[08.09] Overview of Kidney Transplantation and its Ethical Issues V2.pdf

Increasing trend

What is the trend in the number of new Filipinos starting dialysis from 2001 to 2007 according to the chart?

10000

What is the most recent estimate of Filipinos who will need to start dialysis every year?

9th leading cause

Where does kidney failure rank as a cause of death for Filipinos?

Kidney transplantation

What is the treatment of choice for advanced chronic renal failure or end stage renal disease stage 5?

Quality of life

Kidney transplantation provides better results in what specific category compared to dialysis?

Cost effective

Transplantation has been shown to be more what for some patients compared to dialysis?

Every 9 minutes

How often is one patient added to the transplant list?

21

How many patients die every day while waiting for a transplant?

Risk versus benefit evaluation

What must all transplant candidates undergo prior to approval for the procedure?

Active malignancy

Name one condition that would cause a patient to be excluded from transplantation.

NYHA III or IV heart disease

What severity of heart disease is an exclusion for transplantation?

Greater than 30 percent

To avoid exclusion, a patient's ejection fraction should be above what percentage?

Severe CAD or severe valvular disease

Name two specific cardiac conditions that are exclusions.

Irreversible obstructive or restrictive lung disease

What type of lung disease leads to exclusion from transplant?

Multiple myeloma

Which specific plasma cell malignancy is an exclusion for transplant?

LCDD or HCDD

Name two types of deposition diseases that are exclusions for transplant.

AL amyloidosis

Which type of amyloidosis is a contraindication unless in stable remission?

Patient refusal

What is a non medical reason to exclude someone from transplantation?

Properly managed

Transplantation should be delayed until certain disorders are what?

Active infection

What type of infectious state requires a delay in transplantation?

Severe hyperparathyroidism

What metabolic bone related disorder is a reason to delay transplant?

Active peptic ulcer disease or diverticulitis

Name two GI disorders that require delay.

Acute or chronic pancreatitis

What pancreatic condition requires delay?

Asymptomatic cholelithiasis

What gallbladder condition requires delay?

Inflammatory bowel disease

What chronic GI inflammation requires delay?

Systemic Lupus Erythematosus

Name one active immunologic disease that might cause delay.

Unstable psychiatric disorders

What mental health state requires delaying the procedure?

Ongoing substance use disorder

What type of behavioral disorder requires a delay due to decision making risks?

Permanent or irreversible

Cognitive impairment leads to exclusion rather than delay if the condition is what?

Hope vs loss

What is the term for the initial optimism tinged by fears of unfavorable outcomes?

Preparation for living vs dying

What is the term for the balance between promising outlook and the mourning of a deceased donor family?

False starts

What term describes the experience of a delay after initiating the transplant process?

Indebtedness and guilt

What does a recipient often feel toward a living donor regarding their sacrifices?

Survival guilt

What is the term for the recipient's perception that another had to die for them to live?

Chronic disease patients

Which specific group of patients are prone to depression when the wait is long?

Upcoming operation

Over what event do patients often feel anxiety?

Personality impairment

What term describes the potential risk to psychological balance or self esteem after receiving an organ?

Ethics committee

Which body oversees the motivations of both parties in a transplant?

Humanitarian grounds

The ethics committee ensures the process is made purely on what grounds?

Financial gain

The ethics committee ensures the transplant is NOT being made for what?

Coercion

What is the term for persuading someone to do something through force or unethical means?

Urinoma

What is the term for a perirenal pseudocyst caused by leakage between the donor ureter and recipient bladder?

Urinary leak

What technical complication occurs at the anastomosis of the allograft to the bladder?

First 48 hours

Within what timeframe do technical complications like leaks usually occur?

Immunosuppression

What drug treatment leads to an increased risk of infections?

Glucocorticoids

Which class of drugs requires monitoring for avascular necrosis and hyperglycemia?

Prednisone

Name a specific common glucocorticoid mentioned in the source.

GI bleeding and hypertension

Name two side effects of prednisone besides hyperglycemia.

