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Path: bloom-beacon.mit.edu!hookup!swrinde!cs.utexas.edu!howland.reston.ans.net!darwin.sura.net!udel!newsserv.cs.sunysb.edu!ysics.physics.sunysb.edu!mhollowa From: mhollowa@epo.som.sunysb.edu (Michael Holloway) Newsgroups: bit.listserv.transplant,sci.med,sci.answers,news.answers Subject: bit.listserv.transplant FAQ, Organ transplantation newsgroup (Part 1 of 2) Followup-To: bit.listserv.transplant Date: 31 Mar 1994 20:18:37 GMT Organization: Institute For Theoretical Physics Lines: 903 Approved: news-answers-request@MIT.Edu Distribution: world Expires: 04/30/94 Message-ID: <medicine/transplant-faq-1-765145097@sunysb.edu> Reply-To: mhollowa@epo.som.sunysb.edu (Michael Holloway) NNTP-Posting-Host: csws2.ic.sunysb.edu Summary: This is a description of the bit.listserv.transplant newsgroup and its parent mail list, TRNSPLNT. Frequently asked questions regarding organ transplantation are addressed. A list of resources for transplantation patients is provided. Originator: mhollowa@csws2.ic.sunysb.edu Xref: bloom-beacon.mit.edu bit.listserv.transplant:678 sci.med:37272 sci.answers:1028 news.answers:17058 Posted-By: auto-faq 2.4 Archive-name: medicine/transplant-faq/part1 3/31/94 Modifications since 2/14/94: Addition of donor awareness stamp campaign information and sources for stickers, buttons, etc.(item VI). Additional drug company information added to the resources directory (part 2). Added UNOS's info e-mail address to Joel Newman. Added info on "Encore: Another Chance at Life" gratis magazine subscription (item VII) and info about the magazine's publisher, Chronimed Pharmacy, to part 2. Contents Part 1: I. The TRNSPLNT mail list II. Organ and tissue transplant info via gopher III. Organ donation, frequently asked questions IV. The organ donor shortage V. Transplant and organ donation myths VI. Organ donor awareness postage stamp campaign and other awareness materials VII. Sources of information on organ and tissue donation and transplantation VIII. Transplant fund raising (BMT Newsletter) IX. Live kidney donor information X. Renal transplant specific sources and information XI. Blood marrow transplant specific sources Part 2: National Transplant Patient Resources Directory About this FAQ -------------- This FAQ is archived at rtfm.mit.edu and available by gopher or ftp under usenet/bit.listserv.transplant. The subjects treated in this FAQ are, for the most part, specific for the state of organ and tissue transplantation in the United States. If anyone would be interested in providing information that might be helpful to people of other countries please let me know. If anyone has other information they would like to have included in this FAQ please send it along. Many thanks to the people who have contributed information and otherwise helped with the FAQ: Alex Bost, Dan Flasar, Kimberly Montgomery, Arthur Flatau, Katherine Eberle and Anne Treffeisen. Part 2, the National Transplant Patient Resources Directory, lists information on organizations providing support (financial and otherwise) to transplant patients. It is taken largely from a pamphlet published by Stadtlander Pharmacy and The Transplant Foundation, a copy of which can be found on Yale biomedical gopher site. Mike Holloway mhollowa@epo.som.sunysb.edu ========================================================================= I. Description of the TRNSPLNT mail list and bit.listserv.transplant ========================================================================= bit.listserv.transplant is a bi-directional echo of the listserv mail list TRNSPLNT. If you have an interest in transplantation, and think that the posted news and discussions are of interest, it may be more convenient for you to subscribe. This also provides a way to see who's listening since a list of subscribers and their addresses can be accessed through the listserv. All posts to TRNSPLNT or bit.listserv.transplant are archived by the listserv system at Washington U. You can get an index of the archive by following the directions below. To have a list of listserv commands sent to you, send mail to LISTSERV@WUVMD.WUSTL.EDU and place either HELP or INFO REFCARD on the first line of text. Below is the introduction to TRNSPLNT written by Dan Flasar. Since Dan started the group early in `93 the posts have been on everything from copies of news and information to recipes for low salt diets. It has been a useful electronic support group for some participants who are either waiting for a transplant, recovering from a transplant, or just getting on with life after a transplant. We encourage recipients, caregivers and medical professionals to introduce themselves to the group. The list is also a tool for organ and tissue donor education. ------------------------------------------------------------------------- TRNSPLNT on LISTSERV@WUVMD.WUSTL.EDU or LISTSERV@WUVMD.BITNET TRNSPLNT is a discussion list for organ transplant recipients and anyone else intested in the issues, experiences