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Attitudes among transplant professionals regarding shifting paradigms in eligibility criteria for live kidney donation.

Attitudes among transplant professionals regarding shifting paradigms in eligibility criteria for live kidney donation.
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Lafranca JA, Spoon EQW, van de Wetering J, IJzermans JNM, Dor FJMF,


Lafranca JA, Spoon EQW, van de Wetering J, IJzermans JNM, Dor FJMF, (click to view)

Lafranca JA, Spoon EQW, van de Wetering J, IJzermans JNM, Dor FJMF,

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PloS one 2017 07 2112(7) e0181846 doi 10.1371/journal.pone.0181846
Abstract
BACKGROUND
The transplant community increasingly accepts extended criteria live kidney donors, however, great (geographical) differences are present in policies regarding the acceptance of these donors, and guidelines do not offer clarity. The aim of this survey was to reveal these differences and to get an insight in both centre policies as well as personal beliefs of transplant professionals.

METHODS
An online survey was sent to 1128 ESOT-members. Questions were included about several extended donor criteria; overweight/obesity, older age, vascular multiplicity, minors as donors and comorbidities; hypertension, impaired fasting glucose, kidney stones, malignancies and renal cysts. Comparisons were made between transplant centres of three regions in Europe and between Europe and other countries worldwide.

RESULTS
331 questionnaires were completed by professionals from 55 countries. Significant differences exist between regions in Europe in acceptance of donors with several extended criteria. Median refusal rate for potential live donors is 15%. Furthermore, differences are seen regarding pre-operative work-up, both in specialists who perform screening as in preoperative imaging.

CONCLUSIONS
Remarkably, 23.4% of transplant professionals sometimes deviate from their centre policy, resulting in more or less comparable personal beliefs regarding extended criteria. Variety is seen, proving the need for a standardized approach in selection, preferably evidence based.

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