Fasting before living-kidney donation: effect on donor well-being and postoperative recovery: study protocol of a multicenter randomized controlled trial

Background One of the main effectors on the quality of life of living-kidney donors is postoperative fatigue. Caloric restriction (CR) and short-term fasting (STF) are associated with improved fitness and increased resistance to acute stress. CR/STF increases the expression of cytoprotective genes, increases immunomodulation via increased anti-inflammatory cytokine production, and decreases the expression of pro-inflammatory markers. As such, nutritional preconditioning by CR or STF represents a non-invasive and cost-effective method that could mitigate the effects of acute surgery-induced stress and postoperative fatigue. To investigate whether preoperative STF contributes to a reduction in fatigue after living-kidney donation, a randomized clinical trial is indicated. Methods We aim to determine whether 2.5 days of fasting reduces postoperative fatigue score in subjects undergoing living-kidney donation. In this randomized study, the intervention group will follow a preoperative fasting regime for 2.5 days with a low-dose laxative, while the control group will receive standard care. The main study endpoint is postoperative fatigue, 4 weeks after living-kidney donation. Secondary endpoints include the effect of preoperative fasting on postoperative hospital admission time, the feasibility of STF, and the postoperative recovery of donor and recipient kidney function. This study will provide us with knowledge of the feasibility of STF and confirm its effect on postoperative recovery. Discussion Our study will provide clinically relevant information on the merits of caloric restriction for living-kidney donors and recipients. We expect to reduce the postoperative fatigue in living-kidney donors and improve the postoperative recovery of living-kidney recipients. It will provide evidence on the clinical merits and potential caveats of preoperative dietary interventions. Trial registration Netherlands Trial Register NL9262. EudraCT 2020-005445-16. MEC Erasmus MC MEC-2020-0778. CCMO NL74623.078.21

Living kidney donation and reasons for denial: A report from a Brazilian single-center cross-sectional study

Chronic kidney disease is increasingly more prevalent worldwide, and kidney transplant remains the best option for patient survival. Living kidney transplants (LKT) pose advantages over deceased donor transplants, such as longer graft survival, lower ischemia time, and better HLA match. However, LKT is not always attainable for multiples reasons, with the absence of a suitable living donor being a significant barrier. Therefore, meticulous donor screening must be performed in order to guarantee donation safety. We examined medical appointments of living kidney donors evaluated at Hospital do Rim, São Paulo, between January and December 2020. Reasons for not proceeding with the donation were evaluated and were categorized as medical, surgical, immunological, psychosocial, or other. A total of 506 donor -receptor pairs were enrolled for evaluation during the study period. More than half of screened donor -receptor pairs (N=296, 58.5%) were not considered feasible for LKT. The primary cause for refusal was medical contraindication (32.1%), followed by immune (21.3%) and social (19.3%) causes. In addition, a considerable proportion of patients voluntarily withdrew themselves at variable time points during the evaluation process (N=79). In our center, most patients did not meet the criteria for kidney donation owing to medical reasons, similarly to other centers, and this reflects the importance of meticulous donor screening. In addition, the current Covid -19 pandemic affected the living transplant program, contributing to delayed complete donor and receptor evaluation.

Perception Regarding Live Kidney Donation in the General Population of South Korea

This study aimed to know how the general population recognizes live kidney donation in Korea. Participants were randomly selected from the general population after proportional allocation by region, sex, and age. Selected participants received a questionnaire that included demographic information, socioeconomic and marital statuses, prior recognition of live donor KT, expected changes after donation, and the need for support after donor nephrectomy. Among the 1,000 participants from the web-based survey, 83.8% answered they fully understood living donor KT, 81.1% knew about them, and 51.1% were willing to donate. Various complications after nephrectomy and deterioration in health after donation were the most significant reasons for those reluctant to donate. Most agreed that the government should provide social and economic support to living kidney donors, especially after exposure to the description of donor nephrectomy. Financial support, including surgery and regular medical check-up costs, was the most preferred government support. The Korean general population seemed aware of the value and safety of kidney donation, although only half of them were willing to donate due to concerns about possible complications. Most participants agreed on social and economic support for living kidney donors, especially surgery-related costs.

Kidney Paired Exchanges and Variants

Given the growing gap between the demand and supply of kidneys needed for transplantation, and the better outcomes of living versus deceased donor kidney transplants, living kidney donation is being more aggressively endorsed and promoted. Traditionally, living kidney donors were ABO- and HLA-compatible with their recipients, with whom they were genetically and/or emotionally related. When a living donor-recipient pair is not compatible, there is growing acceptance of employing alternative living donor transplantation strategies such as paired kidney exchanges and domino chains. This chapter addresses the ethical and policy issues that are raised by participation in kidney paired exchanges and domino kidney chains. Specific attention is given to the participation of histocompatible donor-recipient pairs in these programs when the donor could just donate directly. Justice and other ethical issues raised by advance donor programs and list-paired exchanges are also discussed.