and realities of living with an organ trasplant. Over the last 30 years, the number of transplants performed each year has grown steadily in both absolute numbers and type of organs transplanted. Though there are hospital, clinical and pharmaceutical industry-sponsored newsletters, there are few, if any, completely independent discussion forums for those who have experienced this oftentimes dramaticaly effective therapy. There are many life issues for the transplant patient that are simply not covered in medical literature or by medical personnel. TRNSPLNT will provide a way for members to share information on such things as as travel, both domestic and abroad, how to deal with a compromised immune system, stories about transplant experiences, and anything that the members feel is worth discussing. Archives of TRNSPLNT postings can be listed by sending an INDEX TRNSPLNT command to LISTSERV@WUVMD.BITNET (or LISTSERV@WUVMD.WUSTL.EDU). To subscribe, send the following command to LISTSERV@WUVMD.WUSTL.EDU or LISTSERV@WUVMD.BITNET via email: SUB TRNSPLNT Your Full Name where "Your Full Name" is your name. For example: SUB TRNSPLNT Billy Rubin Owner: Dan Flasar SYSFLASAR@WUGCRC.WUSTL.EDU NOTE: This is NOT a medical forum! Though advice may be offered, you should, as with any medical issue, check with your physician before you accept anything said in this forum as a basis for doing anything that might affect your physical condition! ========================================================================= II. Organ and tissue transplant info via gopher ========================================================================= The Yale biomedical gopher is accepting information related to transplantation for presentation at their gopher site. As of this writing, issues of UNOS Update, UNOS ethics committee and statistics reports, Stadtlanders list of support groups for transplant patients and excerpts of the National Kidney Foundation newsletters are available. Point your gopher at: Hostname: yaleinfo.yale.edu Port: 7000 The "Organ and tissue transplant information" submenu is under "Biomedical disciplines and specific diseases/diseases and disorders". Any organization that has information, newsletters, or papers that they would like posted are invited to send an ASCII file to Susan Grajek at Yale, email: grajekse@medpo1.med.yale.edu, phone: 203-785-5181. Other file types can be accommodated but please check with Ms. Grajek ahead of time. If you need help with e-mail or preparation of the file, please contact Michael Holloway at mhollowa@epo.som.sunysb.edu, phone: 516-444-3090. Most word processors have a simple command for making an ASCII, or plain text, file from anything created in that program. ========================================================================= III. Organ donation, frequently asked questions ========================================================================= contributed by Alex Bost, alex@unx.sas.com *** Commonly Asked Questions About Being an Organ Donor: - Where can I get an Organ Donor Card? Many organizations, including the NKF and AAKP will provide donor cards free of charge. Many physicians, pharmacies, and hospitals will also provide them. [Free cards and pamphlets also available from (800)24-DONOR] - Should I mention being an Organ Donor in my Will? No. Your will may be read too late to take your organs. However, you should definitely mention Organ Donation in your Living Will. - What is a Living Will? A Living Will is a document where you stipulate what kind of medical attention you will receive if you are unable to make decisions for yourself. You may state your wish to become an organ donor in a Living Will. - Who pays for the medical costs of being a donor? The transplant recipient is responsible for all costs involved in organ procurement. The donor's family will not pay any of the cost. - Does organ donation disrupt funeral arangements? No. Organ donation will not disfigure the body. A donor may still have an "open casket" funeral. - Will becoming a donor mean a doctor will let me die? Absolutely not! Medical personnel must follow very strict guidelines before a donor can be pronounced dead. You can expect the same quality of health care as you would if you weren't a donor. ------------------------------------------------------------------------ The following was written by Anne Treffeisen of the Long Island Chapter of TRIO (Transplant Recipients International Organization) (516-421-3258). The week of April 18th to the 24th has been proclaimed National Organ and Tissue Donor Awareness Week by the US Congress. She asks that pastors or rabbis include mention of the gift of life in their sermon or bulletin during this week and provides this message as a guide. ORGAN DONATION AND TRANSPLANTATION FACT SHEET The donation of organs is a unique opportunity to save lives. It is possible for the organs, tissues, and corneas of a single donor to save or help as many as 25 people. Transplantation works. As