Search

In this study we systematically reviewed outcomes in recipients and donors of commercial kidney transplants. Inherent in a study of this nature is the possibility of center and country bias, in particular there are no publications from China and South America. Publications also tended to report poor outcomes which may reflect bias on the part of the authors or to highlight the ethical issues in this area. We were unable to perform a meta-analysis due to variability in studies making it impossible to synthesize the data other than descriptive. Furthermore, these studies were not large or well conducted. We found that patient and graft survival was generally inferior to the data obtained from the UNOS (United Network for Organ Sharing). Some studies did achieve good outcomes, however, due to lack of details, it was not possible to infer if the donor hospital, surgical technique or immunosuppressive regimen was a factor. There was a higher incidence of unconventional and life-threatening infections such as malaria, invasive fungal infections, pneumonia, HIV and hepatitis. There was also a markedly increased incidence of postoperative surgical interventions in recipients. We suggest the establishment of a database for both recipients and donors to identify unique surgical, medical, infectious and immunosuppressive protocols for the recipients and donors in these hospitals. This could lead to better liaison between the recipient and donor hospitals so that modern surgical and medical practices can be implemented. There should also be improved emotional and psychological support to both the recipient and the donor. However, these steps could be seen as condoning the reprehensible practice of commercialization of human body parts., (Copyright 2008 S. Karger AG, Basel.)

Psychosocial issues in kidney transplant donors and recipients are a cause for concern. We reviewed studies that investigated psychosocial issues in donors and recipients of living kidney transplants. A variety of instruments were used for this purpose. However, there was a lack of consensus regarding the structure and method of psychosocial assessment in living kidney donors. We found that only a few centers currently carry out a systematic psychosocial follow-up of recipients and their donors. The majority of psychosocial studies were of living kidney donors, indicating a preference of researchers to study psychosocial issues in live kidney donors. We believe living kidney transplant recipients are also an important group, and more studies should be done to better understand the psychosocial issues in this group. The majority of studies were retrospective in nature. We also discuss relationships, interactions, and communication patterns that characterize living kidney donation. We place emphasis on understanding the relational history of donors and recipients to provide supportive intervention and enable the potential donor make an informed decision about surgery. We recommend comprehensive psychosocial screening before and after transplantation and donation. This may decrease psychological problems and increase satisfaction with the transplantation process. Furthermore, the transplant community will need to address the type of instruments, duration of follow-up, and funding sources to carry out our recommendations.

There is a chronic shortage of organs for transplantation in the UK. This problem is particularly acute amongst Asians living within the UK. The Transplant Unit, University of Glasgow, joined forces with local businessmen to initiate a public meeting to promote awareness of transplant issues affecting Asians in the greater Glasgow area. During the Forum, we conducted a survey to determine the level of knowledge about organ transplantation, donation and willingness to donate, in relationship to the age, gender, marital status and religious affiliation amongst the attendees. The Forum was conducted at a public hall after publicity in the local press and Asian shops. The meeting was attended by over 300 people of Asian origin. Of the 90 survey forms handed out, 80 were returned fully completed. There was almost no opposition to organ donation, and many of the respondents were aware that religious leaders in the UK had endorsed organ donation. However, favourable disposition to these issues was not accompanied by carrying of the organ donor card, despite an awareness of the National Donor Register. The majority of the respondents were willing to undergo live organ donation, but were undecided about cadaveric donation. The issue of presumed consent drew mixed responses. Asians in the Glasgow region are not sympathetic to the matter of organ transplantation and donation, despite their recognition of the issues of organ shortage. We suggest that the matter needs to be further integrated into Asian culture by religious leaders and business persons. Our findings indicate that women over the age of 30 and based in the home may be in a unique position of influence by virtue of their position of centrality within the social network. This approach may also be suitable in other areas of the UK and the world with a large number of ethnic minorities.