MEP group for kidney health dinner seminar:

Chronic kidney disease-

organ donation and transplantation

Daniel Abramowicz, MD, PhD

Free University of Brussels, Belgium

TP with LD

What are the risks for the donor?

What are the benefits for the recipient?

HD

Renal transplantation from a living donor: recipient benefits

Pre-emptive TP possible: no need for dialysis, AVF surgery etc.

Elective, planned procedure

Reliefs the stress on the deceased donor recipient waiting list

No tt

GP

Living donors live longer

Medical evaluation of the donor candidate

1) Assess vital/surgical risk (minimal)

2) Assess renal risk (minimal)

• 62 servicemen who lost

a kidney due to trauma

during WW II;

• 62 matched subjects

• Mean FU: 45 y

• Creat, Creat Cl, U prot,

BP identical

One normal kidney is sufficient for life

Kidney International, 1993

Can we accept senior living donors?

WG on Transplantation guidelines: topic on donor evaluation

Minimal work-up (assays to be done)

Guive guidance/recommendations covering debated isssues

(Old age, hypertension, obesity, proteinuria, renal function, etc)

Measures to improve living donation rates

1. Information/sensitisation of general population/medical teams /

paramedic (campaigns, seminars, CME, brochures)

2. Logistical help (nurse, transplant coordinator) for the nephrologist

faced with a patient with a failing kidney (kidney function 20% of

normal)

Inform/discuss about dialysis/transplantation/living donation

3. Timely information about living donation of the patient with a

failing kidney (Anglo-saxon type of communication?)

Measures to improve living donation rates

1. Discussion with health authorities of a full refund of the donor

expenses pre- and post-TP; tackle issues about life insurance

2. Coverage of health problems costs (HTA, renal failure; priority for KT)

3. National protocol for ABO-incompatible transplant (25% of cases)

4. Registries of donor data (free of charge)

0

5

10

15

20

25

30

35

40

45

All donors DD DBD DCD LD

Kidney donors (pmp) – the Netherlands

1995-1999

2000-2004

2005-2009

p=0.01

p=0.01

p<0.01

Courtesy of Dr. I Jochmans, KUL, Belgium

Organ donation, what are the gaps? summary

Organ shortage: not a fatality LD in Nederlands (25) + DD in Spain (45) = 70 KT/pmp/y

1. Deceased donation: local coordinators

2. Living donation: 1. Timely information (GP, patients, medical profession at large)

2. Logistical help to nephrologist to prepare the chart

Important docs from the EC (Action plan 2009-2015, Directive 2010/45/Ue about quality and safety of organ transplantation) that provides crucial informations/initiatives to improve organ donation and kidney transplantation.