of 1993, over 160 thousand people have been transplanted, and the majority are living full productive lives more than five years after surgery. Over 28,000 people in the United States, many of them children under 10 years of age, are currently waiting for transplants, and someone is added to the waiting list every 30 minutes. Many will die waiting. All potential recipients are listed on the United Network for Organ Sharing, UNOS, computer. Organs are assigned as they become available considering the severity of a patient's condition, medical requirements (such as blood type, size, and tissue match), proximity to the available organ, and time on the waiting list. More organ donors are needed. Only about 20% of the potential donors actually have their organs donated. Organ donors are healthy people who have died suddenly, usually through accident or head injury. They are brain dead. The organs are kept alive through mechanical means. No one involved with the life saving care of an individual is involved in the transplantation or organ recovery process. No one on the transplant team has any role in the diagnosis, treatment or declaration of death of a patient. Organs for transplant must be made available soon after death. Organ removal will not take place without the permission of the next of kin. Therefore, the decision to donate should have been discussed earlier and the next of kin should understand and be prepared to carry out their loved one's wishes. This is the heart of DONOR AWARENESS. There is no cost or payment to the donor family or estate. All normal funeral arrangements are possible. All religious groups approve of organ and tissue donation as charitable acts toward one's fellow human beings. Organ donation is a true gift. In general, the donor family will never know the recipient. They do know that out of their tragic loss, they have given others life and health. ========================================================================== IV. The organ donor shortage ========================================================================== UNOS statistics reveal that in 1992, on average, 7 people a day died in the US while on the waiting list. As organ transplantation has passed out of the experimental stage, the number of people with end stage diseases seeking a transplant has slowly but steadily increased. The number of donations however, has not increased. Sadly, this is not because there are not more potential donors. Various estimates are that anywhere from 60 to 80% of potential donations are either refused by the next-of-kin or are never requested. These estimates take into account the criteria for brain-dead, heart-beating donors and other contraindications. Roughly half of the missed donations appear to result from failure of physicians to either declare brain death in a timely manner, or their failure to notify their Organ Procurement Organization of potential donors. This is despite enactment in all 50 states of "required request" legislation that mandates that all potential donations be sought. Apparently, there is no enforcement of these laws. There are a variety of proposals to increase the number of donations, for example: public and professional education, and changing the structure of donation from a required opting-in to a required opting-out strategy. These and others have all met with resistance from sectors of the medical community, public and government that don't seem to realize that the present system, and the people trapped in it, are in a crisis situation. References: Wolf JS The role of the United Network for Organ Sharing and designated organ procurement organizations in organ retrieval for transplantation. Arch Pathol Lab Med 1991 Mar;115(3):246-9 Prottas J Batten HL Health professionals and hospital administrators in organ procurement: attitudes, reservations, and their resolutions. Am J Public Health 1988 Jun;78(6):642-5 Annas GJ The paradoxes of organ transplantation [editorial] Am J Public Health 1988 Jun;78(6):621-2 Evans RW Orians CE Ascher NL The potential supply of organ donors. An assessment of the efficacy of organ procurement efforts in the United States. JAMA 1992 Jan 8;267(2):239-46 Spital A Mandated choice. The preferred solution to the organ shortage? Arch Intern Med 1992 Dec;152(12):2421-4 "Solving the Organ Donor Shortage", The Partnership for Organ Donation, Inc. (617)330-8650. UNOS Ethics Committee Reports on alternatives for organ donation: "Financial Incentives for Organ Donation" "Preferred Status for Organ Donors" "An Evaluation of the Ethics of Presumed Consent and a Proposal Based on Required Response" - available from UNOS (804)330-8500 - also available through the Yale biomedical gopher, yaleinfo.yale.edu port 7000 ========================================================================== V. Transplant and organ donation myths ========================================================================== As with any new technology, rumors, myths and misunderstandings about organ transplantation are wide spread. Frustration produced by the high cost, the effect of the organ donor shortage, and the unavailability of transplantation throughout most of the rest of the world have probably contributed to this. Since rumors can often be more entertaining than the truth, tabloid media will often pick up and help spread them, despite the great harm they cause. Urban legends about organ transplantation are uniquely dangerous since organ transplantation can not succeed without the participation and support of the majority of the population. Bad press, urban legends, even fiction portraying organ transplantation as somehow evil, all have prevented full support for donation and led to the death of people who might otherwise be leading productive and happy lives now. Another factor fueling the proliferation of myths is the unfortunate institution in India of payment for unrelated live kidney donation that preys on the poor in that country. While it may be true that the Indian medical community is not required to abide by western standards of ethics, neither is the US medical community required to interact with them, train their physicians, publish their research, etc. Its past time that the US medical community started taking visible responsibility for influencing transplantation ethics in foreign countries. The black market myth: ---------------------- There has never been any evidence produced that a black market in organs, or organ-swiping, exists. Any rumor regarding a black market in organs, or organ piracy, needs to be evaluated in light of the necessity of matching the organ and recipient in order to avoid rejection by the recipient's immune system. One can not take any old organ and just put it anywhere you please. A rather complex system has been set up in the US to handle matching and distribution. Its unlikely that any number of evil people in the US or abroad will be able to duplicate such a system in secret. Adding this simple fact with the necessity of having many highly skilled medical professionals involved, along with modern medical facilities and support, makes it plain why rumors of the involvement of murder, violence and organized crime in organ procurement can not be given any credence. These stories have done great damage to the public's appreciation of the need for organ donation. The racism myth: ---------------- The chance of getting a good organ or tissue match is more likely within an ethnic group. Since minorities in the US have traditionally been less likely to participate in organ and tissue donation, the chances of a patient from one of these groups finding a match is decreased. The urban legend, of course, is that organ distribution discriminates by race and, therefore, donation should be refused since it will punish the oppressors. The tragic reality is that the people they are hurting the most by doing this are the people within their own ethnic group. References: Kallich JD. Wyant T. Krushat M., The effect of DR antigens, race, sex, and peak PRA on estimated median waiting time for a first cadaver kidney transplant. Clinical Transplants. :311-8, 1990. Pike RE. Kahn D. Jacobson JE., Demographic factors influencing consent for cadaver organ donation. South African Medical Journal. 79(5):264-7, 1991 Mar 2. Arnason WB., Thomas Jefferson Memorial Church, Unitarian Universalist, Charlottesville, Va. Directed donation. The relevance of race. Hastings Center Report. 21(6):13-9, 1991 Nov-Dec. Plawecki HM. Plawecki JA., Improving organ donation rates in the black community. Journal of Holistic Nursing. 10(1):34-46, 1992 Mar. Mozes, Hayes, Tang Impediments to Successful Organ Procurement in the "Required Request" Era: An Urban Center Experience Transplantation Proceedings 1991 October; 23(5):2545 The preferential treatment on the US waiting list myth ------------------------------------------------------ Since patients are not listed by name in the regional and national lists, its hard to imagine how this is supposed to take place. It is likely that people taken in by this myth are having a hard time distinguishing preferential treatment on the list (which doesn't exist) with the problems of simple access to health care in general. This is a problem with the entire US health care system and has nothing to do with how patients are treated once they are on the transplant waiting list. ========================================================================== VI. Organ donor awareness postage stamp campaign ========================================================================== A petition is being circulated for a postage stamp to promote organ donor awareness. A similar stamp promoting blood donation had a large impact on increasing blood donation. Copies of the petition are available from the address below but any sheet of paper with names and addresses will do. The following appears at the head of the petition sheet: ------------------------------------------------------------------------- December 