Editing Kidney transplantation (section)

=== Living donors ===
Approximately one in three donations in the US, UK, and Israel is now from a live donor.<ref>{{cite news |url=http://www.thisisstaffordshire.co.uk/health/transplanted-kidneys-come-living-donors/article-721562-detail/article.html |title=How to become an organ donor |newspaper=[[The Sentinel (Staffordshire)|The Sentinel]] |date=24 February 2009 |access-date=19 December 2010 }}</ref><ref>[https://web.archive.org/web/20121106121822/http://www.highbeam.com/doc/1P1-5994618.html HighBeam] Judy Siegel, "Live liver and lung donations approved. New regulations will give hope to dozens." 'Jerusalem Post', 9 May 1995 "(subscription required)</ref><ref>"National Data Reports". The Organ Procurement and Transplant Network (OPTN). dynamic. Retrieved 22 October 2013.  (the link is to a query interface; Choose Category = Transplant, Organ = Kidney, and select the 'Transplant by donor type' report link)</ref> Potential donors are carefully evaluated on medical and psychological grounds. This ensures that the donor is fit for surgery and has no disease which brings undue risk or likelihood of a poor outcome for either the donor or recipient. The psychological assessment is to ensure the donor gives informed consent and is not coerced. In countries where paying for organs is illegal, the authorities may also seek to ensure that a donation has not resulted from a financial transaction.
[[File:Kidney for transplant from live donor.jpg|thumb|Kidney for transplant from live donor]]

The relationship the donor has to the recipient has evolved over the years. In the 1950s, the first successful living donor transplants were between identical twins. In the 1960s–1970s, live donors were genetically related to the recipient. However, during the 1980s–1990s, the donor pool was expanded further to emotionally related individuals (spouses, friends). Now the elasticity of the donor relationship has been stretched to include acquaintances and even strangers ('altruistic donors'). In 2009, US transplant recipient [[Chris Strouth]] received a kidney from a donor who connected with him on [[Twitter]], which is believed to be the first such transplant arranged entirely through social networking.<ref name = "Minnesota Medicine">{{cite web|url=http://www.minnesotamedicine.com/Past-Issues/Past-Issues-2010/August-2010/Pulse-More-than-Friends-and-Followers-Aug-2010|title=More than Friends and Followers: Facebook, Twitter, and other forms of social media are connecting organ recipients with donors.|publisher=Minnesota Medicine|first=Kim|last=Kiser|date=August 2010 |access-date=17 October 2014}}</ref><ref name = "rickilake">{{Cite episode|title=To Share or Not to Share on Social Media|access-date=17 October 2014|series=[[The Ricki Lake Show]]|network=[[20th Television]]|airdate=4 October 2014|season=1|number=19|time=29:40|url=https://www.youtube.com/watch?v=LPUc8xmukPA| archive-url=https://web.archive.org/web/20130803082753/http://www.youtube.com/watch?v=LPUc8xmukPA&gl=US&hl=en| archive-date=2013-08-03 | url-status=dead}}</ref>

