Fasting before living-kidney donation: effect on donor well-being and postoperative recovery: study protocol of a multicenter randomized controlled trial

Background One of the main effectors on the quality of life of living-kidney donors is postoperative fatigue. Caloric restriction (CR) and short-term fasting (STF) are associated with improved fitness and increased resistance to acute stress. CR/STF increases the expression of cytoprotective genes, increases immunomodulation via increased anti-inflammatory cytokine production, and decreases the expression of pro-inflammatory markers. As such, nutritional preconditioning by CR or STF represents a non-invasive and cost-effective method that could mitigate the effects of acute surgery-induced stress and postoperative fatigue. To investigate whether preoperative STF contributes to a reduction in fatigue after living-kidney donation, a randomized clinical trial is indicated. Methods We aim to determine whether 2.5 days of fasting reduces postoperative fatigue score in subjects undergoing living-kidney donation. In this randomized study, the intervention group will follow a preoperative fasting regime for 2.5 days with a low-dose laxative, while the control group will receive standard care. The main study endpoint is postoperative fatigue, 4 weeks after living-kidney donation. Secondary endpoints include the effect of preoperative fasting on postoperative hospital admission time, the feasibility of STF, and the postoperative recovery of donor and recipient kidney function. This study will provide us with knowledge of the feasibility of STF and confirm its effect on postoperative recovery. Discussion Our study will provide clinically relevant information on the merits of caloric restriction for living-kidney donors and recipients. We expect to reduce the postoperative fatigue in living-kidney donors and improve the postoperative recovery of living-kidney recipients. It will provide evidence on the clinical merits and potential caveats of preoperative dietary interventions. Trial registration Netherlands Trial Register NL9262. EudraCT 2020-005445-16. MEC Erasmus MC MEC-2020-0778. CCMO NL74623.078.21

'It's hard to ask': Examining the factors influencing decision-making amongst end-stage renal disease patients considering asking friends and family for a kidney

<p>Background: Organ donation is an important facet of healthcare delivery in New Zealand, with donation often leading to an increased quality of life for recipients, and a reduction in healthcare costs for the community. People who require new organs have limited options in regards to organ access: they can receive organs from deceased donors, or if a kidney is not volunteered, they might ask someone to donate. For those that choose to ask someone to donate an organ, one barrier that is sometimes voiced is that it is hard to ask family and friends to donate. This project sought to explore the issues surrounding asking for an organ by end-stage renal disease (ESRD) patients, in order to gain a better understanding of the decision-making process and motivations of patients as they choose or decline to approach others for a kidney. Methods: Participants were recruited from patients with ESRD through the Hawke’s Bay District Health Board. Potential participants were identified as being on the deceased donor list (DDL), or had family or friends being worked up for living kidney donation (LKD). Participants were interviewed and asked about the challenges of asking for a kidney, including such questions as: Who did they ask, and why? Who did they exclude, and why? How did they approach the request, and what were their reasons for asking in this way? Could they identify additional strategies which might have been useful to them, but were either not considered or unavailable? A qualitative descriptive approach was utilised to analyse interview data. Results: Fifteen participants were interviewed, with most stating that it was hard to ask for a kidney and almost half having never approached anyone for a kidney. For many patients, being expected to recruit donors for LKD was a barrier in itself. Commonly identified themes indicate that recipients may be concerned for the health and wellbeing of their loved ones, or have limited recruitment opportunities, or poor health literacy or self-efficacy. Many Maori recipients stated they favoured a whanau approach to discussing transplant, and most recipients desired more support in order to facilitate approaching donors. Conclusions: Findings suggest it would be useful to develop a screening tool assessing willingness and motivation to accept a living kidney donation along with self-efficacy, communication and health literacy levels prior to recipients initiating conversations with potential donors, in order to provide tailored support to the recipient with their initial approach. Additionally, psycho-social support could be offered to all recipients to help identify unmet needs or further barriers such as reciprocity or relationship concerns. Finally, closer communication between health professionals who provide care for the recipient, as well as positive media stories and campaigns that raise awareness of the need to transplant may create opportunities for LKD to be discussed within the recipient’s social network.</p>

'It's hard to ask': Examining the factors influencing decision-making amongst end-stage renal disease patients considering asking friends and family for a kidney

<p>Background: Organ donation is an important facet of healthcare delivery in New Zealand, with donation often leading to an increased quality of life for recipients, and a reduction in healthcare costs for the community. People who require new organs have limited options in regards to organ access: they can receive organs from deceased donors, or if a kidney is not volunteered, they might ask someone to donate. For those that choose to ask someone to donate an organ, one barrier that is sometimes voiced is that it is hard to ask family and friends to donate. This project sought to explore the issues surrounding asking for an organ by end-stage renal disease (ESRD) patients, in order to gain a better understanding of the decision-making process and motivations of patients as they choose or decline to approach others for a kidney. Methods: Participants were recruited from patients with ESRD through the Hawke’s Bay District Health Board. Potential participants were identified as being on the deceased donor list (DDL), or had family or friends being worked up for living kidney donation (LKD). Participants were interviewed and asked about the challenges of asking for a kidney, including such questions as: Who did they ask, and why? Who did they exclude, and why? How did they approach the request, and what were their reasons for asking in this way? Could they identify additional strategies which might have been useful to them, but were either not considered or unavailable? A qualitative descriptive approach was utilised to analyse interview data. Results: Fifteen participants were interviewed, with most stating that it was hard to ask for a kidney and almost half having never approached anyone for a kidney. For many patients, being expected to recruit donors for LKD was a barrier in itself. Commonly identified themes indicate that recipients may be concerned for the health and wellbeing of their loved ones, or have limited recruitment opportunities, or poor health literacy or self-efficacy. Many Maori recipients stated they favoured a whanau approach to discussing transplant, and most recipients desired more support in order to facilitate approaching donors. Conclusions: Findings suggest it would be useful to develop a screening tool assessing willingness and motivation to accept a living kidney donation along with self-efficacy, communication and health literacy levels prior to recipients initiating conversations with potential donors, in order to provide tailored support to the recipient with their initial approach. Additionally, psycho-social support could be offered to all recipients to help identify unmet needs or further barriers such as reciprocity or relationship concerns. Finally, closer communication between health professionals who provide care for the recipient, as well as positive media stories and campaigns that raise awareness of the need to transplant may create opportunities for LKD to be discussed within the recipient’s social network.</p>

Barriers to the Donation of Living Kidneys for Kidney Transplantation

Since the waiting time for deceased donor kidney transplantation continues to increase, living donor kidney transplantation is an important treatment for end stage kidney disease patients. Barriers to living kidney donation have been rarely investigated despite a growing interest in the utilization of living donor transplantation and the satisfaction of donor safety. Here, we retrospectively analyzed 1,658 potential donors and 1,273 potential recipients who visited the Seoul National University Hospital for living kidney transplantation between 2010 and 2017 to study the causes of donation failure. Among 1,658 potential donors, 902 (54.4%) failed to donate kidneys. The average number of potential donors that received work-up was 1.30 ± 0.66 per recipient. Among living donor kidney transplant patients, 75.1% received kidneys after work-up of the first donor and 24.9% needed work-up of two or more donors. Donor-related factors (49.2%) were the most common causes of donation failure, followed by immunologic or size mismatches between donors and recipients (25.4%) and recipient-related factors (16.2%). Interestingly, withdrawal of donation will along with refusal by recipients or family were the commonest causes, suggesting the importance of non-biomedical aspects. The elucidation of the barriers to living kidney donation could ensure more efficient and safer living kidney donation.