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Comparison of some socioeconomic characteristics of donors and recipients in a controlled living unrelated donor renal transplantation program
Comparison of Some Socioeconomic Characteristics of Donors and Recipients in a Controlled Living Unrelated Donor Renal Transplantation Program A.J. Ghods, S. Ossareh, and P. Khosravani
B
ECAUSE of a large number of dialysis patients in Iran who needed renal transplantation (Tx) who had no living related donors (LRD) and the absence of cadaveric organ donation program, a controlled living unrelated donor (LUD) renal Tx program was adopted in Iran in 1988. As a result, in last 12 years more than 7,000 renal Tx from LUD and more than 2500 from LRD have been performed. The waiting list for renal Tx in this country has been eliminated. The characteristics, advantages, and disadvantages of this Tx program have previously been published and will briefly be discussed below.1,2 This study compares the socioeconomic characteristics of LUD and their recipients in this program to see which socioeconomic group of the country are being transplanted more from LUD.
DISCUSSION History of Renal Tx in Iran
The first renal Tx in Iran was performed in 1967. The renal Tx program of the country severely lagged in growth in comparison to hemodialysis until 1985.3,4 Between 1967 and 1985 only about 100 renal Tx were performed and more than 400 patients traveled abroad using government funding to receive renal Tx.5 In 1985, the costly end-stage renal disease program prompted health authorities to foster renal Tx. Between 1985 and 1987, about 300 renal Tx from LRD were performed. In 1988 a controlled LUD renal Tx program was adopted. As a result, between 1988 and 2000, more than 7000 renal Tx from LUD and more than 2500 from LRD were performed, and the renal Tx waiting list in the country was eliminated. Characteristics of LUD Tx Program
PATIENTS AND METHODS The study population consisted of 1000 patients (500 LUD, 500 recipients) chosen randomly. Each group of 500 was divided into four sub-groups according to their level of education (ie, illiterate, preliminary school, high school, and university training). All donors and recipients were divided in three sub-groups to describe their economic standing. Those who were able to afford only average housing, food, and college training of their children were included in the intermediate group or middle class. Those who could not afford any of the above were considered to be poor, and all those whose economic condition was better than middle class were included in the group considered wealthy.
RESULTS
The results showed that 451 (90.2%) LUD and 315 (63%) recipients were male. Thirty (6%) LUD were illiterate, whereas 122 (24.4%) had elementary school, 317 (63.4%) high school, and 31(6.2%) university training. These data for 500 Tx recipients were 90(18%), 100(20%), 254(50.8%) and 56 (11.2%), respectively. The study of economic status of LUD showed 420 (84%) to be in poor and 80(16%) to be middle class. None of LUD fulfilled the criteria to be wealthy. From 500 recipients, 252 (50.4%) were poor, 181(36.2%) middle class, and 67 (13.4%) wealthy.
In brief, the reasons for adoption of this program in 1988 was to accomodate the large number of dialysis patients who had no LRD, no legislation for cadaveric Tx (passed later in April 2000), and a strong cultural and religious reluctance to accept cadaveric organ donation. In this program, volunteered LUD introduce themselves to the Dialysis and Transplant Patients Association (DTPA). There is no role for a middle man or agencies. The Tx candidates and their LUD are referred by DTPA to Tx teams. The LUD receives an award from the government, and most of them receive a rewarding gift from their recipients after Tx. All Tx teams belong to university hospitals and all Tx expenses in the hospital are paid, by the government. The Tx team has no incentives from personal gifts or government awards. The program is under close observation of the Iranian Society of Organ Tx for its ethical issues. No foreigners are allowed to undergo renal Tx from LUD. This program has created a significant number of renal From the Transplantation Unit, Hashemi Nejad Hospital, Iran University of Medical Sciences, Tehran, Iran. Address reprint requests to A.J. Ghods, Transplantation Units, Hashemi Nejad Hospital, Iran University of Medical Sciences, Tehran, Iran.
0041-1345/01/$–see front matter PII S0041-1345(01)02118-2
© 2001 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010
2626
Transplantation Proceedings, 33, 2626–2627 (2001)
DONOR AND RECIPIENT SOCIOECONOMICS
2627
Tx cases that have had acceptable outcomes and eliminated the renal Tx waiting list. However, it has had an adverse effect on the number of LRD and probably on cadaveric organ Tx.6
REFERENCES
CONCLUSION
3. Ghods AJ, Abdi E: In Haberal MA (ed) : Chronic Renal Failure and Transplantation. Ankara: Semith Offset; 1987, p 103
According to the results of this study, the majority of LUD are male. The level of education of LUD and their recipients are not significantly different. The majority of LUD (84%) are poor and no single wealthy individual is a LUD. More than 50% of kidneys from LUD are donated to poor patients; this is an advantage for this type of program.