Exchanges and chains are a novel approach to expand the living donor pool. In February 2012, this novel approach to expand the living donor pool resulted in the largest chain in the world, involving 60 participants organized by the [[National Kidney Registry]].<ref>{{cite news|last=Sack|first=Kevin|date=18 February 2012|title=60 Lives, 30 Kidneys, All Linked|url=https://www.nytimes.com/2012/02/19/health/lives-forever-linked-through-kidney-transplant-chain-124.html|newspaper=New York Times}}</ref> In 2014 the record for the largest chain was broken again by a swap involving 70 participants.<ref>{{cite news|last=Pitts|first=Byron|date=15 April 2015|title=Changing Lives Through Donating Kidneys to Strangers|url=https://abcnews.go.com/Health/donating-kidney-complete-stranger-order-save-loved/story?id=30288400|publisher=ABC News Nightline}}</ref> The acceptance of altruistic donors has enabled chains of transplants to form. Kidney chains are initiated when an altruistic donor donates a kidney to a patient who has a willing but incompatible donor. This incompatible donor then 'pays it forward' and passes on the generosity to another recipient who also had a willing but incompatible donor. Michael Rees from the University of Toledo developed the concept of open-ended chains.<ref>{{cite journal |author1=Rees M. A. |author2=Kopke J. E. |author3=Pelletier R. P. |author4=Segev D. L. |author5=Rutter M. E. |author6=Fabrega A. J. | year = 2009 | title = A nonsimultaneous, extended, altruistic-donor chain | url = http://nrs.harvard.edu/urn-3:HUL.InstRepos:29408291| journal = The New England Journal of Medicine | volume = 360 | issue = 11| pages = 1096–1101 | doi = 10.1056/NEJMoa0803645 |display-authors=etal | pmid=19279341|s2cid=2581617 | doi-access=free }}</ref> This was a variation of a concept developed at Johns Hopkins University.<ref>{{cite journal |author1=Montgomery R. A. |author2=Gentry S. E. |author3=Marks W. H. |author4=Warren D. S. |author5=Hiller J. |author6=Houp J. | year = 2006 | title = Domino paired kidney donation: a strategy to make best use of live non-directed donation | journal = Lancet | volume = 368 | issue = 9533| pages = 419–421 | doi = 10.1016/S0140-6736(06)69115-0 |display-authors=etal | pmid=16876670|citeseerx=10.1.1.576.6386 |s2cid=2035816 }}</ref>  On 30 July 2008, an altruistic donor kidney was shipped via commercial airline from Cornell to UCLA, thus triggering a chain of transplants.<ref>{{cite journal |author1=Butt F. K. |author2=Gritsch H. A. |author3=Schulam P. |author4=Danovitch G. M. |author5=Wilkinson A. |author6=Del Pizzo J. | year = 2009 | title = Asynchronous, Out-of-Sequence, Transcontinental Chain Kidney Transplantation: A Novel Concept | journal = American Journal of Transplantation | volume = 9 | issue = 9| pages = 2180–2185 | doi = 10.1111/j.1600-6143.2009.02730.x |display-authors=etal | pmid=19563335|s2cid=26186779 |doi-access=free }}</ref> The shipment of living donor kidneys, computer-matching software algorithms, and cooperation between transplant centers has enabled long-elaborate chains to be formed.<ref>{{cite news|last=Sack|first= Kevin.|title=60 Lives, 30 Kidneys, All Linked|work= [[The New York Times]]|date=19 February 2012|url= https://www.nytimes.com/2012/02/19/health/lives-forever-linked-through-kidney-transplant-chain-124.html|access-date=22 October 2013}}</ref>

In 2004, the FDA approved the Cedars-Sinai High Dose IVIG therapy which reduces the need for the living donor to be the same [[blood type]] (ABO compatible) or even a tissue match.<ref name="dupeRef1">{{cite web|url=http://www.csmc.edu/12391.html|title=Kidney and Pancreas Transplant Center – ABO Incompatibility|publisher= Cedars-Sinai Medical Center|access-date=12 October 2009}}</ref><ref name="pmid15579530">{{cite journal  |vauthors=Jordan SC, Tyan D, Stablein D, etal | title = Evaluation of intravenous immunoglobulin as an agent to lower allosensitization and improve transplantation in highly sensitized adult patients with end-stage renal disease: report of the NIH IG02 trial | journal = J Am Soc Nephrol | volume = 15 | issue = 12 | pages = 3256–62 |date=December 2004 | pmid = 15579530 | doi = 10.1097/01.ASN.0000145878.92906.9F | doi-access = free }}</ref> The therapy reduced the incidence of the recipient's immune system rejecting the donated kidney in highly sensitized patients.<ref name="pmid15579530" />

