By N. Curtis. Saint Lawrence University.

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    A suitable living donor is better than a cadaveric donor because graft survival is better and preemptive transplantation Candidate for renal transplantation is possible buy cialis 20 mg fast delivery. Psychosocial and biological factors m ust be taken into account when choosing am ong two or m ore living prospective donors generic 2.5 mg cialis overnight delivery. Every effort m ust be m ade to ensure that the donation is truly voluntary. Caregivers W illing to Yes should tell prospective donors that if they do not wish to donate, accept living then friends and relatives will be told “the donor was not m edically donor? No Evaluate for cadaveric No Cross-match Yes transplantation negative? W illing and available No ABO-compatible Yes emotionally related donor? Proceed with evaluation Evaluation of Prospective Donors and Recipients 12. Yes No Voluntarism reasonably No Surgical risk certain? Yes Yes Yes No Preliminary No Yes Financial Long-term risk medical incentive? No donor Yes CM V titer Yes Risk positive or Risk of acceptable? No Yes Proceed with No No Screening for Yes Proceed with evaluation diabetes evaluation negative? FIGURE 12-32 Prelim inary evaluation of a living prospective donor. The FIGURE 12-33 prospective donor m ust be m ade aware of the possible costs Assessing risks. O lder age m ay place the living prospective donor at associated with donation, including travel to and from the greater surgical risk and m ay be associated with reduced graft sur- transplantation center and tim e away from work. The prospective donor m ust be inform ed of donor m ust undergo a psychological evaluation to ensure the both the short-term surgical risks (very low in the absence of car- donation is voluntary. A prelim inary m edical evaluation should diovascular disease and other risk factors) and the long-term conse- assess the risks of transm itting infectious diseases with the kid- quences of having only one kidney. W ith regard to long-term risks, ney, eg, infection with hum an im m unodeficiency virus (H IV) it should be considered whether there is a fam ilial disease that the and cytom egalovirus (CM V). These questions are often m ost pertinent for relatives of patients with diabetes. Results of 27 an Am erican Society of Transplantation survey of the United N etwork for O rgan Sharing centers showed that m any centers 22 either use no specific age exclusion criteria or have no policy. In a meta-analysis combining 48 studies of the long-term effects of reduced renal mass in humans, Screening living prospective donors for diabetes. Results of the sur- no evidence was found of a progressive decline in renal function vey of the United N etwork for O rgan Sharing centers showed that after a 50% reduction in renal mass. Indeed, a small but statistically m ost centers exclude patients with a m ildly elevated fasting blood significant increase occurred over time in the glomerular filtration sugar (FBS) and patients with norm al FBS but an abnorm al glucose rate. A small increase in urine protein excretion occurred; however, tolerance test (GTT). M ost centers exclude donors with m ild type the rate of increase per decade was less than that generally considered II diabetes. A small increase in systolic blood pressure was noted; however, it was not enough to lead to an increase in the incidence of hypertension. Thus, it appears that the long-term risks of kidney donation are very small. Shown are multiple linear regression coefficients and 95% confidence intervals. Failure of the confidence interval to include zero indicates P < 0. Results of the survey of the United Network for Organ 60 Sharing centers showed that most exclude 54 prospective donors who require antihyper- 50 tensive medication or whose BP is persistent- ly elevated over 130/80 mm Hg.

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