Risk appreciation for living kidney donors: Another new subspecialty?
Risk appreciation for living kidney donors: Another new subspecialty?
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DOI：
10.1111/j.1600-6143.2004.00424.x
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发表时间：
2004-05-01
影响因子：
8.8
通讯作者：
Steiner, RW
中科院分区：
文献类型：
--
作者：
Steiner, RW
定量估计终末期肾病（ESRD）的风险，活捐助者似乎是必不可少的辩护捐助者选择的做法，因为“安全/不安全”的模式供者选择是不可行的。所有的肾脏捐献者都有风险，应该使用四个基本的定性标准来决定何时拒绝捐献者。这些标准是缺乏关于移植的捐赠者教育，捐赠者不合理，缺乏自由和自愿捐赠，和/或捐赠者的接受将不可避免地威胁到公众的信任或中心选择程序的完整性。这样一种基于数据的选择政策，明确记录了公正和全面的捐赠者教育，将有助于以一种比立即拒绝“复杂”肾脏捐赠者更有防御力的方式来中和中心的自身利益，并且比通过更实际的方式来中和中心的自身利益。创建独立的捐赠者顾问或等待捐赠者登记处取得成果。有孤立医学异常的活体供肾者包括相当大的一部分有风险的供肾者，这些供肾者的中心接受实践差异很大。这一人群为定量风险估计和咨询提供了一个范例。
Quantitative estimates of the risk of end stage renal disease (ESRD) for living donors would seem essential to defensible donor selection practices, as the 'safe/unsafe' model for donor selection is not viable. All kidney donors take risk, and four fundamental, qualitative criteria should instead be used to decide when donor rejection is justified. These criteria are lack of donor education about transplantation, donor irrationality, lack of free and voluntary donation, and/or that donor acceptance would unavoidably threaten the public trust or the integrity of the center's selection procedures. Such a data-based selection policy, with explicit documentation of unbiased and comprehensive donor education, will help neutralize the center's self interest in a more defensible way than by rejecting 'complicated' kidney donors out of hand, and in a more practical way than by the creation of center-independent donor counselors or waiting for donor registries to come to fruition. Living kidney donors with isolated medical abnormalities comprise a sizable subset of at risk donors for whom center acceptance practices vary markedly. This population provides a paradigm opportunity for quantitative risk estimation and counseling.