In carefully screened kidney donors, survival and the risk of end-stage renal disease appear to be similar to those in the general population.<ref>{{cite journal|journal=N Engl J Med|year=2009|volume=360|issue=5|pages=459–46|doi=10.1056/NEJMoa0804883|title=Long-Term Consequences of Kidney Donation|author=Ibrahim, H. N.|pmid=19179315|last2=Foley|first2=R|last3=Tan|first3=L|last4=Rogers|first4=T|last5=Bailey|first5=RF|last6=Guo|first6=H|last7=Gross|first7=CR|last8=Matas|first8=AJ|pmc=3559132}}</ref> However, some more recent studies suggest that lifelong risk of [[chronic kidney disease]] is several-fold higher in kidney donors although the absolute risk is still very small.<ref>{{cite journal |vauthors=Muzaale AD, Massie AB, Wang MC, Montgomery RA, McBride MA, Wainright JL, Segev DL |title=Risk of end-stage renal disease following live kidney donation |journal=JAMA |volume=311 |issue=6 |pages=579–86 |date=12 February 2014 |pmid=24519297
|pmc=4411956 |doi=10.1001/jama.2013.285141 |url=}}</ref>

A 2017 article in the ''[[New England Journal of Medicine]]'' suggests that persons with only one kidney, including those who have donated a kidney for transplantation, should avoid a high protein diet and limit their protein intake to less than one gram per kilogram body weight per day in order to reduce the long-term risk of chronic kidney disease.<ref>{{cite journal |vauthors=Kalantar-Zadeh K, Fouque D |title=Nutritional management of chronic kidney disease |journal=N. Engl. J. Med. |volume=377 |issue=18 |pages=1765–1776 |date=2 November 2017 |pmid=29091561
|doi=10.1056/NEJMra1700312 |s2cid=27499763 |url=https://escholarship.org/uc/item/02m5c6qr }}</ref> Women who have donated a kidney have a higher risk of [[gestational hypertension]] and [[preeclampsia]] than matched nondonors with similar indicators of baseline health.<ref name="GargNevis2014">{{cite journal|last1=Garg|first1=Amit X.|last2=Nevis|first2=Immaculate F.|last3=McArthur|first3=Eric|last4=Sontrop|first4=Jessica M.|last5=Koval|first5=John J.|last6=Lam|first6=Ngan N.|last7=Hildebrand|first7=Ainslie M.|last8=Reese|first8=Peter P.|last9=Storsley|first9=Leroy|last10=Gill|first10=John S.|last11=Segev|first11=Dorry L.|last12=Habbous|first12=Steven|last13=Bugeja|first13=Ann|last14=Knoll|first14=Greg A.|last15=Dipchand|first15=Christine|last16=Monroy-Cuadros|first16=Mauricio|last17=Lentine|first17=Krista L.|title=Gestational Hypertension and Preeclampsia in Living Kidney Donors|journal=New England Journal of Medicine|year=2014|pages=124–133|issn=0028-4793|doi=10.1056/NEJMoa1408932|pmid=25397608|volume=372|issue=2|pmc=4362716}}</ref>

====Surgical procedure====
Traditionally, the donor procedure has been through a single incision of {{convert|4|-|7|in|cm}}, but live donation is being increasingly performed by [[laparoscopic surgery]]. This reduces pain and accelerates recovery for the donor. Operative time and complications decreased significantly after a surgeon performed 150 cases. Live donor kidney grafts have higher long-term success rates than those from deceased donors.<ref>{{cite web |url= http://www.nhs.uk/conditions/Kidney-transplant/Pages/Introduction.aspx |title=Kidney Transplant |publisher=[[National Health Service]] |date=29 March 2010 |access-date=19 November 2011}}</ref> Since the increase in the use of laparoscopic surgery, the number of live donors has increased. Any advance which leads to a decrease in pain and scarring and swifter recovery has the potential to boost donor numbers.  In January 2009, the first [[robotic surgery|all-robotic]] kidney transplant was performed at [[Saint Barnabas Medical Center]], located in [[Livingston, New Jersey]], through a two-inch incision. In the following six months, the same team performed eight more robotic-assisted transplants.<ref>[http://wcbstv.com/health/da.vinci.robot.2.1055154.html New Robot Technology Eases Kidney Transplants] {{Webarchive|url=https://web.archive.org/web/20090804104220/http://wcbstv.com/health/da.vinci.robot.2.1055154.html |date=4 August 2009 }}, ''CBS News'', 22 June 2009 – accessed 8 July 2009</ref>

