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A Spital

Publications and source records attributed to A Spital.

78 records · Page 5Linked to original sources

Donor's choice or Hobson's choice?

During the evaluation of the living-related renal donor, medical abnormalities may be uncovered. When the added risk to the donor, resulting from such abnormalities, is greater than the chance of a successful transplant, most would agree that such individuals should be excluded from donating. However, when minor abnormalities are uncovered, adding small or unknown risk, is the donor given a choice in his own medical suitability? To answer this, a questionnaire was mailed to transplant centers around the country. The results indicate that many centers do not allow the potential donor to accept uncertain risks. In their effort to protect the donor, these centers actually practice pseudoprotectionism, since they deprive some individuals of the right to give, perhaps one of life's most meaningful experiences. We propose that under the circumstances described, the final decision regarding acceptability for donation should rest with the donor. If this attitude were adopted, perhaps the renal donor pool would increase.

Adult↗

Hyponatremia in adrenal insufficiency: review of pathogenetic mechanisms.

The pathophysiology of hyponatremia in adrenal insufficiency has been a subject of intense controversy. The controversy centers on whether the inability of the kidney to maximally dilute the urine is secondary to increased levels of antidiuretic hormone (ADH) or is independent of ADH. Review of the pertinent studies allows us to conclude that (1) in prolonged glucocorticoid deficiency, plasma ADH levels are elevated because of decreased effective circulating blood volume; (2) in mineralocorticoid deficiency, plasma ADH levels may also be elevated, but in this case because of decreased absolute circulating blood volume; (3) in both instances the elevated ADH levels impair the ability to dilute the urine; and (4) in both glucocorticoid and mineralocorticoid deficiency hemodynamic changes may also contribute, independently of ADH, by limiting delivery of tubular fluid to the diluting site.

Adrenal Insufficiency↗