Proportion Of Donors Research Articles

Medical Outcomes in African American Live Kidney Donors: A Matched Cohort Study

It is uncertain if live kidney donation increases future risk of hypertension and kidney disease in African Americans. We conducted a cohort study across two transplant centers enrolling African Americans who donated between 1993 and 2006. A comparison group of African American nondonors were selected from healthy participants in the Coronary Artery Risk Development in Young Adults (CARDIA) prospective cohort study. A total of 103 donors and 235 matched nondonors were assessed at mean ( ± SD) of 6.8 ± 2.3 and 6.4 ± 2.2 years after donation or cohort entry, respectively. The primary outcome was risk of hypertension in donors at follow-up. The secondary outcomes were proportion of donors with eGFR <60 mL/min/1.73 m2 and microalbuminuria. Hypertension risk was higher in donors compared to nondonors (42/103 [40.8%] vs. 42/235 [17.9%]), absolute risk difference 22.9% (95% confidence interval 12.2-33.6%) and relative risk 2.4 (95% confidence interval 1.7-3.4). Of the 42 donors with hypertension, 22 (52.4%) were untreated. Sixteen donors (15.5%) had an eGFR <60 mL/min/1.73 m(2) , 6 (5.8%) had microalbuminuria and none were on dialysis. Our retrospective study shows that live kidney donation is associated with increased risk of hypertension in African Americans and emphasizes the importance of donor follow-up.

Does Questionnaire Distribution Promote Blood Donation? An Investigation of Question–Behavior Effects

The purpose of this study is to assess the effectiveness of survey administration as a population-level intervention to increase blood donation. Study 1 was a randomized controlled trial of new donors comparing 3,518 who received a questionnaire and 3,490 who did not. Study 2 compared matched, randomly selected samples of active donors; 5,789 received a questionnaire, while 6,000 did not. In both studies, the dependent measure was the proportion of donors who attended a blood donation center to give blood within 6 months of survey posting. Study 3 compared data across five similar trials. No difference in volunteering to give blood was observed between those who did and did not receive a questionnaire among either new or active donors, confirming the findings of two other Canadian trials. Despite earlier optimistic findings, there is little evidence to suggest that survey administration per se will be effective in increasing blood supplies. Implications for behavior change mechanisms are discussed.

Renal Outcomes in Hypertensive African American Live Kidney Donors

Introduction: African Americans (AA) with mild degree of hypertension (HTN) are currently considered unsuitable for live kidney donation due to concerns surrounding its negative effect on long term kidney function. To examine this issue further we conducted a retrospective cohort study of AA live kidney donors with and with-out HTN and compared their kidney function post donation. Methods: We enrolled 134 AA who underwent donor nephrectomy at Harper Hospital or Henry Ford Transplant Institute in Detroit from 1993 to 2007. None of the participants were diabetic or had GFR < 80 mL/min/1.732 m2 at time of evaluation. The donors were grouped as 1) HTN if SBP/DBP > 140/90 mm of Hg or used antihypertensive agent(s); 2) pre-HTN if SBP/DBP was 139-120/80-89 mm of Hg; else were 3) normotensive (NT). We compared the renal function, blood pressure (BP) and use of anti-hypertensive medications among donors in each of these three groups. Renal function was assessed as glomerular filtration rate as calculated via the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Results: Of the 134 AA donors, 17 (12%) were HTN, 65 (49%) were pre-HTN and 52 (39%) were NT. Of the 17 donors with HTN, 7 (41%) were on anti-hypertensive medications and all had BP < 150/90 at the time of donation. The donors from the HTN group were older (42±9 years) than those in the pre-HTN and NT group (37±8 and 35±8 years; p< 0.01); however there was no difference with regards to renal function, gender and body mass index at the time of donation. At median follow up of 7 years (range: 3-18 years) the mean GFR was similar in the three groups (NT: 76±19, pre-HTN: 77±19, HTN: 70±20 mL/min/1.732 m2; p=0.52). The proportion of donors with GFR < 60 mL/min/1.732m2 were not different in the three groups. The median micro-albuminuria was also not different between the groups. The mean BP was higher in the HTN than the pre-HTN and NT (138±15/86±12 vs. 130±16/82±12 and 123±15/ 78±9; p=0.01). Thirteen of the 52 donors (20%) in the NT group and 36 of the 65 donors (55%) in the pre-HTN were diagnosed with HTN. The use of antihypertensive medications increased in the donors with HTN with 75% of them requiring one to two anti-hypertensive medications at follow-up. Conclusions: AA live kidney donors with HTN do not have lower renal function than those without HTN. These results should not be used to encourage use of kidneys from AA living donors with HTN; but should be used to reassure those AA donors that have developed HTN after donation.