1. Ghods AJ, Fazel I, Nikbin B, et al: In Abouna GM, Kumar MSA, White AG (eds): Organ Transplantation 1990. Kluwar Academic; Netherlands: 1991, p 247 2. Ghods AJ: In Chugh KS (ed): Asian Nephrology. Delhi: Oxford University Press; 1994, p 701
4. Ghods AJ, Taghavi M, Fazel I: In Haberal MA (ed):Recent Advances in Nephrology and Transplantation. Ankara: Pelin Offset, 1990, p 49 5. Ghods AJ: Acta Medica Iranica 32:35, 1994 6. Ghods AJ, Savaj S, Khosravani P : Transplant Proc 32: 541, 2000
B
ECAUSE of a large number of dialysis patients in Iran who needed renal transplantation (Tx) who had no living related donors (LRD) and the absence of cadaveric organ donation program, a controlled living unrelated donor (LUD) renal Tx program was adopted in Iran in 1988. As a result, in last 12 years more than 7,000 renal Tx from LUD and more than 2500 from LRD have been performed. The waiting list for renal Tx in this country has been eliminated. The characteristics, advantages, and disadvantages of this Tx program have previously been published and will briefly be discussed below.1,2 This study compares the socioeconomic characteristics of LUD and their recipients in this program to see which socioeconomic group of the country are being transplanted more from LUD.
DISCUSSION History of Renal Tx in Iran
The first renal Tx in Iran was performed in 1967. The renal Tx program of the country severely lagged in growth in comparison to hemodialysis until 1985.3,4 Between 1967 and 1985 only about 100 renal Tx were performed and more than 400 patients traveled abroad using government funding to receive renal Tx.5 In 1985, the costly end-stage renal disease program prompted health authorities to foster renal Tx. Between 1985 and 1987, about 300 renal Tx from LRD were performed. In 1988 a controlled LUD renal Tx program was adopted. As a result, between 1988 and 2000, more than 7000 renal Tx from LUD and more than 2500 from LRD were performed, and the renal Tx waiting list in the country was eliminated. Characteristics of LUD Tx Program
PATIENTS AND METHODS The study population consisted of 1000 patients (500 LUD, 500 recipients) chosen randomly. Each group of 500 was divided into four sub-groups according to their level of education (ie, illiterate, preliminary school, high school, and university training). All donors and recipients were divided in three sub-groups to describe their economic standing. Those who were able to afford only average housing, food, and college training of their children were included in the intermediate group or middle class. Those who could not afford any of the above were considered to be poor, and all those whose economic condition was better than middle class were included in the group considered wealthy.
RESULTS
The results showed that 451 (90.2%) LUD and 315 (63%) recipients were male. Thirty (6%) LUD were illiterate, whereas 122 (24.4%) had elementary school, 317 (63.4%) high school, and 31(6.2%) university training. These data for 500 Tx recipients were 90(18%), 100(20%), 254(50.8%) and 56 (11.2%), respectively. The study of economic status of LUD showed 420 (84%) to be in poor and 80(16%) to be middle class. None of LUD fulfilled the criteria to be wealthy. From 500 recipients, 252 (50.4%) were poor, 181(36.2%) middle class, and 67 (13.4%) wealthy.
In brief, the reasons for adoption of this program in 1988 was to accomodate the large number of dialysis patients who had no LRD, no legislation for cadaveric Tx (passed later in April 2000), and a strong cultural and religious reluctance to accept cadaveric organ donation. In this program, volunteered LUD introduce themselves to the Dialysis and Transplant Patients Association (DTPA). There is no role for a middle man or agencies. The Tx candidates and their LUD are referred by DTPA to Tx teams. The LUD receives an award from the government, and most of them receive a rewarding gift from their recipients after Tx. All Tx teams belong to university hospitals and all Tx expenses in the hospital are paid, by the government. The Tx team has no incentives from personal gifts or government awards. The program is under close observation of the Iranian Society of Organ Tx for its ethical issues. No foreigners are allowed to undergo renal Tx from LUD. This program has created a significant number of renal From the Transplantation Unit, Hashemi Nejad Hospital, Iran University of Medical Sciences, Tehran, Iran. Address reprint requests to A.J. Ghods, Transplantation Units, Hashemi Nejad Hospital, Iran University of Medical Sciences, Tehran, Iran.
0041-1345/01/$–see front matter PII S0041-1345(01)02118-2
© 2001 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010
2626
Transplantation Proceedings, 33, 2626–2627 (2001)
DONOR AND RECIPIENT SOCIOECONOMICS
2627
Tx cases that have had acceptable outcomes and eliminated the renal Tx waiting list. However, it has had an adverse effect on the number of LRD and probably on cadaveric organ Tx.6
REFERENCES
CONCLUSION
3. Ghods AJ, Abdi E: In Haberal MA (ed) : Chronic Renal Failure and Transplantation. Ankara: Semith Offset; 1987, p 103
According to the results of this study, the majority of LUD are male. The level of education of LUD and their recipients are not significantly different. The majority of LUD (84%) are poor and no single wealthy individual is a LUD. More than 50% of kidneys from LUD are donated to poor patients; this is an advantage for this type of program.
1. Ghods AJ, Fazel I, Nikbin B, et al: In Abouna GM, Kumar MSA, White AG (eds): Organ Transplantation 1990. Kluwar Academic; Netherlands: 1991, p 247 2. Ghods AJ: In Chugh KS (ed): Asian Nephrology. Delhi: Oxford University Press; 1994, p 701
4. Ghods AJ, Taghavi M, Fazel I: In Haberal MA (ed):Recent Advances in Nephrology and Transplantation. Ankara: Pelin Offset, 1990, p 49 5. Ghods AJ: Acta Medica Iranica 32:35, 1994 6. Ghods AJ, Savaj S, Khosravani P : Transplant Proc 32: 541, 2000