(Risk of diabetic nephropathy in potential living related kidney donors)
The possibility of kidney disease as a result of diabetes can be a particular dilemma when cadaveric organs are in short supply and a living donor who is related to the patient is required. In this week's BMJ Simmons and Searle report that this can be especially difficult within ethnic populations, who have a high incidence of diabetes (for example 30 per cent of UK South Asians are likely to develop non-insulin dependent diabetes by the time they are 70 years) and are at risk of consequent kidney problems themselves.
The main reason for not transplanting kidneys, say the authors is the low availability of compatible organs. For example, some ethnic groups object to donating body parts after death for cultural reasons. Therefore organ donation from living relatives is particularly encouraged in these groups. But diabetes and the development of kidney disease as a result of diabetes, tends to run in the family, therefore potential donors may themselves have an increased risk of diabetes and kidney problems.
The authors suggest that kidney donors should be tested for diabetes and impaired glucose tolerance routinely and that their ethnic group be taken into consideration. Simmons and Searle conclude that clinicians in conjunction with patients, should balance the immediate benefit of kidney transplantation to the recipient with the possible long term harm to the donor when considering the option of transplantation.
Contact:
Dr D Simmons, Senior Lecturer in Medicine, University of Auckland, Middlemore Hospital, Private Bag 93 311, Auckland 6, New Zealand