EDUCATING, EVALUATING, AND SELECTING LIVING KIDNEY DONORS This page intentionally left blank EDUCATING, EVALUATING, AND SELECTING LIVING KIDNEY DONORS Edited by Robert W. Steiner University of California, UCSD Center for Transplantation, San Diego, U.S.A. KLUWER ACADEMIC PUBLISHERS NEW YORK, BOSTON, DORDRECHT, LONDON, MOSCOW eBook ISBN: 1-4020-2276-X Print ISBN: 1-4020-1271-3 ©2004 Kluwer Academic Publishers New York, Boston, Dordrecht, London, Moscow Print ©2004 Kluwer Academic Publishers Dordrecht All rights reserved No part of this eBook may be reproduced or transmitted in any form or by any means, electronic, mechanical, recording, or otherwise, without written consent from the Publisher Created in the United States of America Visit Kluwer Online at: http://kluweronline.com and Kluwer's eBookstore at: http://ebooks.kluweronline.com Table of Contents Foreword vii Chapter One Ethical Approaches to Living Kidney Donor Education and Acceptance Robert W. Steiner, M.D., William M. Bennett, M.D. and Bernard Gert, Ph.D. 1 Chapter Two Quality of Life and Survival on Dialysis and after Renal Transplantation Paul A. Keown, M.D., DSc., M.B.A. 13 Chapter Three Outcomes for Living Donor and Cadaver Donor Kidney Transplantation Pablo Ruiz-Ramón, M.D. and Lawrence Hunsicker, M.D. 35 Chapter Four The Medical Evaluation and Risk Estimation of End Stage Renal Disease for Living Kidney Donors Robert W. Steiner, M.D. and Gabriel Danovitch, M.D. 51 Chapter Five The Risk of End Stage Renal Disease for Hypertensive Kidney Donors Scott R. Mullaney, M.D. and Michael G. Ziegler, M.D. 81 Chapter Six Risk of Diabetes and Diabetic Nephropathy David M. Ward, M.D. 99 Chapter Seven The Education and Counseling Process for Potential Donors and Donor Attitudes after Living Kidney Donation Robert W. Steiner, M.D. and Christine A. Frederici, L.C.S.W. 129 Chapter Eight Attitudes, Practices, and Ethical Positions among Transplant Centers Concerning Living Kidney Donor Selection Aaron Spital, M.D. 141 Index 157 v This page intentionally left blank Foreword This book is intended to provide information and policy and procedure suggestions for centers that perform living donor kidney transplantation. Its purpose is not to argue either for kidney donation for any candidate or against donation for most candidates, but rather to help make the donation process well considered regard- less of individual decisions. We look forward to an ongoing effort that will improve and expand the offerings in this volume, to promote defensible kidney donor education, evaluation, and selection. The Authors vii This page intentionally left blank Chapter One Ethical Approaches to Living Kidney Donor Education and Acceptance Robert W. Steiner, M.D., William M. Bennett, M.D. and Bernard Gert, Ph.D. Summary Points • The center’s desire to perform transplants creates a conflict of interest that it must explicitly address. • In evaluating a donor, ethical issues should be distinguished from factual ones and approached accordingly. • The medical question is always the degree of risk, not whether donation is (safe) for the donor. • To accept living kidney donors, centers must have good reason to believe that they are: (1) informed, (2) acting freely, and (3) acting rationally. • Willing, informed, and rational donors at increased risk can only be rejected if acceptance would unavoidably erode the standards of the center or engender public suspicion of the selection process. • Centers must distinguish rejecting a donor due to increased medical risk from rejecting a donor who is inadequately informed or for whom the risk is truly unknown. • The donor’s decision must be reasonable (rational) for him, but it does not have to be the decision that the donor counselor or many others would make in the same situation. • Transplant centers are held to a higher standard for determining donor suit- ability, compared to self interested supporters of other activities involving personal risk in our society. 1 R.W. Steiner (ed.), Educating, Evaluating, and Selecting Living Kidney Donors, 1–12.  2004 Kluwer Academic Publishers. Printed in the Netherlands.