31, 1993 Revision No. 11 225,859 signatures secured Ed Heyn, Chairman of Organ Transplants of Southwestern Michigan Support Group, has begun a campaign to create a United States postage stamp to promote organ donor awareness. Eds's group must receive a positive recommendation from the Citizen's Stamp Advisory Committee before they go to the Postmaster General. Please sign this support signature sheet and pass it around. Upon completion please return it to the address on the bottom of this sheet. This stamp will encourage donor awareness, donor awareness saves lives. Please return to Ed Heyn, 8637 Ruggles Rd. Baroda, MI 49101 -------------------------------------------------------------------------- Sources of the "Don't take your organs to heaven. Heaven knows we need them here" bumper sticker and other materials: The Aurora Group in Arkansas: 501-2-CHANCE. The New York Regional Transplant Organization: 212-870-2240 and 212-861-7370 UNOS (see below). ========================================================================== VII. Sources of information on organ donation and transplantation ========================================================================== UNOS ---- The United Network of Organ Sharing is a private, nonprofit, corporation that set up, and continues to receive the federal contracts to run, the Organ Procurement and Transplantation Network (OPTN) and the U.S. Scientific Registry for Organ Transplantation mandated by federal law. In addition to it's responsibilities related to procurement, matching and distribution of solid organs, the latest renewal of these contracts places greater responsibility on UNOS for communicating information to the public concerning organ donation and transplantation. Information from UNOS on a number of topics ranging from transplant center statistics to transplantation ethics is available by e-mail, phone, mail, and through their monthly to bi-monthly magazine "UNOS Update". Sometime toward the middle of 1994, they plan on making data and information available to the general public over Internet. "UNOS Update" June '93, July/August `93 and Sept/Oct `93 issues, the UNOS Ethics Committee whitepaper reports on alternative organ donation and a sample of a recent UNOS statistics report on organ transplantation, are in the TRNSPLNT archive and available through the Yale biomedical gopher (see above). The UNOS 800 number for organ donation information, pamphlets, and organ donor cards is: 1-800-24-donor. To request transplantation statistics, UNOS Update, or ethics committee reports call (804) 330-8500. UNOS Update gratis subscription requests can also be made by writing to Esther Benenson, Managing Editor, UNOS Update, P.O. Box 13770, Richmond, VA 23225-8770. A list of educational material is also available. Some of these require a fee. You can also send a request for information or donor education materials to newmanjd@comm5.unos.org. TRIO ---- The Transplant Recipients International Organization is a network of local support groups that meet for the benefit of members and to promote organ donor awareness. Their national headquarters can put you in touch with your local chapter: (412) 687-2210. They also have pamphlets and organ donor cards available. Long distance love ------------------ The Sept/Oct `93 issue of UNOS Update carried a story about a pen-pal support network for transplant recipients. The address is: Long Distance Love, P.O. Box 2301, Ventnor, NJ 08406. A $6 donation is requested. Encore: Another Chance at Life ------------------------------ A slick magazine published by Chronimed Pharmacy "exclusively for organ transplant patients, their families and friends." Apparently published 4 times a year. "This publication provides a broad look at many issues surrounding organ transplantation and encourages personal stories and feedback from readers." For a gratis subscription write to: Chronimed Publishing, P.O. 46181, Minneapolis, MN, 55446-9920 Local transplant centers and OPOs --------------------------------- Local Organ Procurement Organizations (OPOs) often have education and promotion activities. A local transplantation center will be able to give you information on this. ============================================================================ VIII. Transplant fundraising (BMT Newsletter) ============================================================================ (see also the National Transplant Patient Resources Directory, part 2 of the FAQ) The following is from the BMT Newsletter, November 1993, and reproduced by Kimberly.A.Montgomery.1@ND.EDU with the publisher's permission. Copyright 1993 BMT Newsletter 1985 Spruce Ave. Highland Park, Illinois 60035 708-831-1913 The information is applicable to any kind of transplant fundraising. Two other excellent articles from the BMT Newsletter on organizing fundraising and support are available in the TRNSPLNT archive and will soon be available at the Yale biomedical gopher (yaleinfo.yale.edu port 7000). Agencies Provide Fundraising