A systematic review of 35 years of global medical literature identifies a number of reasons why people sell a kidney. The study, led by Bijaya Shrestha of the Center for Education, Health and Social Sciences Research, Kathmandu, Nepal, finds limited efforts to mitigate the problem and a lack of evidence on the impact of policies and biotechnology.
There research was published in the open access journal PLOS Global Public Health.
Selling a kidney due to poverty
Demand for kidney donations exceeds supply and it has become one of the most salable human organs, with kidney sales being a global phenomenon. Illegal organ donation often takes advantage of vulnerable people and poses medical, social, psychological and legal risks. Bijaya Shrestha and colleagues wanted to explore the reasons why people sell their kidneys and conducted a systematic review of relevant medical literature from around the world.
Poverty is the main reason cited, but lack of information, debt, using payments to purchase goods such as motorbikes, phones, extra land, the desire for financial freedom and altruism are also reported. At a social level, studies highlight the influence of family and social norms. Fulfillment of family demands may be rooted in social conformity, and studies report that men sometimes resort to selling their organs to obtain dowry money, while women sell their organs due to the physical labor expected of men in the their families.
There were also regional variations. Poverty was the main reason among the individuals of the Indian subcontinent. In Bangladesh, Nepal, India and the Philippines, brokers play a significant role in connecting potential sellers and buyers. Studies conducted in India and the Philippines have reported how cities with advanced medical facilities have effectively facilitated kidney trade by serving as meeting points for donors and recipients.
The authors also highlight policy shortcomings in addressing the challenges of kidney sales and cross-border organ trafficking.
The authors add: “Although economics appears to be the primary reason for kidney sales, there are multiple reasons for kidney sales. This article explores different aspects of kidney sales.”
Living kidney donors experienced lower fracture rates overall
According to a study published online in JAMA Network Open, during an average follow-up of 25 years, living kidney donors showed a lower rate of overall fractures than eligible non-donor controls.
Hilal Maradit Kremers, MD, of the Mayo Clinic in Rochester, Minnesota, and colleagues compared the overall and site-specific risk of fractures among living kidney donors with closely matched controls from the general population who would have been eligible to donate a kidney but not they did. do not do it. The analysis included 2,132 living kidney donors and 2,014 non-donor controls.
The researchers reported that the average time between the date of donation or index and the date of the survey was 24.2 years for donors and 27.6 years for controls. They found that the overall rate of fractures among living kidney donors was significantly lower than among controls (standardized incidence ratio, 0.89), although there were significantly more vertebral fractures among living kidney donors than among controls (standardized incidence ratio, 0.89). standardized incidence, 1.42).
The researchers reported that the average time between the date of donation or index and the date of the survey was 24.2 years for donors and 27.6 years for controls. They found that the overall rate of fractures among living kidney donors was significantly lower than among controls (standardized incidence ratio, 0.89), although there were significantly more vertebral fractures among living kidney donors than among controls (standardized incidence ratio, 0.89). standardized incidence, 1.42).
“This study suggests that although the overall fracture rate among donors was low, reduced renal mass and prolonged hyperparathyroidism may predispose living kidney donors to trabecular bone loss and vertebral fractures,” the authors write.
Living kidney donor surgery is low risk for most patients
The risk of major complications for people who donate a kidney via laparoscopic surgery is minimal. That's the conclusion of a 20-year Mayo Clinic study of more than 3,000 living kidney donors. Only 2.5% of patients in the study experienced serious complications, and all recovered fully.
“The results of this study are extremely reassuring for people who are considering becoming living kidney donors. We have found that this life-saving surgery, when performed at expert transplant centers, is extremely safe,” says Timucin Taner, M.D., Ph.D., chair of the Division of Transplant Surgery at the William J. von Liebig Transplant Center and Mayo Clinic Clinical Regeneration in Minnesota. Dr. Taner is a co-author of the study.
The study was published in the Mayo Clinic Proceedings.
The findings are significant, given that nearly 90,000 people in the United States are waiting for a life-saving kidney transplant. Patients who receive a kidney from a living donor generally have better outcomes. Kidneys from living donors usually function longer than those from deceased donors.