Mycophenolate mofetil

Which drug causes GI side effects and a slightly increased susceptibility to cancer?

Azathioprine

Which drug is associated with bone marrow suppression and lymphopenia?

Cyclosporine

Which drug causes nephrotoxicity?

Creatinine

What lab value must be monitored in patients taking cyclosporine?

OKT3 monoclonal antibody

Which drug is associated with pulmonary edema early in the transplant process?

UTI and wound infections

Name two common infections that occur in the first month after transplant.

Opportunistic organisms

After the first month, what category of organisms causes infections?

Pneumocystis, CMV, and Herpes

Name three opportunistic organisms that cause post transplant infections.

Skin cancer

What is one type of malignancy that has an increased incidence in allograft recipients?

Lymphoproliferative disorders

What type of lymph related malignancy is more common after transplant?

Central nervous system lymphomas

Where in the body can lymphomas specifically occur more often post transplant?

Cadaveric donors

In the US, most organs come from what source?

Living related donors

What type of donors do most US centers pursue to variable degrees?

Deceased donor network and living related donors

Which two types of donor sources are used in the Philippines?

Adults greater than 18 years old

What is the age requirement for a living donor?

Directed or non directed

What are the two classifications of living donors?

Directed donor

What is the term for a donor who names a specific person to receive the kidney?

Living related

What is the term for biologically related blood relatives who donate?

Higher tissue compatibility

Why are living related donors preferred?

Emotionally related

A spouse or friend is categorized as what type of donor?

Biologically unrelated

What is the relationship status of an emotionally related donor?

Non directed non related

What is the term for a person who donates to someone they do not know?

Organ vendors

What is the common term for non directed donors who are not truly altruistic?

Organ allocation system

What must be developed for cadaveric donation to be medically appropriate and ethically fair?

Point system

What kind of system can be used for deceased organ allocation?

Waiting time, immunological matching, urgency, and age

Name four factors used in a deceased donor point system.

Certification of brain death and cardiac death

What must be obtained before an organ is harvested?

Irreversible coma

Brain death destroys the brain's ability to regulate functions, leading to what state?

Two

How many doctors must determine brain death?

WHO Guiding Principle 2

Which principle states certifying doctors must not be involved in the organ removal or transplant?

Non heart beating donors

What is another name for cardiac death donors?

Funeral expenses and travel costs

Name two financial incentives for deceased donor families from the government.

Bread winner

The state may provide compensation for the family of a deceased donor who was the what?

30 days paid leave

Employees who donate a kidney can receive up to how much paid leave?

Lifetime tax exemption and life insurance

Name two suggested but not yet regulated incentives for American donors.

Lower

In the standard hookup method, where is the kidney placed compared to its usual spot?

Pelvic cavity

In what specific body cavity is the allograft placed?

Recipient external iliac artery

To what artery is the donor renal artery anastomosed?

Recipient external iliac vein

To what vein is the donor renal vein anastomosed?

Anti reflux technique

What technique is used when the donor ureter is attached to the recipient bladder?

Beneficence

Which ethical principle involves doing good and avoiding harm?

Psychosocial benefits

What is the primary benefit used to justify the risks for a living donor?

Donor assessment and risk limitation

What is of paramount importance before a living donation can take place?

Decision making capacity

What is the term for a donor's ability to understand info and implications to make a decision?

Justice

Which principle is most important in organ allocation when demand exceeds supply?

Ranking system

What type of system allows organ allocation in a morally justified order of priority?

Availability of organs

Allocation considers matching, patient need, and what third factor?

RA 7170

What is the name of the Organ Donation Act of 1991 in the Philippines?

Sound mind

According to RA 7170, a legacy of one's body takes effect after death if the person was of what mind?

Late 1990s to early 2000s

When was there a steep surge in kidney transplantation in the Philippines?

52 percent

What was the percentage increase during the surge of transplant procedures in the Philippines?

Living donors

Which category of donors markedly outnumbered deceased donors during the surge?