Help --------------------------------- What do you do when you need to raise $10,000 for a bone narrow transplant, but have no fundraising experience? Some BMT patients have turned to groups such as the Organ Transplant Fund in Memphis TN or the Children's Organ Transplant Association in Bloomington IN for help. The Organ Transplant Fund (OTF) was founded in 1983 to raise funds for organ transplant recipients. Since its inception, the group has orchestrated more than 500 successful fundraising campaigns including 100 for bone narrow transplant patients. On average, $200,000 is raised per patient, says national director Suzanne Norman. Initially, a staff person from Organ Transplant Fund meets with the family to identify a fundraising chairperson, and to set up a committee of local volunteers. "We then meet with the volunteers, help them develop a fundraising plan, and show them how to tap into resources in their community quickly and effectively. We provide them with a fundraising packet and ideas for events, as well as access to low-cost products they might want to sell to raise funds such as cookbooks, candy bars, etc." Funds raised through OTF are used solely to pay transplant-related expenses. OTF controls the funds and administers payments directly to the health care provider. In the event of death, funds remain in the patient's account for up to one year to pay transplant-related bills. Thereafter, the funds are transferred to a general account that provides emergency grants and support services for future patients. "Since contributions to the Organ Transplant Fund are tax-deductible. working with us expands the universe of potential contributors," says Norman. "Large corporations, for example, will simply not make a contribution to an individual but they will contribute to a tax-exempt organization." Fundraising guidance is not the only help Organ Transplant Fund provides. '"We offer our families a multitude of support services such as arranging for lodging and transportation to the transplant center, identifying BMT centers that do transplants for their particular disease, negotiating a reduced down payment at the BMT center so the transplant can begin quickly, etc." says Norman. Organ Transplant Fund retains 5 percent of the funds raised to cover administrative costs. "Many patients have told us that our support services, alone, are worth the price," says Norman. The Children's Organ Transplant Association (COTA) also provides fundraising assistance to organ transplant patients, both children and adults. Founded in 1985, the group has conducted more than 150 fundraising campaigns on behalf of organ transplant patients, approximately half of which have been for bone marrow transplant patients, according to COTA executive director David Cain. "The amount of money varies according to the number of volunteers working on the fundraising campaign and the size of the community." says Cain. "Typically, $75,000-$100,000 can be raised in a period of 60-90 days." Like OTF, COTA asks families to identify a network of volunteers who will orchestrate fundraising activities in the community. "We provide them with a fundraising kit, ideas for events, and help with publicity," says Cain. "Depending on the amount of money to be raised, COTA staff may meet with the family or simply provide guidance over the phone." All contributions are deposited in a tax-exempt COTA fund and are used strictly to pay medical expenses. "It's important that the public have confidence that their contributions will be used only for necessary medical expenses," says Cain. "Having the funds controlled directly by COTA rather than the family provides that assurance." COTA's administrative expenses are covered by the interest earned on the accounts into which funds raised for patients are deposited. All funds are invested in government securities, says Cain. "Our goal is not only to raise funds for transplant patients, but to get the community educated and involved in the process," says Cain. "Our emphasis is on having friends and neighbors help each other." To contact the Organ Transplant Fund, phone 800-489-FUND. To contact the Children's Organ Transplant Association, phone 800-366-2682. Life-Core (Oregon), 503-366-9125, also provides fundraising assistance. ============================================================================ IX. Live kidney donor information ============================================================================ The following is a summary of "Donating a kidney to a family member- How primary care physicians can help prepare potential donors" Authors: Michael L. O'Dell, MD Kristi J. O'Dell, ACSW Thomas T. Crouch, MD VOL 89/NO 3/February 15, 1991/Postgraduate Medicine . Kidney Donation Summarized by Katherine Eberle, eberle@gdls.com for the TRNSPLNT FAQ Jan 1994. Preview When a relative needs a kidney to survive, family members often impulsively offer to donate one without stopping to consider the physical, emotional, and financial ramifications, which