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de Klerk M, Witvliet MD, Haase-Kromwijk BJJM, Weimar W, Claas FHJ. A flexible national living donor kidney exchange program taking advantage of a central histocompatibility laboratory: the Dutch model. CLINICAL TRANSPLANTS 2008:69-73. [PMID: 19711512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The shortage of deceased donor kidneys for transplantation has resulted in the expansion of living donation programs. A number of possibilities have been explored, since it became clear that donors do not need to be genetically related to their recipients. Apart from classical direct donation, other options such as paired exchange, list exchange, altruistic donation and domino paired exchange programs have been implemented. In the Netherlands, patients who cannot be transplanted with their potential living donor because of ABO blood group incompatibility or a positive crossmatch, have the option to participate in a national paired kidney exchange program. The practical issues related to this program are described. The 5-years experience with the Dutch kidney exchange program is very positive as, so far, 42% of the recipients included have been transplanted. Recommendations are given for a successful implementation of a common kidney exchange program of different transplantation centers focusing on the advantage of a central histocompatibility laboratory.
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Pontoriero G, Pozzoni P, Vecchio LD, Locatelli F. International Study of Health Care Organization and Financing for renal replacement therapy in Italy: an evolving reality. ACTA ACUST UNITED AC 2007; 7:201-15. [PMID: 17641969 DOI: 10.1007/s10754-007-9016-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The Italian national health system funds universal health care through general taxation, but health services are provided by local institutions. This study examines the epidemiology, provision, and funding of renal replacement therapy (RRT) in Italy. In 2001, prevalence and incidence of RRT in Italy were 0.083% and 0.014%, respectively. A 1999 donation law markedly increased renal transplantation rates. Italy spends 8.3% of its GDP on health care; 1.8% is for end-stage renal disease (ESRD) patients, who represent 0.083% of the general population. The reorganization of the NHS requires attention from the health community so that economic and geographic health disparities are not exacerbated.
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Abstract
BACKGROUND Consequences of the volume outcome relationship are controversial. Objectification based on data analysis is strongly needed. The aim of this publication was to analyse the effects of volume outcome reallocations based on German inpatient data. METHOD The analysis based on inpatient data of the Krankenhauszweckverband Koeln, Bonn und Region (Hospital Association of the Cologne and Bonn Region) of 2002 and 2005. Relevant data sets were identified according to the effects of current German regulations on volume outcome on the special fields liver transplant, kidney transplant, complex pancreatic surgery, and complex oesophageal surgery. RESULTS The effects of current German regulations on volume outcome results differed greatly between the four surgical specialities. There were fewer effects on kidney transplant, but due to an already very high level of centralisation 34% (oesophagus) and 8% (pancreas) of the hospitals stopped related surgery. This affected 8.9% (oesophagus) and 2.2% (pancreas) of related cases. CONCLUSION Concentration and the formation of specialised medical centres are results of the implementation of volume outcome relationships. The quality of medical treatment does not automatically improve from this development. It is necessary to analyse any correlation between quality and frequency of treatment or other criteria such as know-how, structure and process management, and multidisciplinarity.
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79
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Kirste G. [Kidney transplantation--standard method for terminal kidney failure. More sucess through living donation]. MMW Fortschr Med 2007; 149:22-3. [PMID: 17849781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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80
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Pisarski P. [Living kidney donation--selection criteria for the donor]. MMW Fortschr Med 2007; 149:24-6. [PMID: 17855844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
In Germany, the average waiting time for a kidney is between five and six years. Living kidney donation has a unique status among the various alternatives for shortening the waiting list. The frequency of living kidney donations has increased from 3.9% in 1993 to 19.1% in 2005. The German transplantation law of 1997 permits living kidney donation as a possibility if a suitable organ from a deceased donor is not available at the time of organ removal. Organs from living persons that are suitable for donation include primarily the kidney, but also parts of the liver, the lung and sometimes also the small intestine. The continuously improving immunosuppressive treatment procedures in the meantime have made transplantation to recipients with increased risk also possible.
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81
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Robertson A, Noble H. Renal nursing and the Human Tissue Act 2004. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2007; 16:750-5. [PMID: 17851366 DOI: 10.12968/bjon.2007.16.12.23729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The Human Tissue Act of 2004 was introduced in the UK on 1 September 2006. It replaced all Acts that previously governed the procurement and utilization of tissues, cells and organs. It has promoted changes in requirements predominantly in transplantation settings. Past research has highlighted a shortage of organs for transplantation, particularly in renal donation. The new act hopes to remedy this so that future renal transplantations will occur more frequently, therefore improving choice and quality of life for patients with end stage renal disease. For UK renal nurses, the implementation of the Human Tissue Act 2004 presents challenges requiring adaptations of prior learning with new nursing roles. Recommendations can be made to help during the change process. Kurt Lewin's model of change provides a foundation for the understanding and recognition of change processes that occur in the implementation of individual and organizational change.