In 2009, at [[Johns Hopkins Hospital]] in [[Baltimore]], a healthy kidney was removed through the donor's vagina. Vaginal donations promise to speed recovery and reduce scarring.<ref>{{cite news|url=http://news.bbc.co.uk/2/hi/health/7867837.stm|title=  Donor kidney removed via vagina|access-date=12 October 2009 | date=3 February 2009 | work=BBC News}}</ref> The first donor was chosen as she had previously had a [[hysterectomy]].<ref>{{cite news|url=http://edition.cnn.com/2009/HEALTH/02/03/kidney.vagina.surgery/index.html|title=Surgeons remove healthy kidney through donor's vagina - CNN.com|publisher=cnn.com|access-date=12 October 2009 | date=3 February 2009}}</ref> The extraction was performed using [[natural orifice transluminal endoscopic surgery]], where an [[endoscope]] is inserted through an orifice, then through an internal incision, so that there is no external scar. The recent advance of [[single port laparoscopy]] requiring only one entry point at the navel is another advance with potential for more frequent use.

====Organ trade====
{{main|Organ trade}}
In the developing world, some people sell their organs illegally. Such people are often in grave poverty<ref>{{cite news |url=https://query.nytimes.com/gst/fullpage.html?res=9C0CE0DD163EF930A15756C0A9629C8B63 |title=The Organ Trade – A Global Black Market – Tracking the Sale of a Kidney On a Path of Poverty and Hope |newspaper=[[New York Times]] |date=23 May 2004 |last1=Rohter |first1=Larry |access-date=19 December 2010 }}</ref> or are exploited by salespersons. The people who travel to make use of these kidneys are often known as 'transplant tourists'. This practice is opposed by a variety of human rights groups, including Organs Watch, a group established by medical anthropologists, which was instrumental in exposing illegal international organ selling rings. These patients may have increased complications owing to poor infection control and lower medical and surgical standards. One surgeon has said that organ trade could be legalised in the UK to prevent such tourism, but this is not seen by the [[National Kidney Research Fund]] as the answer to a deficit in donors.<ref>{{Cite news|url=http://news.bbc.co.uk/2/hi/health/3041363.stm|title=Call to legalise live organ trade|date=19 May 2003|via=news.bbc.co.uk}}</ref>

In the illegal black market, the donors may not get sufficient after-operation care,<ref name=wsj>[https://online.wsj.com/news/articles/SB10001424052748703481004574646233272990474?mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB10001424052748703481004574646233272990474.html#mod=todays_us_weekend_journal The Meat Market], The Wall Street Journal, 8 January 2010.</ref> the price of a kidney may be above $160,000,<ref>{{cite web|url=https://www.cbsnews.com/news/black-market-kidneys-160000-a-pop/ |title=Black Market Kidneys, $160,000 a Pop |last=Martinez |first=Edecio |date=27 July 2009 |work=CBS News |access-date=12 June 2011 |url-status=live |archive-url=https://web.archive.org/web/20121104053745/http://www.cbsnews.com/8301-504083_162-5190413-504083.html |archive-date=4 November 2012 }}</ref> middlemen take most of the money, the operation is more dangerous to both the donor and receiver, and the buyer often gets [[hepatitis]] or [[HIV]].<ref name=Economist/> In legal markets of Iran the price of a kidney is $2,000 to $4,000.<ref name=Economist>{{cite magazine|url=http://www.economist.com/node/8173039?story_id=8173039|title=Psst, wanna buy a kidney?|date=16 November 2006|magazine=Organ transplants|publisher=The Economist Newspaper Limited 2011|access-date=12 June 2011}}</ref><ref>{{cite web|url=http://www.aakp.org/aakp-library/Compensated-Donations/|title=A New Outlook on Compensated Kidney Donations|last=Schall|first=John A.|date=May 2008|work=RENALIFE|publisher=American Association of Kidney Patients|access-date=14 June 2011|url-status=dead|archive-url=https://web.archive.org/web/20110927221324/http://www.aakp.org/aakp-library/Compensated-Donations/|archive-date=27 September 2011}}</ref>