can be considerable. The family's primary care physician can be very helpful in guiding and educating potential donors and, by arranging for screening to be done in the community, can ease the financial strain. The authors discuss the things a potential kidney donor should consider. The desirability of transplantation is increasing and the supply of cadaveric kidneys falls far short of the demand. So searching for a possible living related donor is becoming more and more common. Much of the preliminary testing required to identify a donor can be easily performed in the potential donor's community, under the direction of the primary care physician in communication with the transplant team. Additionally, the donor's care is aided when the evaluating physician serves as an advocate. Evaluation for Immunologic Match Usually, the first test performed is determination of ABO blood type compatibility. Many physicians follow ABO compatibility testing with HLA typing. Tests required by most centers and a description of results that may prohibit transplantation: TESTS Potential Disqualifying Factor History and Physical Age under 18 or over 55 yr Examination Obesity Hypertension Systemic disorder with potential to impair health Psychiatric disorder Deep vein thrombosis Family history of polycystic kidney disease, diabetes in both parents, hereditary nephritis, systemic lupus erythematosus Laboratory Studies Blood typing Poor match with recipient Complete blood cell count Anemia or blood dyscrasia Automated biochemical Abnormalities indicating analysis significant disease state Screening for diabetes Evidence of diabetes Serologic tests for syphilis Evidence of current infection Hepatitis B surface antigen, Evidence of current antibodies, core antigen infection Human immunodeficiency virus Evidence of current testing infection 24-hr urine collection for Creatinine Diminished clearance Protein Significant proteinuria Calcium Hypercalciuria Oxalate Hyperoxaluria Urate Hyperuricemia Urine osmolality after Inability to concentrate to overnight thirst >700 mOsm/L Urinalysis Unexplained hematuria and/or other abnormality (eg, proteinuria) Urine culture Evidence of urinary tract infection Pregnancy test (where Positive for pregnancy applicable) HLA typing Poor immunologic match with recipient Radiographic Studies Chest x-ray film Evidence of significant disease Intravenous urography Anatomic abnormality Renal arteriography Anatomic abnormality Other Studies other significant abnormality Tuberculin and Candida skin Evidence of active tests tuberculosis or anergy Multiple gated acquisition Evidence of ischemic heart stress test (in men over age disease 45 yr and women over 50 yr) Pulmonary function testing Significant abnormality in (in smokers) lung function If the potential recipient is a reasonable match, renal angiography is performed to determine which of the donor's kidneys is the more accessible and the better anatomic match and to screen for abnormalities that might preclude uninephrectomy. In general, the left kidney, with its longer renal vein, is selected. Potential donors should also be screened for psychosocial risk factors. An evaluation of the stability of the individual and the family and the financial impact of donation should be undertaken. This is often performed by social workers. An important consideration is psychosocial evaluation is whether the potential donor is being coerced into the donation. Purchase of a kidney is illegal in the United States. Occasionally, evaluators discover potential donors who are unwilling to donate and yet are being significantly pressured to do so by family members. Such persons should be skillfully assisted in resisting such coercion, perhaps by honestly describing them as "not an appropriate match." Potential Disqualifying Psychosocial Factors in Kidney Donor: Evidence of significant coercion to donate Evidence that donation would cause extreme financial hardship Evidence that spouse is strongly opposed to donation Evidence of significant psychiatric disturbance Often, family members spontaneously decide to donate a kidney before they have had an opportunity to consult medical personnel. They make their decision on moral rather than technical grounds, often describing it as "the right thing to do" or their "calling." Effects on the Donor PHYSICAL EFFECTS - The actual risks to the donor from uninephrectomy may be divided into short- and long-term. Short-term risks are those typically seen with this major surgical procedure (ie, pulmonary embolus, severe infection or sepsis, renal failure, hepatitis, myocardial infarction, splenic laceration, pneumothorax). Estimates of the mortality rate are generally less than 0.1% and of significant complications less than 5%. Less than 1% of donors have any permanent disability. Long term risks are controversial and largely unknown. In one third of all donors, nonprogressive proteinuria develops. This finding has led to a recommendation that donors restrict their