Lisa's presentation - patible living kidney donation IA 丽莎的演讲不相容的活体肾脏捐赠IA.ppt

INCOMPATIBLE LIVING DONOR KIDNEY TRANSPLANTATION
What Choices?
Lisa Burnapp
Consultant Nurse
Directorate of Nephrology, Transplantation and Urology
Guy’s and St Thomas’ NHS Foundation Trust
London, UK
Our Responsibility
To optimise
Patient outcome
Transplant outcome
Planning
Opportunity & choice
Use of kidneys
Donor safety & well-being
The health economy
The Challenge
More
Patients
Choice & capability
Expectation
Complex
Ethnically diverse
New Trends in Living Donor Transplantation
Extended Criteria (High-Risk) Recipients
‘Recipients at a significantly higher risk of
death, complications or graft failure because
of pre-existing co-morbidity or
immunological status’1
High-risk includes
Immunological/ABO incompatibility
The elderly
Significant co-morbidity
Primary disease
1 Guidelines for Living Donor Kidney Transplantation in High-Risk Adult Recipients, 2008
High-Risk Recipients: Our Approach
Living donation treatment of choice
All patients provided with information early
Evidence and/or lack of evidence shared with recipient and donor
Risk benefit analysis discussed
Tailored management plan agreed
Peer support
Who Makes the Choice?
Patient & family?
What is best for them
Healthcare professionals?
Most clinically effective
Outcome reporting
What is feasible/available
Local logistics/infrastructure
Financial constraints
Primary care Trusts/Commissioners?
Health economics
National Guidance (NICE)
Incompatible Living Kidney Donation
Tailored Option Appraisal
Do nothing
Acceptable if recipient & donor informed of possible options
Paired/pooled donation
Antibody removal strategies (ABO/HLA)
Offer neither
Lack of equity
Paired/Pooled Donation
Compatible living donor transplant
Clinically more straightforward
Logistically challenging
Uncertainty about timing & ‘matchability’
Donors & recipients unknown to one another
indirect donation