Looking for new sources of organ donations

Javier L. Deira, Anunciación, González, Hugo Díaz and Jesús Grande

Department of Internal Medicine, Division of Nephrology, Hospital Virgen de la Concha, Zamora, Spain

Sir,

In recent years, technical advances and the shortage of donor organs for transplant have favoured the search for new sources of donations. Thus, the kidneys of hepatitis C virus-infected patients [1], elderly people [2], or non-heart-beating-donors [3] have been used. At present, xenotransplantation is still in the preliminary study stage [4] and the ethical–legal considerations concerning payment for organ donation and the use of executed prison inmates as donors is being discussed [5].

Patients with chronic renal failure (CRF) on haemodialysis form part of the waiting list for kidney transplantation and are the main receptors of transplanted solid organs. However, only rarely can they become donors of their useful organs, because patients with CRF are excluded as donors.

Case.

We report the case of a 40-year-old patient who had been undergoing haemodialysis for 10 years, due to CRF secondary to chronic glomerulonephritis, and awaiting kidney transplantation, who died of an intracerebral haemorrhage. After evaluating the protocol for the donation of organs specified by the National Transplantation Organization, the patient was considered to be a suitable donor of liver and cornea. The patient's viral serology was negative. Neither the long period on haemodialysis nor the cause of death, frequently associated with atheroembolic illness, contraindicated the donation.

Comment.

Nephrologists should be foresighted with their patients and should not only consider the possibility of their becoming kidney recipients, but also assess the donation potential of their other organs, thus increasing donor sources.

References

  1. Morales JM, Rodicio JL. Should hepatitis C positive donors be accepted for renal transplantation? Curr Opin Nephrol Hypertens1996; 5: 199–201[Medline]
  2. Roberts J, Talbot D. Recovery of kidneys from older donors: is it worthwhile? J Transplant Coord1997; 7: 202–204[Medline]
  3. Daemen JHC, de Wit RJ, Bronkhorst MW, Yin M, Heineman E, Koostra G. Non-heart-beating donor program contributes 40% of kidneys for transplantation. Transplant Proc1996; 28: 105–106[ISI][Medline]
  4. Auchincloss HJ. Literature uptodate 1998, part 2. Xenotransplantation1998; 5: 305–309[ISI][Medline]
  5. Cameron JS, Hoffenberg R. The ethics of organ transplantation reconsidered: Paid organ donation and use of executed prisoners as donors. Kidney Int1999; 2: 724–732




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