Ways to Overcome Organ Shortage: Increasing Donor Pool by Accepting Suboptimal Kidney Donors.

Many factors affect organ donations worldwide, including religious factors, legislative decisions, economic factors, presence of organ procurement organizations, cultural issues, the presence of commercial transplant, and other unknown factors. The number of patients with end-stage renal disease has increased by 6% worldwide. Even with more transplant procedures, these numbers have not combated the dramatically increased number of patients on wait lists. With regard to potential living donors, around 50% are either blood group or HLA incompatible with the recipient, which then requires patient desensitization or paired kidney donation or a combination of both. Survival rates of kidney donors and the general population are almost the same 35 to 40 years after donation. Although the renal consequences of diabetes after kidney donation are almost the same as that shown in the general population, other risk factors should be considered, such as hypertension, proteinuria, and low glomerular filtration rate, before donation. It is so far unknown whether donors with impaired glucose tolerance can safely donate. With diabetes, what was considered normal blood sugar in 1960 to 1990 is now considered frank diabetes. What was considered normal blood pressure is now considered hypertension. Because individuals with these parameters were accepted as organ donors in the past and have been shown to maintain good health, it is worth considering the safe use of organs from donors with early diabetes and hypertension. Whereas young donors may have not reached the age at which hypertension, diabetes, and other kidney diseases develop, older donors have the lowest likelihood of developing end-stage renal disease after donation. As a general approach, young donors can be accepted if they have high glomerular filtration rate, but young donors from certain ethnic minorities and/or extensive family history of chronic kidney disease and those less than 18 years old should not be considered.

Multinational observational study on clinical practices and therapeutic management of mineral and bone disorders in patients with chronic kidney disease stages 4, 5, and 5D: The OCEANOS study.

Our aim is to assess the current clinical practices in monitoring and treatment patterns of chronic kidney disease (CKD)-mineral bone disorder and the degree to which these practices met the kidney disease improving global outcome (KDIGO) guidelines. This was an international, multi-center, cross-sectional, observational study in adult patients diagnosed with CKD Stages 4, 5, and 5D. Patients were enrolled from Middle East, South Asia, Eurasia, and Africa; patients with estimated glomerular filtration rate ≥30 mL/min/1.73 m(2) or with any medical/surgical conditions precluding their participation were excluded. Frequency of measurements, levels of serum calcium (Ca), phosphorus and parathormone (parathyroid hormone [PTH], and presence vascular/valvular calcification were recorded. Of the 2250 patients enrolled, data on 2247 patients were evaluated. Overall, only a small percentage of patients met all three target KDIGO ranges of serum Ca, phosphorus, and PTH (13.7% [95% confidence interval: 12.0; 15.4], with a higher proportion among CKD Stage 5D patients (14.8%) than CKD Stage 4 and 5 (5.6%) patients. Majority (84.3%) of the patients received treatment with phosphorous binders, of whom 85.5% received Ca-based phosphate binders. Overall, 57.0% of patients received Vitamin D treatment with a similar frequency among patients with CKD Stages 4, 5, and 5D. Over half (65.7%) of the patients were screened for vascular/valvular calcification; of these, 58.8% had ≥1 calcification. Diabetes status, P, PTH, and low density lipoprotein-cholesterol had significant impact on the prescription pattern of phosphorous binders. The current practices for the management of bone and mineral metabolism in CKD patients in the study region fall far short of meeting the KDIGO target range.

Comparative psychosocial analysis of patients on maintenance hemodialysis and transplanted patients.

OBJECTIVE: Many previous studies have shown that renal transplantation is associated with superior psychosocial rehabilitation than patients on dialysis. Our objective was to test if the same findings apply in Saudi patients. PATIENTS AND METHODS: Questionnaires probing demographic data, income, mental status, literacy and unemployment rates, family support, home ownership, satisfaction with previous transplantation and views and preferences about different types of transplantation were distributed to transplanted patients (n= 150) and patients on maintenance hemodialysis (HD) (n=210) at the Jeddah Kidney Center, King Fahd Hospital, Jeddah, Saudi Arabia. Illiterate patients were helped in completing the questionnaires by the social worker. RESULTS: We found that the male to female ratio in the transplanted group was 1.7:1 whereas it was 1:1 in the HD group. It was also found that more people in the transplant group owned houses than in the HD group (52% vs. 36.7%). Twice as many transplanted patients earned more than 7000 Saudi Riyals monthly. The unemployment rates were equal in the two groups (25-26%). Interestingly, the rate of illiteracy in the transplant group was almost half the rate in the HD group. More transplanted patients were assessed as being mentally balanced and, rational (92%) as compared to 66.2% in the HD group. Gratifyingly, however, both groups reported solid family support in the majority of patients (>80%). Of particular interest was the finding that well over one third (37%) of the patients on dialysis preferred to have live-unrelated transplants. This is far higher than those wishing for live-related (16.7%) or cadaveric (17.1%). CONCLUSION: Many of our findings coincide with what has been reported earlier. More patients with higher income were transplanted and there was no detected improvement in the employment rate associated with transplantation. Moreover, the vast majority of patients (92.7%) had no objection to receiving a living unrelated kidney and, in fact, as many as 37.6% actually felt preference for a living unrelated kidney over other types of transplantations.

Social and cultural issues in organ transplantation in Islamic countries.

The importance of religion In Islamic countries is undoubted. Fatwas (opinion from religious scholars) have been passed in most Islamic countries approving the concepts of brain death and organ transplantation. There are some specific points that have be considered while talking of organ transplantation in Islamic countries. They include public attitude, taking organ(s) from donors who have committed suicide, the influence of local Imams as well as feeding breast milk, concept of spousal donation, timing of death as well as soul departure and extended families that exist in these countries. Sound knowledge of these factors is mandatory to any transplant coordinator and lack of sensitivity to these issues could be disastrous.