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What Dominates Living Donor Kidney Transplantation: Altruism or Loss of Dignity?
Correspondence
References
References
1. Chao C-T. Predialysis care: intertwined roles of nephrologists and dietitians. Am J Kidney Dis. 2012;59(2):316. 2. Slinin Y, Guo H, Gilbertson DT, et al. Prehemodialysis care by dietitians and first-year mortality after initiation of hemodialysis. Am J Kidney Dis. 2011;58(4):583-590. 3. Grams ME, Plantinga LC, Hedgeman E, et al; CDC CKD Surveillance Team. Validation of CKD and related conditions in existing data sets: a systematic review. Am J Kidney Dis. 2011;57(1): 44-54. 4. Binik YM, Devins GM, Barré PE, et al. Live and learn: patient education delays the need to initiate renal replacement therapy in end-stage renal disease. J Nerv Ment Dis. 1993;181(6): 371-376. 5. Devins GM, Mendelssohn DC, Barré PE, Taub K, Binik YM. Predialysis psychoeducational intervention extends survival in CKD: a 20-year follow-up. Am J Kidney Dis. 2005;46(6):10881098.
1. Levey AS, Danovitch G, Hou S. Living donor kidney transplantation in the United States—looking back, looking forward. Am J Kidney Dis. 2011;58:343-348. 2. Ghods AJ, Savaj S. Iranian model of paid and regulated living-unrelated kidney donation. Clin J Am Soc Nephrol. 2006;1: 1136-1145. 3. Harmon W, Delmonico F. Payment for kidneys: a governmentregulated system is not ethically achievable. Clin J Am Soc Nephrol. 2006;1:1146-1147. 4. Ghods AJ. Ethical issues and living unrelated donor kidney transplantation. Iran J Kidney Dis. 2009;3:183-191.
Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is a US Government Work. There are no restrictions on its use. doi:10.1053/j.ajkd.2011.12.005
What Dominates Living Donor Kidney Transplantation: Altruism or Loss of Dignity? To the Editor: We were deeply moved by the altruistic kidney donations of Dr Levey and his colleague, as described in the recent perspective by Levey et al.1 The authors encourage transplant professionals and agencies to increase access to the living kidney donation system, with particular emphasis on donor autonomy, medical care, and long-term surveillance after transplant.1 However, we suggest that prior to taking practical measures to expand this system in the United States, transplant professionals and agencies consider and plan for the ethical issues that may accompany kidney donation by unrelated individuals. Since the 1988 implementation of a government-funded, -regulated, and -compensated unrelated living donor kidney transplantation program in Iran, the kidney transplant waiting list has been eliminated in this country.2 Nevertheless, this program has not yet met several ethical standards.3 We recently saw an advertisement, which translated into English read, “A kidney with O blood type for sale”. Although we had already seen such advertisements on the walls of Iranian hospitals, this one reminded us that the open sale of organs is still practiced in Iran.4 This example, along with previous reports, suggests that poor people, whose dignity may be threatened in such transactions, are the main source of kidneys in the Iranian model.3 Although we do not undervalue the venerable role of altruism in living kidney donation, we believe that particular attention should be given to the ethical standards of unrelated living kidney donation programs.
© 2012 by the National Kidney Foundation, Inc. doi:10.1053/j.ajkd.2011.11.032
In Reply to ‘What Dominates Living Donor Kidney Transplantation: Altruism or Loss of Dignity?’ In our recent perspective,1 as in our article 25 years ago,2 we focused on voluntary kidney donation from living kidney donors. Voluntarism is a core principle of the Declaration of Istanbul on Organ Trafficking and Transplant Tourism, as is donor protection and advocacy, promotion of deceased donation, and professional and governmental transparency of practice. As noted by Drs Shoja and Ghabili in their letter,3 the experience in Iran demonstrates the consequences for the living donor when this approach is ignored. We appreciate the concern voiced by our colleagues and recognize that even in a system based on voluntary kidney donation, the need to safeguard the dignity and health of the living donor requires constant vigilance. The US Department of Health and Human Services–mandated donor follow-up that we envisioned in our article would address both the physical and emotional health of donors. Gabriel Danovitch, MD David Geffen School of Medicine at UCLA Los Angeles, California Susan Hou, MD Loyola University Medical Center Maywood, Illinois Andrew S. Levey, MD Tufts Medical Center Boston, Massachusetts
Acknowledgements Financial Disclosure: The authors declare that they have no relevant financial interests.
References
Acknowledgements
1. Levey AS, Danovitch G, Hou S. Living donor transplantation in the United States—looking back, looking forward. Am J Kidney Dis. 2011;58:343-348. 2. Levey AS, Hou SH, Bush HL Jr. Kidney transplantation from unrelated living donors: time to reclaim a discarded opportunity. New Engl J Med. 1986;314:914-916. 3. Ghabili K, Shoja MM. What dominates living donor kidney transplantation: altruism or loss of dignity? Am J Kidney Dis. 2012;59:317.
Financial Disclosure: The authors declare that they have no relevant financial interests.
