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UNRELATED LIVING KIDNEY TRANSPLANTATION. MINISTERIAL ADVISORY COMMITTEE Y VERIAVA C SWANEPOEL. FUNCTIONS OF THE MINISTERIAL ADVISORY COMMITTEE. To determine the need for the establishment of transplant facilities
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UNRELATED LIVING KIDNEY TRANSPLANTATION MINISTERIAL ADVISORY COMMITTEE Y VERIAVA C SWANEPOEL
FUNCTIONS OF THE MINISTERIAL ADVISORY COMMITTEE • To determine the need for the establishment of transplant facilities • To advise the minister on approval of all transplant operations involving unrelated donors • To approve related living donor applications where genetic tests have failed to confirm relationships. • Propose granting of authority to a unit to perform organ or tissue transplantation as a form of control • To monitor unethical behavior in transplantation • Working with relevant units within the public and private health systems to determine the cost of transplantation • Determine future requirements in transplantation services • To receive reports from each transplant unit and evaluation of their performance on an annual basis
UNRELATED LIVING KIDNEY TRANSPLANTATION • SPECIAL CONSIDERATIONS • A great need for living donor kidney transplantation • A gift of a kidney by an altruistic donor is a gift to society • It is incumbent upon the transplant team and the ministerial advisory committee to protect the donor • The balancing of risks and benefits for both recipients and donors is a concept that is referred to as Double Equipoise • It is incumbent upon the transplant team and the ministerial committee to protect the donor, the donor kidney and to ensure a successful outcome
GENETICALLY RELATED IVING DONORS • Natural parents and children • Brothers and sisters of whole/half blood • Brothers and sisters of whole/half blood of natural parents • Children of brothers/sisters whole/half blood • Natural children of brother/sister of whole/half blood of natural parent
RATIONALE FOR UNRELATED LIVING KIDNEY TRANSPLANTATION • Low rate of cadaveric donations • Kidneys from living donors have better outcomes than those from cadavers • Minimal risk to donor (1 death in 3000 – 5000 cases) • Cost of continuous dialysis • Problem of access to transplant units for cadaveric transplants
UNRELATED LIVING KIDNEY TRANSPLANTATION • It must be established by the transplant team that the motive of the donation is altruistic • Both donor and recipient should undergo psychological assessment by an independent competent social worker or psychologist to ensure that there is no form of coercion that exist. This is also to ensure that both parties clearly understand all that is involved and the implications of surgery • All medical investigations conducted should conform to international standards.
UNRELATED LIVING KIDNEY TRANSPLANTATION(CONTRA-INDICATIONS TO DONATION) • HYPERTENSION • PROTEINURIA/HAEMATURIA • RENAL DYSFUNTION • RENAL STONES • FAMILY HISTORY OF APCKD • STRUCTURAL ABNORMALITIES • Multiple cysts • Three or more arteries • Fibromuscular dysplasia • HIV/Hep C/Hep B carriers • Active malignancy • Chronic illness: vascular/pulmonary/neurological • Psychosis • Substance abuse • Pregnancy • Donor follow up can not be assured
NON APPROVALS • Hypertension • Diabetes mellitus • ABO incompatibility • Diffuse vascular disease • Renal stones • Aortic anneurysm • Decrease GFR • MGUS • Haematuria
UNRELATED LIVING KIDNEY TRANSPLANTATIONALTRUISTIC DONORS • ALTRUISTIC DONATIONS • Directed (presently the majority) • Undirected • The processes and protocol to be followed must be established by the transplant teams. • The consideration in the choice of the most suitable recipient must be determined by a team which includes members of the transplant team from both the public and private sectors • In the final decision, issues of a conflict of interest must be taken into account and the donor kidney should go to the most deserving patient (from the private or public sector).
UNRELATED LIVING KIDNEY TRANSPLANT(2008 – 2010) • Total number: 118 • Donor Gender: • Male 36% • Females 74% • Not approved: 21
THE ROAD AHEAD • Establishment of an Expert Committee on Organ Transplantation • Establishment of an ESRD treatment registry • Formalize the reporting of the outcome, regular follow up of recipients and donors of all transplantations • Review the existing guidelines for ESRD treatment including transplantation and formalise these into regulations with the national department of health • Formal acceptance and compliance with the recommendations enunciated in the Declaration of Istanbul