An article by [[Gary Becker]] and Julio Elias on "Introducing Incentives in the market for Live and Cadaveric Organ Donations"<ref>{{cite news |url=http://graphics8.nytimes.com/images/blogs/freakonomics/pdf/BeckerEliasOrgans(5-06).pdf |newspaper=New York Times |title=Introducing Incentives in the Market for Live and Cadaveric Organ Donations |author1=Gary S. Becker |author2=Julio Jorge Elías |access-date=24 December 2013}}</ref> said that a [[free market]] could help solve the problem of a scarcity in organ transplants. Their economic modeling was able to estimate the price tag for human kidneys ($15,000) and human livers ($32,000).

Jason Brennan and Peter Jaworski from [[Georgetown University]] have also argued that any moral objections to a market for organs are not inherent in the market, but rather the activity itself.<ref>{{cite web|url=http://www.cato-unbound.org/2015/11/02/jason-brennan-peter-jaworski/you-may-do-it-free-you-may-do-it-money|title=If You May Do It for Free, You May Do It for Money|last1=Comments|last2=Tweet|last3=Like|last4=Submit|last5=Plus|date=2 November 2015|website=Cato Unbound}}</ref>

Monetary compensation for organ donors in the form of reimbursement for out-of-pocket expenses, has been legalised in 23 countries<ref>{{Cite journal |last1=Siddique |first1=Abu Bakkar |last2=Apte |first2=Vandana |last3=Fry-Revere |first3=Sigrid |last4=Jin |first4=Yanhong |last5=Koizumi |first5=Naoru |date=2020-08-01 |title=The impact of country reimbursement programmes on living kidney donations |url=https://gh.bmj.com/content/5/8/e002596 |journal=BMJ Global Health |language=en |volume=5 |issue=8 |pages=e002596 |doi=10.1136/bmjgh-2020-002596 |issn=2059-7908 |pmid=32792408|pmc=7430320 }}</ref> including the [[United States]]<ref>{{Cite web |title=National Living Donor Assistance Center > How to Apply > Eligibility Guidelines |url=https://www.livingdonorassistance.org/How-to-Apply/Eligibility-Guidelines |access-date=2023-02-28 |website=www.livingdonorassistance.org}}</ref> [[United Kingdom]],<ref>{{Cite web |title=Reimbursement of Living Donor Expenses |url=https://www.kidney.org.uk/reimbursement-of-living-donor-expenses |access-date=2023-02-28 |website=National Kidney Federation |date=15 April 2019 |language=en}}</ref> [[Australia]]<ref name="aus">{{Cite news|last=Plibersek|first=Tanya|date=7 April 2013|title=Supporting Paid Leave for Living Organ Donors|url=https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id:%22media/pressrel/2357133%22|access-date=18 August 2021}}</ref> and [[Singapore]].<ref name=bmj>{{cite journal | year = 2008 | title = Singapore legalises compensation payments to kidney donors | url = http://www.bmj.com/content/337/bmj.a2456 | journal = BMJ | volume = 337 | page = a2456 | doi = 10.1136/bmj.a2456 | pmid = 18996933 | last1 = Bland | first1 = B | s2cid = 38062784 }}</ref><ref>{{Cite web|date=15 April 2009|title=Singapore: Human Organ Transplant Act Amended|url=https://www.loc.gov/item/global-legal-monitor/2009-04-15/singapore-human-organ-transplant-act-amended/|access-date=19 August 2021|website=Library of Congress}}</ref>