Perception Regarding Live Kidney Donation in the General Population of South Korea

Background: It is necessary to know how the general population recognizes live kidney donation in Korea, where living donor kidney transplantations (KT) are the mainstream.Methods: Participants were randomly selected from the general population after proportional allocation by region, sex, and age. Selected participants received a questionnaire that included demographic information, socioeconomic and marital statuses, prior recognition of live donor KT, expected changes after donation, and the need for support after donor nephrectomy.Results: In total, 1,000 participants responded to the web-based survey. After reading the detailed explanation, 83.8% of the respondents answered that they fully understood living donor KT. Among the participants, 811(81.1%) answered that they knew about living donor KT, and 51.1% were willing to donate. Various complications after nephrectomy (54.4%) and deterioration in health after donation (69.1%) were the most important reasons for those who were reluctant to donate, and the possibility of a decrease in economic activities after donation accounted for 33.8%. Overall, 73.2% were more likely to agree that the government should provide social and economic support to living kidney donors; this number increased to 81.3% after exposure to the description of donor nephrectomy (P<0.001). Financial support, including surgery (74.2%) and regular medical check-up costs (70.1%), was the most preferred government support.Conclusions: The Korean general population seemed to be aware of the value and safety of kidney donation, although only half of them were willing to donate due to concerns about possible complications. Most participants agreed on social and economic support for living kidney donors, especially for surgery-related costs.

'It's hard to ask': Examining the factors influencing decision-making amongst end-stage renal disease patients considering asking friends and family for a kidney

<p>Background: Organ donation is an important facet of healthcare delivery in New Zealand, with donation often leading to an increased quality of life for recipients, and a reduction in healthcare costs for the community. People who require new organs have limited options in regards to organ access: they can receive organs from deceased donors, or if a kidney is not volunteered, they might ask someone to donate. For those that choose to ask someone to donate an organ, one barrier that is sometimes voiced is that it is hard to ask family and friends to donate. This project sought to explore the issues surrounding asking for an organ by end-stage renal disease (ESRD) patients, in order to gain a better understanding of the decision-making process and motivations of patients as they choose or decline to approach others for a kidney. Methods: Participants were recruited from patients with ESRD through the Hawke’s Bay District Health Board. Potential participants were identified as being on the deceased donor list (DDL), or had family or friends being worked up for living kidney donation (LKD). Participants were interviewed and asked about the challenges of asking for a kidney, including such questions as: Who did they ask, and why? Who did they exclude, and why? How did they approach the request, and what were their reasons for asking in this way? Could they identify additional strategies which might have been useful to them, but were either not considered or unavailable? A qualitative descriptive approach was utilised to analyse interview data. Results: Fifteen participants were interviewed, with most stating that it was hard to ask for a kidney and almost half having never approached anyone for a kidney. For many patients, being expected to recruit donors for LKD was a barrier in itself. Commonly identified themes indicate that recipients may be concerned for the health and wellbeing of their loved ones, or have limited recruitment opportunities, or poor health literacy or self-efficacy. Many Maori recipients stated they favoured a whanau approach to discussing transplant, and most recipients desired more support in order to facilitate approaching donors. Conclusions: Findings suggest it would be useful to develop a screening tool assessing willingness and motivation to accept a living kidney donation along with self-efficacy, communication and health literacy levels prior to recipients initiating conversations with potential donors, in order to provide tailored support to the recipient with their initial approach. Additionally, psycho-social support could be offered to all recipients to help identify unmet needs or further barriers such as reciprocity or relationship concerns. Finally, closer communication between health professionals who provide care for the recipient, as well as positive media stories and campaigns that raise awareness of the need to transplant may create opportunities for LKD to be discussed within the recipient’s social network.</p>

'It's hard to ask': Examining the factors influencing decision-making amongst end-stage renal disease patients considering asking friends and family for a kidney

<p>Background: Organ donation is an important facet of healthcare delivery in New Zealand, with donation often leading to an increased quality of life for recipients, and a reduction in healthcare costs for the community. People who require new organs have limited options in regards to organ access: they can receive organs from deceased donors, or if a kidney is not volunteered, they might ask someone to donate. For those that choose to ask someone to donate an organ, one barrier that is sometimes voiced is that it is hard to ask family and friends to donate. This project sought to explore the issues surrounding asking for an organ by end-stage renal disease (ESRD) patients, in order to gain a better understanding of the decision-making process and motivations of patients as they choose or decline to approach others for a kidney. Methods: Participants were recruited from patients with ESRD through the Hawke’s Bay District Health Board. Potential participants were identified as being on the deceased donor list (DDL), or had family or friends being worked up for living kidney donation (LKD). Participants were interviewed and asked about the challenges of asking for a kidney, including such questions as: Who did they ask, and why? Who did they exclude, and why? How did they approach the request, and what were their reasons for asking in this way? Could they identify additional strategies which might have been useful to them, but were either not considered or unavailable? A qualitative descriptive approach was utilised to analyse interview data. Results: Fifteen participants were interviewed, with most stating that it was hard to ask for a kidney and almost half having never approached anyone for a kidney. For many patients, being expected to recruit donors for LKD was a barrier in itself. Commonly identified themes indicate that recipients may be concerned for the health and wellbeing of their loved ones, or have limited recruitment opportunities, or poor health literacy or self-efficacy. Many Maori recipients stated they favoured a whanau approach to discussing transplant, and most recipients desired more support in order to facilitate approaching donors. Conclusions: Findings suggest it would be useful to develop a screening tool assessing willingness and motivation to accept a living kidney donation along with self-efficacy, communication and health literacy levels prior to recipients initiating conversations with potential donors, in order to provide tailored support to the recipient with their initial approach. Additionally, psycho-social support could be offered to all recipients to help identify unmet needs or further barriers such as reciprocity or relationship concerns. Finally, closer communication between health professionals who provide care for the recipient, as well as positive media stories and campaigns that raise awareness of the need to transplant may create opportunities for LKD to be discussed within the recipient’s social network.</p>