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Biomedical subjects

A Spital

Publications and source records attributed to A Spital.

At least 37 records · Page 2Linked to original sources
PubMed1996

Health insurance for kidney donors: how easy is it to obtain?

Because there is a severe shortage of cadaver organs, living donors are a valuable source of kidneys for patients with end-stage renal disease. One area of concern to many potential donors is their ability to obtain health insurance after donation. To investigate this issue, we surveyed 99 health insurance organizations in the United States, including the 10 largest health maintenance organizations, asking for their views and practices regarding living kidney donors; 44% of these organizations responded. The responses were strikingly uniform and indicate that healthy kidney donors should be able to obtain and maintain health insurance at standard rates. This information should be reassuring for concerned people who are considering donating a kidney.

Humans↗
PubMed1996

Mandated choice for organ donation: time to give it a try.

A severe shortage of organs greatly limits the ability to deliver the miracle of transplantation to people suffering from end-stage organ disease. Contributing to this shortage is a high rate of refusal among families who are asked for permission to remove organs from a recently deceased relative. Mandated choice offers an alternative to obtaining consent from the family by returning control to the individual. This plan would require all adults to record their wishes about posthumous organ donation and would consider those wishes binding. By moving the decision-making process to a relaxed setting and ensuring that a person's wishes would be honored, mandated choice would hopefully take advantage of favorable public attitudes toward donation and thereby facilitate organ procurement. Preliminary research suggests that public commitment to organ donation would increase under mandated choice. A pilot study of this promising proposal should be undertaken.

Adult↗
PubMed1996

Do U.S. transplant centers encourage emotionally related kidney donation?

Stimulated by a severe organ shortage and an improving ability to successfully transplant poorly matched donor-recipient pairs, many transplant centers are now willing to accept emotionally related (but genetically unrelated) people (e.g., spouses) as kidney donors. To see whether this practice is encouraged, a survey was mailed to all 209 adult renal transplant centers in the United States. Of the 154 (74%) responding centers, 90% said they accept emotionally related donors and 60% said they actually encourage this practice. Nearly 40% prefer spouses to cadavers, while only 21% prefer friends to cadavers. To further explore the degree to which emotionally related donation is encouraged, a second questionnaire was sent to a sample of centers (n = 51) that support this practice; 94% responded. While only 44% said they encourage the use of friends, nearly all of these preselected centers said they encourage spouses to donate. On the other hand, judging from their stated approach to this issue, only about half of these supportive centers seem to actively encourage emotionally related donation. These data suggest that, overall, at most only about one third of U.S. transplant centers actively encourage spousal donation and at most about one quarter encourage the use of friends. Consistent with these results, emotionally related donors contribute only a small fraction of all kidneys transplanted in this country. If the large potential contribution of emotionally related donors is ever to be realized, transplant centers must go beyond simply accepting such individuals and begin to actively encourage their participation. Medical and ethical considerations strongly support this proposal.

Adult↗
PubMed1995

Mandated choice. A plan to increase public commitment to organ donation.

OBJECTIVES: To estimate the impact of mandated choice--a system that requires competent adults to decide prospectively whether or not they wish to be organ donors when they die--on public commitment to organ donation; and to explore who is best suited to provide consent--the family or the individual? DESIGN: A national, random-digit telephone survey conducted by the Gallup Organization in July 1993. PARTICIPANTS: A representative sample (n = 1002) of adults (aged 18 years and older) living in homes with telephones in the continental United States. RESULTS: Although the majority of respondents had given at least some thought to organ donation, only 25% had carefully considered this issue. Overall, 30% had decided to donate, but 58% were undecided and only 38% had made their wishes known to a family member. Yet the vast majority (82%) believes that the best way to obtain consent is for each adult to decide for himself or herself, rather than leaving this decision for the family. Under mandated choice, which is designed to encourage such self-determination, 63% would sign up to donate, 24% would not, and 13% were unsure. CONCLUSIONS: Only a small fraction of the US public is currently committed to organ donation and relatively few people have carefully considered and communicated their wishes regarding this important issue. Therefore, the difficult question of consent is often left for the family. Yet most people believe that ideally all adults should answer this question for themselves, in contrast to our present family-oriented approach, but consistent with the design of mandated choice. If mandated choice became law, it appears that most adults would sign up to donate, thereby increasing the pool of desperately needed committed donors.

Family↗
PubMed1995

Extrarenal potassium adaptation: review of a concept.

Animals chronically fed a high-potassium diet may survive an acute potassium load which is lethal to animals fed a control diet. This 'potassium tolerance' is clearly related to an enhanced ability of the kidneys to excrete potassium. However, in their now classic studies, Alexander and Levinsky suggested that a nonrenal mechanism also contributes to this phenomenon. They showed that despite nephrectomy just prior to acute potassium loading, animals accustomed to a high-potassium diet had a smaller increment in plasma potassium than did controls. As a result of this work, it is now widely believed that chronic exposure to large amounts of potassium somehow directly enhances cellular potassium uptake, a process referred to as extrarenal potassium adaptation. However, it is important to note that in these studies, the animals were fasted prior to nephrectomy. We have shown that when potassium is withdrawn from potassium-adapted animals, high rates of potassium excretion persist and eventually result in the development of paradoxical potassium depletion. We believe that it is this potassium depletion which accounts for the enhancement of cellular potassium uptake sometimes seen in potassium-adapted animals. Indeed, extrarenal potassium adaptation can only be demonstrated after a prolonged period of dietary potassium withdrawal has provided the opportunity for potassium depletion to occur. Furthermore, there is actually little evidence that chronic potassium feeding directly enhances the cellular uptake of an acute potassium load. We conclude that extrarenal potassium adaption is a time-honored concept which, for practical purposes, does not exist.

Adaptation, Physiological↗
PubMed1995

Renal biopsy.

Explore the source record for details and available documents.

Biopsy↗
PubMed1994

Unrelated living kidney donors. An update of attitudes and use among U.S. transplant centers.

A severe shortage of organs is perhaps the most important obstacle facing transplantation today. In an attempt to address this serious problem, several transplant centers have suggested a reconsideration of genetically unrelated living kidney donors. Recently, there have been reports of excellent results using such unconventional donors, and cogent arguments have been made that this approach is ethically acceptable, at least when the donor is motivated by altruism. To see what impact this new information has had on the transplant community, I mailed a questionnaire to all adult renal transplant centers in the United States asking for their views and practices regarding unrelated living kidney donation. Of the 127 (64%) responding, 88% would accept spouses as donors, 63% would accept friends, and 15% would even consider altruistic strangers. When compared with the results of a similar survey completed six years ago, it became clear that support for unrelated living kidney donation had increased, as the great majority of centers now believe that emotionally related donors are acceptable. On the other hand, while more of these donors are being used, they still account for only a small fraction of all kidney transplants. It appears that medical successes and favorable ethical arguments have generated broad support for some types of unrelated living donors, but more in principle than in practice, as there still seems to be some hesitation to actually proceed. It is hoped that dissemination of the favorable attitudes uncovered will reduce anxiety and thereby encourage greater use of unrelated living donors, a large and valuable source of kidneys.

Adult↗