© 2012 by the National Kidney Foundation, Inc. doi:10.1053/j.ajkd.2011.11.031
Kamyar Ghabili, MD Mohammadali M. Shoja, MD Tabriz University of Medical Sciences Tabriz, Iran
Am J Kidney Dis. 2012;59(2):315-317
317
References
References
1. Chao C-T. Predialysis care: intertwined roles of nephrologists and dietitians. Am J Kidney Dis. 2012;59(2):316. 2. Slinin Y, Guo H, Gilbertson DT, et al. Prehemodialysis care by dietitians and first-year mortality after initiation of hemodialysis. Am J Kidney Dis. 2011;58(4):583-590. 3. Grams ME, Plantinga LC, Hedgeman E, et al; CDC CKD Surveillance Team. Validation of CKD and related conditions in existing data sets: a systematic review. Am J Kidney Dis. 2011;57(1): 44-54. 4. Binik YM, Devins GM, Barré PE, et al. Live and learn: patient education delays the need to initiate renal replacement therapy in end-stage renal disease. J Nerv Ment Dis. 1993;181(6): 371-376. 5. Devins GM, Mendelssohn DC, Barré PE, Taub K, Binik YM. Predialysis psychoeducational intervention extends survival in CKD: a 20-year follow-up. Am J Kidney Dis. 2005;46(6):10881098.
1. Levey AS, Danovitch G, Hou S. Living donor kidney transplantation in the United States—looking back, looking forward. Am J Kidney Dis. 2011;58:343-348. 2. Ghods AJ, Savaj S. Iranian model of paid and regulated living-unrelated kidney donation. Clin J Am Soc Nephrol. 2006;1: 1136-1145. 3. Harmon W, Delmonico F. Payment for kidneys: a governmentregulated system is not ethically achievable. Clin J Am Soc Nephrol. 2006;1:1146-1147. 4. Ghods AJ. Ethical issues and living unrelated donor kidney transplantation. Iran J Kidney Dis. 2009;3:183-191.
Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is a US Government Work. There are no restrictions on its use. doi:10.1053/j.ajkd.2011.12.005
What Dominates Living Donor Kidney Transplantation: Altruism or Loss of Dignity? To the Editor: We were deeply moved by the altruistic kidney donations of Dr Levey and his colleague, as described in the recent perspective by Levey et al.1 The authors encourage transplant professionals and agencies to increase access to the living kidney donation system, with particular emphasis on donor autonomy, medical care, and long-term surveillance after transplant.1 However, we suggest that prior to taking practical measures to expand this system in the United States, transplant professionals and agencies consider and plan for the ethical issues that may accompany kidney donation by unrelated individuals. Since the 1988 implementation of a government-funded, -regulated, and -compensated unrelated living donor kidney transplantation program in Iran, the kidney transplant waiting list has been eliminated in this country.2 Nevertheless, this program has not yet met several ethical standards.3 We recently saw an advertisement, which translated into English read, “A kidney with O blood type for sale”. Although we had already seen such advertisements on the walls of Iranian hospitals, this one reminded us that the open sale of organs is still practiced in Iran.4 This example, along with previous reports, suggests that poor people, whose dignity may be threatened in such transactions, are the main source of kidneys in the Iranian model.3 Although we do not undervalue the venerable role of altruism in living kidney donation, we believe that particular attention should be given to the ethical standards of unrelated living kidney donation programs.
© 2012 by the National Kidney Foundation, Inc. doi:10.1053/j.ajkd.2011.11.032
In Reply to ‘What Dominates Living Donor Kidney Transplantation: Altruism or Loss of Dignity?’ In our recent perspective,1 as in our article 25 years ago,2 we focused on voluntary kidney donation from living kidney donors. Voluntarism is a core principle of the Declaration of Istanbul on Organ Trafficking and Transplant Tourism, as is donor protection and advocacy, promotion of deceased donation, and professional and governmental transparency of practice. As noted by Drs Shoja and Ghabili in their letter,3 the experience in Iran demonstrates the consequences for the living donor when this approach is ignored. We appreciate the concern voiced by our colleagues and recognize that even in a system based on voluntary kidney donation, the need to safeguard the dignity and health of the living donor requires constant vigilance. The US Department of Health and Human Services–mandated donor follow-up that we envisioned in our article would address both the physical and emotional health of donors. Gabriel Danovitch, MD David Geffen School of Medicine at UCLA Los Angeles, California Susan Hou, MD Loyola University Medical Center Maywood, Illinois Andrew S. Levey, MD Tufts Medical Center Boston, Massachusetts
Acknowledgements Financial Disclosure: The authors declare that they have no relevant financial interests.
References
Acknowledgements
1. Levey AS, Danovitch G, Hou S. Living donor transplantation in the United States—looking back, looking forward. Am J Kidney Dis. 2011;58:343-348. 2. Levey AS, Hou SH, Bush HL Jr. Kidney transplantation from unrelated living donors: time to reclaim a discarded opportunity. New Engl J Med. 1986;314:914-916. 3. Ghabili K, Shoja MM. What dominates living donor kidney transplantation: altruism or loss of dignity? Am J Kidney Dis. 2012;59:317.
Financial Disclosure: The authors declare that they have no relevant financial interests.
© 2012 by the National Kidney Foundation, Inc. doi:10.1053/j.ajkd.2011.11.031
Kamyar Ghabili, MD Mohammadali M. Shoja, MD Tabriz University of Medical Sciences Tabriz, Iran
Am J Kidney Dis. 2012;59(2):315-317
317