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Author Topic: Broken Chains and Reneging: A Review of 1,748 Kidney Paired Donation Transplants  (Read 290 times)

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Offline Clark

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http://onlinelibrary.wiley.com/doi/10.1111/ajt.14343/full

Broken Chains and Reneging: A Review of 1,748 Kidney Paired Donation Transplants
Nick Cowan, H. Albin Gritsch, Nima Nisseri, Joe Sinacore, Jeffrey Veale
Accepted manuscript online: 10 May 2017
DOI: 10.1111/ajt.14343

Brief Communication:
Concerns regarding the potential for broken chains and reneges within kidney paired donation (KPD) and its effect on chain length have been previously raised. While these concerns have been tested in simulation studies, “real world” data has yet to be evaluated. The purpose of this study was to evaluate the actual rate and cause of broken chains within a large KPD program. All patients undergoing renal transplantation through the National Kidney Registry from 2008 through May 2016 were included for analysis. Broken chains and loops were identified. A total of 344 chains and 78 loops were completed during the study period yielding a total of 1,748 transplants. Twenty broken chains and one broken loop were identified. The mean chain length (# of transplants) within broken chains was 4.8 compared to 4.6 of completed chains (p=0.78). The most common causes of a broken chain were donor medical issues incurred while acting as a bridge donor (n=8), donors electing not to proceed (n=6), and kidneys being declined by the recipient surgeon (n=4). All recipients involved in a broken chain have subsequently received a transplant. Based on the results broken chains are infrequent, rarely due to lack of donor motivation, and have no significant impact on chain length.

Unrelated directed kidney donor in 2003, 57 gallon blood & platelet donor and counting!
Rep to the OPTN/UNOS Boards of Directors & Executive, Kidney Transplantation, & Ad Hoc Public Solicitation of Organ Donors Committees 2005-2011

Offline Clark

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These authors perpetuate the offensive, inaccurate terminology removed from the draft OPTN/UNOS KPD Guidelines due to my objections. One cannot renege on a gift, only on a promise or a contract, especially on a gift not yet given. We can not and do not provide full, informed, final consent until the general anesthesia is administered prior to our organ removal surgery. To imply any promise or contract in a KPD chain inappropriately burdens these donor candidates. This language was flagged as unacceptably inaccurate almost a decade ago at the highest level of national policy development. These authors, and the editors of AJT, please revise this title and article content. Thank you.
Unrelated directed kidney donor in 2003, 57 gallon blood & platelet donor and counting!
Rep to the OPTN/UNOS Boards of Directors & Executive, Kidney Transplantation, & Ad Hoc Public Solicitation of Organ Donors Committees 2005-2011

 

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