Year: 2008
Type: letter
Abstract: To the Editor: We appreciate Dr. Davis' comments on the current practices for the evaluation of living kidney donors in this country, as noted in her editorial accompanying our published survey on the subject (1). The call for funding studies to assess long-term kidney donor outcomes is particularly important, because we suspect that much of the variation in medical evaluation practices in this country results from the lack of good data defining the risks for a specific donor. Dr. Davis renews the call for a nationally standardized living donation evaluation and selection protocol. However, a cautionary note is important. National rules mandating an exacting and expensive predonation medical evaluation, in the absence of data validating these tests, are fraught with potential problems. The first draft of the UNOS proposal out for public comment included such suggestions as checking an HbA1c in potential donors at increased risk for diabetes and performing a chest CT for those with a history of smoking. Neither of these recommendations will likely stand the public comment process, since they are not standard of care procedures to detect the conditions of interest (diabetes and lung cancer). For now, national rules for donor evaluation should be limited to tests which are unequivocally accepted for the detection of disease and future risk, such as age-appropriate cancer screening and renal function evaluation. The presence of interprogram variability in the medical evaluation of the kidney donor sometimes reflects absence of data, not absence of good medical practice. We should continue to lobby for funding of studies to answer outstanding questions in the evaluation of live donors, before we mandate tests based on opinion.
Institution: Beth Israel Deaconess Medical Center
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,300
OpenAlex ID: W1966164791