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82
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Mansell MA. Still an abhorrent practice? Med Leg J 2007; 75:1-2. [PMID: 17506337 DOI: 10.1258/rsmmlj.75.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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83
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Sarig M. Israeli transplant surgeon is arrested for suspected organ trafficking. BMJ 2007; 334:973. [PMID: 17494004 PMCID: PMC1867886 DOI: 10.1136/bmj.39206.395370.4e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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84
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Goldberg AM, Simmerling M, Frader JE. Why Nondocumented Residents Should Have Access to Kidney Transplantation: Arguments for Lifting the Federal Ban on Reimbursement. Transplantation 2007; 83:17-20. [PMID: 17220784 DOI: 10.1097/01.tp.0000247795.41898.55] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Current U.S. legislation restricts reimbursement for organ transplantation for nondocumented residents, which makes it difficult for many immigrants, including children, to access the transplants they need. In this article, we offer moral, economic, and legal reasons that nondocumented immigrants deserve the same access to kidney transplantation as do legal residents. We argue that the current reasoning for such a ban is based on unjustified fears and unsupported assumptions, which are not a solid basis for determining eligibility for lifesaving therapy for the neediest members of our society.
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85
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Fortin MC, Roigt D, Doucet H. What should we do with patients who buy a kidney overseas? THE JOURNAL OF CLINICAL ETHICS 2007; 18:23-34. [PMID: 17546931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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86
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Taylor JS. Black markets, transplant kidneys and interpersonal coercion. JOURNAL OF MEDICAL ETHICS 2006; 32:698-701. [PMID: 17145908 PMCID: PMC2563357 DOI: 10.1136/jme.2005.015859] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
One of the most common arguments against legalising markets in human kidneys is that this would result in the widespread misuse that is present in the black market becoming more prevalent. In particular, it is argued that if such markets were to be legalised, this would lead to an increase in the number of people being coerced into selling their kidneys. Moreover, such coercion would occur even if markets in kidneys were regulated, for those subject to such coercion would not be able to avail themselves of the legal protections that regulation would afford them. Despite the initial plausibility of this argument, there are three reasons to reject it. Firstly, the advantages of legalising markets in human kidneys would probably outweigh its possible disadvantages. Secondly, if it is believed that no such coercion can ever be tolerated, markets in only those human kidneys that fail to do away with coercion should be condemned. Finally, if coercion is genuinely opposed, then legalising kidney markets should be supported rather than opposed, for more people would be coerced (ie, into not selling) were such markets to be prohibited.
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87
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88
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Abstract
Living kidney donation by minors is an infrequently performed although highly controversial procedure. This manuscript reports the frequency of this practice in North America, Europe, Australia and New Zealand. The relevant laws and professional guidelines are reviewed and the ethical considerations discussed.
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89
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90
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Hoyer PF. Commercial living non-related organ transplantation: a viewpoint from a developed country. Pediatr Nephrol 2006; 21:1364-8. [PMID: 16810510 DOI: 10.1007/s00467-006-0169-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 03/26/2006] [Accepted: 03/29/2006] [Indexed: 11/24/2022]
Abstract
In developed countries, the use of living unrelated donors is restricted to purely altruistic donors who have a close and emotional relationship with the recipients. By law, commercial transplantation is illegal. Increasing shortness of donors, the excellent results of kidney transplants from spousal and living unrelated donors as well as the very low risk for the donor has been used as an argument for paid organ donation. Arguments in favour are the relief of donor-organ shortage, short waiting times for renal transplantation, economic benefits for the donor as well as the economic benefits for society by reducing the costs of dialysis by more transplants. Major arguments against are exploitation of the donor, coercion, and a growing black market. Despite the fact that different societies have different norms or reproaches that we are failing our patients and accept the death of thousands, kidney trade has created an environment of corruption and commercialisation, which brings even the cadaver transplant program into disrepute. However, denying the existence of paid organ donation does not contribute to solve the problem. A public discussion about consequences of changing ethics and human rights, rather than pragmatic solutions, is needed.
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91
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Spinsanti S. [Commentary on 'Ethical issues in living renal transplantation']. GIORNALE ITALIANO DI NEFROLOGIA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI NEFROLOGIA 2006; 23:512-4. [PMID: 17123265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Legalizing kidney market: ethics considerations. The paper by E A Friedman and A L Friedman, advocating suitable kidney sale legislation, recently published in Kidney International, has aroused some controversy among the Italian Society of Nephrology Mailing List members (ML-SIN). A previous article reviewed the main issues and summarized Italian nephrologists' opinions. Generally speaking, ML-SIN participants were critical towards this proposal; the most widespread opinion was that trade of organs for transplant purposes is unethical and that Friedman's legislative suggestion is unlikely to succeed in Italy. To complete discussion, we report also the opinion of an authoritative Ethics expert.