The findings are significant, given that nearly 90,000 people in the United States are waiting for a life-saving kidney transplant. Patients who receive a kidney from a living donor generally have better outcomes. Kidneys from living donors usually function longer than those from deceased donors.
The single-center retrospective study is believed to be the largest study to date examining the risks associated with living kidney donation via laparoscopic surgery. The study involved 3,002 living kidney donors who underwent laparoscopic surgery at the transplant center from January 1, 2000 to December 31, 2019. The study tracked complications that occurred up to 120 days after the surgery.
Overall, 12.4% of patients experienced postoperative complications, and most of them experienced an incision-related infection or hernia. Most of these complications occurred in the earlier phase of the study. No patients died. The researchers found that 76 percent of these complications occurred after the patient was discharged.
“Although this study strengthens the safety of this surgical procedure, it highlights the importance of following donors after donation. This ensures that any complications can be treated quickly without long-term damage,” says Dr. Taner.
Improved long-term survival for kidney transplant patients
If you are a kidney transplant patient, your chances of living a longer life increase.
This is according to a recent review published in the New England Journal of Medicine. It showed that the five-year survival rate of transplant recipients who received a deceased donor kidney increased from 66% in 1996-1999 to 78% in 2012-2015. And for patients who received a kidney from a living donor, that rate improved from 79.5% to 88%.
What's behind the better results?
Long-term survival rates for kidney transplant patients have improved over the past three decades.
“Significant progress has been made particularly in the detection of antibodies to kidney transplants. Tests have become much more sensitive, so we are now able to avoid transplants that could lead to early rejection,” says Dr. Carrie Schinstock, MD, MD, MD, director of the Kidney Transplant Program at the Mayo Clinic in Rochester, Minnesota.
“There have also been significant advances in the field of immunosuppression and in our ability to detect viruses that may be harmful to kidney transplant patients.”
According to her, another factor has been the improvement at Mayo in the post-transplant management of hypertension, hyperlipidemia, diabetes and obesity which can lead to cardiovascular death.
“We now have protocols for post-transplant weight management and also for implementing pre- and post-transplant bariatric surgery with the hope of improving long-term outcomes,” says Dr. Schinstock.
Social determinants of disparities in kidney transplantation
Among US adults with kidney failure, race and social determinants of health were associated with patients' likelihood of receiving a kidney transplant.
Blacks are more likely than whites to develop kidney failure, but are less likely to undergo kidney transplant, the optimal treatment for kidney failure. Blacks also have disproportionately lower rates of living donor kidney transplants, which offer superior patient and graft survival rates compared to deceased donor kidney transplants.
To explore whether social determinants of health – such as demographics, cultural factors, psychosocial characteristics, and transplant knowledge – may play a role in these disparities, Larissa Myaskovsky, Ph.D. (University Health Sciences Center of New Mexico) and his colleagues prospectively followed 1,056 kidney transplant patients from 2010 to 2012 (with follow-up through 2018) at the University of Pittsburgh Medical Center. Patients completed an interview immediately after the initial kidney transplant evaluation and were followed until the kidney transplant was performed.
The team found that even after accounting for social determinants of health, blacks were less likely to receive a kidney transplant overall, and a living donor transplant in particular but not a deceased donor transplant.
Black race, older age, lower income, public insurance, more comorbidities, transplants before 2014, changes in kidney allocation policy, greater religiosity, less social support, less knowledge of transplants, and fewer learning activities were all associated with higher less likely to receive a kidney transplant.
“Our data suggests a critical need for transplant centers to identify and intervene on social determinants for at-risk populations,” said Dr. Myaskovsky.
“Based on our findings, developing interventions aimed at patients with little knowledge about transplantation, religious objection to living donor transplantation, or poor social support can improve equal access to kidney transplantation because transplant teams can use these risk factors to target patients who may need more support to ensure they receive a transplant.”
An accompanying Patient Voice editorial provides the perspective of a Black American woman who was suddenly diagnosed with kidney failure 7 years ago at age 49. She is a kidney transplant recipient and also director of public and government relations for the National Kidney Foundation of Illinois.
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