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In this issue of Annals, three articles and an editorial address KIDNEY TRANSPLANTS. In the United States, about 67,000 people are waiting for a kidney transplant.
In the United States, kidneys for transplant operations come from people who are declared brain-dead in the hospital (“heart-beating donors”) or from living donors. But in Spain, eligible kidney donors include “non-heart-beating donors,” who are people who die of cardiac arrest in the community after unsuccessful CPR if a series of other stringent criteria are met. In a new study, Spanish researchers compared outcomes of 584 recipients of kidneys from heart-beating donors and 320 recipients of kidneys from non-heart-beating donors (Article, p.148). One-year and five-year graft survival rates were similar for transplantations from heart-beating donors under 60 and from non-heart-beating donors (about 90 percent and 85 percent, respectively).
An analysis of data from published research found that, after at least five years from donation, the blood pressure of kidney donors was 5 mm Hg higher than would be expected with normal aging (Article, p. 185). The authors note important problems with available studies such as lack of uniform definitions for hypertension and incomplete information on many donors. However, the authors say that even these limited data have implications for informed consent, counseling and education of potential donors, reimbursement policies for future anti-hypertension drugs, donor selection, follow up after kidney donation, and future research.
Organs donated by altruistic strangers (people who do not know the recipient) “do not go necessarily to patients who have the best immunologic match or the most urgent need or who have waited the longest” for a transplant, says a writer (Academia and Clinic, p. 197). The writer calls for an organization to provide public education on the science and ethics of organ allocation. He says altruistic strangers who want to donate an organ should attend a “mandated education program before donation that encourages adherence to allocation guidelines, yet ultimately preserves their freedom of choice.”