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92
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Rifat UN. Kidney transplantation in Iraq. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2006; 17:399-400. [PMID: 16970263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
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Benko LB. Kaiser going consumer-driven. Largest HMO gearing up for HSAs, expansion. MODERN HEALTHCARE 2006; 36:12-3. [PMID: 16958274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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94
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Diskin CJ, Kaserman DL. The transplant donor payment debate. Kidney Int 2006; 70:604-5; author reply 605-6. [PMID: 16871260 DOI: 10.1038/sj.ki.5001667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kenny C. Nurses cautious about donation rules. NURSING TIMES 2006; 102:9. [PMID: 16711278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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96
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Dreihaupt M, Ott U, Wolf G, Schubert J, Steiner T. Realization of the sixth modification of guidelines for organ placement in renal transplantation-a single-center experience. Transplant Proc 2006; 38:682. [PMID: 16647443 DOI: 10.1016/j.transproceed.2006.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Because of the recommendation of the standing commission on organ transplantation, the Board of Bundesärztekammer agreed to a modification of the guidelines for organ transplantation under section 16 of the transplantation law regarding organs from extended donors who have grave diseases. In our case all patients on our waiting list were contacted to be informed about the guideline changes. Only 6 of 322 patients (1.9%) on our waiting list who were transplantable agreed to allow organ placement from a donor with extended criteria.
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Vathsala A. Commercial renal transplantation-- body parts for sale. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2006; 35:227-8. [PMID: 16710491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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98
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Hippen BE. In defense of a regulated market in kidneys from living vendors. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2006; 30:593-626. [PMID: 16396787 DOI: 10.1080/03605310500421397] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The current system of organ procurement which relies on donation is inadequate to the current and future need for transplantable kidneys. The growing disparity between demand and supply is accompanied by a steep human cost. I argue that a regulated market in organs from living vendors is the only plausible solution, and that objections common to opponents of organ markets are de-feasible. I argue that a morally defensible market in kidneys from living vendors includes four characteristics: (1) the priority of safety for both vendors and recipients, (2) transparency regarding the risks to vendors and recipients, (3) institutional integrity regarding guidelines for cooperating with kidney vendors, and (4) operation under a rule of law. I conclude with some remarks on remaining problems with this account, and offer some suggestions as to how these problems might be addressed.
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Abstract
Continuous growth of the end stage renal disease population treated by dialysis, outpaces deceased donor kidneys available, lengthens the waiting time for a deceased donor transplant. As estimated by the United States Department of Health & Human Services: '17 people die each day waiting for transplants that can't take place because of the shortage of donated organs.' Strategies to expand the donor pool--public relations campaigns and Drivers' license designation--have been mainly unsuccessful. Although illegal in most nations, and viewed as unethical by professional medical organizations, the voluntary sale of purchased donor kidneys now accounts for thousands of black market transplants. The case for legalizing kidney purchase hinges on the key premise that individuals are entitled to control of their body parts even to the point of inducing risk of life. One approach to expanding the pool of kidney donors is to legalize payment of a fair market price of about 40,000 dollars to donors. Establishing a federal agency to manage marketing and purchase of donor kidneys in collaboration with the United Network for Organ Sharing might be financially self-sustaining as reduction in costs of dialysis balances the expense of payment to donors.
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Abstract
Organ transplantation is the preferred mode of replacement therapy. Currently acceptable 5-year posttransplantation survival rates are 85% for renal grafts, 70% for liver, and 65% for heart. Organ donation, however, remains a significant factor in organ transplantation, as humans are the only possible donors and the numbers of patients on waiting lists remain high. Several factors affect organ transplantation in countries in the Middle East Society for Organ Transplantation (MESOT) region, including inadequate preventive medicine, differing health infrastructures, poor awareness within the medical community and lay public regarding the importance of organ donation and transplantation, a high level of ethnicity, and poor government support of organ transplantation. Moreover, there is lack of team spirit among transplant physicians, a lack of coordination between groups that manage organ procurement and the transplant centers, and a lack of effective health insurance coverage for many persons. Three models of organ donation and transplantation exist in the MESOT region-the Saudi, Iranian, and Pakistani models. Living-organ donation, the most widely practiced form of donation in countries in the MESOT region, includes kidney and partial liver. Cadaveric organ donation has significant potential in the MESOT region. However, numerous obstacles must be overcome in MESOT countries. Resolution of these obstacles will require continuous work on many fronts. Experiences from all sources must be incorporated into new and improved models that can overcome current inadequacies. Solutions will require continued focus within the medical community, steady support from the lay public and religious institutions, as well as governmental assistance.
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