protein intake after uninephrectomy. In addition, donors experience a slight rise in the serum creatinine level, which is also nonprogressive. PSYCHOSOCIAL EFFECTS - These risks to potential and actual donors may also be short- or long-term. Potential donors who choose not to donate may experience guilt about their decision or be ostracized by the family, although detailed studies of potential donors who choose not to donate are few. About one fourth of those who choose to donate experience moderate to severe financial difficulties. Even though the cost of the evaluation and procedure is borne by the federal End Stage Renal Disease Program, unreimbursed financial losses resulting from job absence and travel can be significant. Most authorities cite a return to work 4 weeks after uncomplicated uninephrectomy. Some centers use donor- specific blood transfusions as a means of enhancing graft survival. This requires blood donation from the potential donor several days before the actual procedure, which may extend the time away from home and work. Troubled marriages may fail when the added stress of a kidney donation is introduced. According to one study, one third of the couples whose marriage failed cited the kidney donation as a major factor in the failure. Although much attention may be lavished on the donor in the perioperative period, it may be short-lived and tends to quickly refocus on the recipient. The recipient may, paradoxically, criticize the donor's decision or become distant or angry toward the donor. However, the increase in self-esteem gained from the altruistic action of donating a kidney may counterbalance such losses. Donation of a kidney has provided many donors with a sense of deep satisfaction. In view of the potential risks to donors, some centers refuse to perform transplantation from a living related donor. With effective immunosuppressive therapy, cadaveric transplantation is quite successful, and these centers argue that the benefit to the recipient is not greatly enhanced by transplantation from a living related donor. However, cadaveric organs are scarce. In contrast, proponents of transplantation from a living related donor argue that thwarting legitimate altruistic behavior by denying the procedure is paternalistic, particularly since enhanced graft survival is noted in such recipients compared with recipients of a cadaveric transplant. Conclusion Although the use of living related donors will remain controversial, everyone involved should be struck by the courage of those willing to donate a kidney to a relative. For physicians providing care to these families, an exceptional opportunity for guidance exists. ============================================================================ X. Renal transplant specific sources and information ============================================================================ (see also the National Transplant Patient Resources Directory, part 2 of the FAQ) contributed by Alex Bost, alex@unx.sas.com *** Periodicals (Magazines) Available to Renal Patients: RenaLife Semi-Annual Publication Publisher: American Association of Kidney Patients Cost: Free with Membership Contact: See AAKP in "Associations" Section For Patients Only Bimonthly Publication Publisher: Contemporary Dialysis, Inc. Cost: $17/year; $27/two years; Canada, $22/year; Foreign, $32/year Contact: For Patients Only 6300 Variel Ave. Suite I. Woodland Hills, CA 91367. *** Do I need a Hepatitis B Vaccine? Hepatitis B is a serious viral disease that attacks the liver. It is highly contagious and is potentially fatal. While there is no cure for the dangerous Hepatitis B, there is a vaccine available. Immunization is recommended for persons of all ages, especially those who are in a high-risk category: healthcare workers; abusers of injectable drugs, sexually active individuals (including heterosexuals with more than one partner in a six month period; homosexuals; bisexuals), patients on dialysis or those receiving frequent blood transfusions, and patients waiting for organ transplantation. If you fit into any of these categories, you should ask your physician about the Hepatitis Vaccine. *** Should I get a Flu Shot? Yearly immunization for the influenza virus is recommended for anyone who has a chronic condition. If you are a transplant recipient or on a donor list, ask your physician about the Flu Vaccine. Starting in 1993, Medicare will pay for the influenza vaccine. =========================================================================== XI. Blood marrow transplant specific sources =========================================================================== The BMT Newsletter is published bi-monthly by a former BMT patient for BMT patients. It is free, although they also accepts contributions. The address is: BMT Newsletter, 1985 Spruce Ave., Highland Park, IL 60035, phone 708-831-1913. BONE MARROW TRANSPLANT SUPPORT NETWORK (800-826-9376) A telephone support network for Bone Marrow Transplant patients & families.