Organ donation from living donors.

-
The incidence of end-stage organ failure is growing exponentially; fueled by an aging population and the burden of metabolic diseases, the gap between the supply and demand of organs continues to widen. Unfortunately many patients die on the waiting list and many more are taken off the list because of worsening health. Despite extensive campaigns to increase donation from deceased donors, the figure has remained around 6000 donors per year. For organs such as the kidney and liver, living donation is an excellent alternative.


Living donor transplants result in outcomes that are substantially better than for deceased donors. In fact, the half life of a deceased donor kidney transplant is 8-10 years compared to the 16-20 years for a living donor. The patients live longer and have a far better quality of life compared with remaining on dialysis. The median survival on dialysis is 2 years, the 5 year survival is 40% and the 10 year survival is 10%. Kidney transplantation is not only life saving it is also cost saving. Chronic dialysis and kidney transplants are covered by Medicare; if the kidney transplant lasts more than a year, the taxpayers begin to save money.


Living donor liver transplants have been performed for more than two decades. It is the commonest form of liver transplantation in Asia because deceased donor programs do not exist. It has not gained momentum in the west because of well publicized living donor deaths and a robust alternative of deceased donor. Unfortunately, many die on the waiting list as we lack artificial liver replacement therapy.


laparoscopic kidney donation results in an easier recovery for the living donor. 

donation of the right lobe of the liver from a live donor. 
Living donor kidney transplant story

Learn more about living donation and transplantation:
 • United Network for Organ Sharing,  UNOS Patient Services Line: 888.894.6361
 • National Living Donor Assitance Center (NLDAC); 888.870.5002
 • National Kidney Foundation
 • Organ donation
Location: Des Moines, IA, USA

Comments

Post a Comment

Popular posts from this blog

Immunosuppression: why and how?

-
Image
Background: Care is taken to perform compatible transplants by checking antibodies to blood (ABO) and tissue (HLA) antigens.The rejection of transplanted organs is caused by the activation of lymphocytes. HLA class 1 molecules are present on all nucleated cells and help the immune system to distinguish self from non-self.  HLA class 2 molecules are only present on antigen presenting cells (dendritic cells, monocytes, macrophages). The dendritic cells of the donor tissue migrate to the recipients lymphoid tissue and present them to the recipients lymphocytes, activating the overwhelming armamentarium of of the immune system. All blood cells arise from a common stem cell but the lymphocytes follow a different lineage.  Once activated, the T lymphocytes differentiate into cytotoxic T cells, tumor suppressor cells, and T-helper cells;  The B lymphocytes become plasma cells and memory cells.  There are essentially two types of rejection although a mixed patt...
Read more

What is KDPI and does it matter?

-
Image
The kidney donor profile index (KDPI)  is used in the new kidney allocation system to match the longevity of the kidney with that of the recipient to maximize the years of life gained through transplantation. It combines 10 donor factors into a single number that summarizes the potential risk of graft failure after kidney transplant.  It is not intended to serve as the only metric for determining donor suitability. Indeed the C-statistic for this is 0.6 , which is a little better than a coin toss. Many of the factors have no bearing on long-term function.  Pediatric en-bloc kidneys and dual kidneys from older donors will have very high KDPI even though they will work far better than a single adult kidney with KDPI<85. It is an improvement over the old system of standard criteria and extended criteria kidneys, but far from perfect.  Given the poor relationship to outcomes, I do not place much value on this in my practice. In my experience the factors ...
Read more

I have a history of cancer, can I still get a transplant?

-
Image
Patients on dialysis have an increased risk of cancer compared to the general population but there is no evidence to support more intensive screening of potential transplant recipients above that suggested for the general population. Cancer is responsible for 9–12% of deaths in renal transplant recipients. Post-transplant immunosuppression likely inhibits surveillance mechanisms that otherwise counteract the development of malignant cell growth. In fact, the risk of a developing new cancers exceeds the risk of recurrence of the original malignancy after transplantation.  Kidney failure patients that have been successfully treated for their cancer are generally considered to be suitable candidates for  transplantation. Tumor biology varies considerably between cancers and even within the same cancer, therefore a blanket recommendation for malignancy overall would not be valid. The current guidelines are based primarily on registry data from the Isra...
Read more