RESUMO
This paper relates to our transplant experiences in Third World countries. Over the years, I have started kidney transplant programs in Aden, Yemen and Abuja, Nigeria and restarted the transplant program in Khartoum, Sudan.
Assuntos
Países em Desenvolvimento , Acessibilidade aos Serviços de Saúde , Falência Renal Crônica/cirurgia , Transplante de Rim , Adulto , Análise Custo-Benefício , Países em Desenvolvimento/economia , Feminino , Custos de Cuidados de Saúde , Acessibilidade aos Serviços de Saúde/economia , Disparidades em Assistência à Saúde , Humanos , Falência Renal Crônica/diagnóstico , Transplante de Rim/efeitos adversos , Transplante de Rim/economia , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Nigéria , Sudão , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: There is no national policy for allocation of kidneys from Donation after circulatory death (DCD) donors in the UK. Allocation is geographical and based on individual/regional centre policies. We have evaluated the short term outcomes of paired kidneys from DCD donors subject to this allocation policy. METHODS: Retrospective analysis of paired renal transplants from DCD's from 2002 to 2010 in London. Cold ischemia time (CIT), recipient risk factors, delayed graft function (DGF), 3 and 12 month creatinine) were compared. RESULTS: Complete data was available on 129 paired kidneys.115 pairs were transplanted in the same centre and 14 pairs transplanted in different centres. There was a significant increase in CIT in kidneys transplanted second when both kidneys were accepted by the same centre (15.5 ± 4.1 vs 20.5 ± 5.8 hrs p<0.0001 and at different centres (15.8 ± 5.3 vs. 25.2 ± 5.5 hrs p=0.0008). DGF rates were increased in the second implant following sequential transplantation (p=0.05). CONCLUSIONS: Paired study sequential transplantation of kidneys from DCD donors results in a significant increase in CIT for the second kidney, with an increased risk of DGF. Sequential transplantation from a DCD donor should be avoided either by the availability of resources to undertake simultaneous procedures or the allocation of kidneys to 2 separate centres.
Assuntos
Isquemia Fria/estatística & dados numéricos , Sobrevivência de Enxerto , Alocação de Recursos para a Atenção à Saúde/métodos , Falência Renal Crônica/cirurgia , Transplante de Rim/estatística & dados numéricos , Bancos de Tecidos/estatística & dados numéricos , Doadores de Tecidos/estatística & dados numéricos , Adulto , Feminino , Rejeição de Enxerto , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Humanos , Falência Renal Crônica/epidemiologia , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Obtenção de Tecidos e Órgãos/métodos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Reino Unido/epidemiologia , Adulto JovemRESUMO
A shortage of organ donors and the large number of patients desperately waiting for kidney transplant have led to the search for new sources of transplantable organs. The waiting list has grown at an alarming rate resulting in increased waiting times and deaths. The introduction of non heart beating (NHB) donation programmes generates a lot of ethical issues. How should death of a patient be defined in the case of NHB donation? Is there a strict separation of responsibilities of the medical teams in the different phases of the procedure (patient treatment and actual donation)? How should consent be obtained? Is sufficient respect and care given to the patient and his family? How is the viability of the organs assessed and how should the organs be allocated? We believe that it is very important to debate these issues and to try to outline an ethical framework for NHB donation that can enjoy the widest possible community support.