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Tuesday, January 10, 2012

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MooseMom

Surely Dr. Mayne has some sort of legal recourse? For a transplant program to accept a living donor with an egfr of 67 surely must be illegal! I'm astonished and very sad for Dr. Mayne. I'd be interested if she shared this information with her recipient.

LivingDonor101

Unfortunately MooseMom, there are no national standards of living donor evaluation, selection or treatment. OPTN attempted to pass such criteria in 2007, but its members (aka the transplant centers) overwhelmingly rejected the effort.


Most transplant centers have adopted an 80 GFR cut-off for prospective LKDs, but even that is dangerously inadequate. A joint societies consensus document from 2011 recommended accepted pre-donation renal function be a function of age, sex, body surface area and GFR because 1. men tend to have higher GFRs than women, 2. larger people need higher GFRs to remain healthy, and GFR naturally declines with age, putting a younger LD at higher risk of the long-term repercussions of decreased renal function.

For example, over 300 prior LKDs have been wait listed in need of their own kidney transplant since 1994*. 63% were 18-34 when they donated; 32% were 35-49.

(I wrote about LKDs on the wait list in much more detail on my blog here: http://bit.ly/xYr2JP


What's infuriating about what Brenda was told - that white women fare well post-donation - is based on ONE, single-center study. Years of data exist on the effects of nephron loss and reduced renal function (thanks, Brenner) yet the transplant industry hangs its hat on one (flawed) study that confirms what they want to believe.

Thanks for the link Peter, and for addressing this issue in your blog.


*We have no info prior to 1994 because no one bothered to collect any identifying info on living donors prior to that - 40 years worth.

MooseMom

LivingDonor101, believe me, we all understand the results of having an entire industry "hanging its hat" on one flawed study. Thrice weekly, standard in-clinic dialysis is such a result.

Actually, in speaking with many people I know who are trying to get on the waitlist for a cadaveric kidney, there doesn't seem to be national standards for that, either. Each tx center makes up their own recipient criteria.

Do you have any idea why tx centers would reject OPTNs suggestions? I'm sure it has to do with money in some way.

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