)
Guive guidance/recommendations covering debated isssues
(Old age, hypertension, obesity, proteinuria, renal function, etc)
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Measures to improve living donation rates
1. Information/sensitisation of general population/medical teams /
paramedic (campaigns, seminars, CME, brochures)
2. Logistical help (nurse, transplant coordinator) for the nephrologist
faced with a patient with a failing kidney (kidney function 20% of
normal)
Inform/discuss about dialysis/transplantation/living donation
3. Timely information about living donation of the patient with a
failing kidney (Anglo-saxon type of communication?)
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Measures to improve living donation rates
1. Discussion with health authorities of a full refund of the donor
expenses pre- and post-TP; tackle issues about life insurance
2. Coverage of health problems costs (HTA, renal failure; priority for KT)
3. National protocol for ABO-incompatible transplant (25% of cases)
4. Registries of donor data (free of charge)
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0
5
10
15
20
25
30
35
40
45
All donors DD DBD DCD LD
Kidney donors (pmp) – the Netherlands
1995-1999
2000-2004
2005-2009
p=0.01
p=0.01
p<0.01
Courtesy of Dr. I Jochmans, KUL, Belgium
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Organ donation, what are the gaps? summary
Organ shortage: not a fatality LD in Nederlands (25) + DD in Spain (45) = 70 KT/pmp/y
1. Deceased donation: local coordinators
2. Living donation: 1. Timely information (GP, patients, medical profession at large)
2. Logistical help to nephrologist to prepare the chart
Important docs from the EC (Action plan 2009-2015, Directive 2010/45/Ue about quality and safety of organ transplantation) that provides crucial informations/initiatives to improve organ donation and kidney transplantation.