Renal Outcomes in Hypertensive African American Live Kidney Donors

Introduction: African Americans (AA) with mild degree of hypertension (HTN) are currently considered unsuitable for live kidney donation due to concerns surrounding its negative effect on long term kidney function. To examine this issue further we conducted a retrospective cohort study of AA live kidney donors with and with-out HTN and compared their kidney function post donation. Methods: We enrolled 134 AA who underwent donor nephrectomy at Harper Hospital or Henry Ford Transplant Institute in Detroit from 1993 to 2007. None of the participants were diabetic or had GFR < 80 mL/min/1.732 m2 at time of evaluation. The donors were grouped as 1) HTN if SBP/DBP ≥ 140/90 mm of Hg or used antihypertensive agent(s); 2) pre-HTN if SBP/DBP was 139-120/80-89 mm of Hg; else were 3) normotensive (NT). We compared the renal function, blood pressure (BP) and use of anti-hypertensive medications among donors in each of these three groups. Renal function was assessed as glomerular filtration rate as calculated via the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Results: Of the 134 AA donors, 17 (12%) were HTN, 65 (49%) were pre-HTN and 52 (39%) were NT. Of the 17 donors with HTN, 7 (41%) were on anti-hypertensive medications and all had BP < 150/90 at the time of donation. The donors from the HTN group were older (42±9 years) than those in the pre-HTN and NT group (37±8 and 35±8 years; p< 0.01); however there was no difference with regards to renal function, gender and body mass index at the time of donation. At median follow up of 7 years (range: 3-18 years) the mean GFR was similar in the three groups (NT: 76±19, pre-HTN: 77±19, HTN: 70±20 mL/min/1.732 m2; p=0.52). The proportion of donors with GFR < 60 mL/min/1.732m2 were not different in the three groups. The median micro-albuminuria was also not different between the groups. The mean BP was higher in the HTN than the pre-HTN and NT (138±15/86±12 vs. 130±16/82±12 and 123±15/78±9; p=0.01). Thirteen of the 52 donors (20%) in the NT group and 36 of the 65 donors (55%) in the pre-HTN were diagnosed with HTN. The use of antihypertensive medications increased in the donors with HTN with 75% of them requiring one to two anti-hypertensive medications at follow-up. Conclusions: AA live kidney donors with HTN do not have lower renal function than those without HTN. These results should not be used to encourage use of kidneys from AA living donors with HTN; but should be used to reassure those AA donors that have developed HTN after donation.

Out-hospital donors after cardiac death in Madrid, Spain: A 5-year review

The Medical Emergencies Service of Madrid (Spain) (Servicio de Urgencias Medicas de Madrid), SUMMA112, forms part of an organ donor program involving patients who have suffered out-hospital cardiac arrest and fail to respond to advanced cardiopulmonary resuscitation maneuvers. Subjects meeting the inclusion criteria are moved to a transplant unit under sustained resuscitation maneuvering in order to harvest the organs. This paper presents compliance with the timelines of the program, the proportion of donors, the characteristics of donors and non-donors, and the number of organs obtained. A retrospective descriptive study was made based on the review of case histories. The SPSS(©) version 16.0 statistical package was used for data analysis. A total of 214 cases were recorded, of which 84% were males. The mean age was 40 years. The mean time to arrival on scene was 13 min and 34 s. The mean time to arrival in hospital was 88 min and 10 s. A total of 522 organs and tissues were harvested (250 kidneys, 33 livers, 123 corneas, 97 bone tissues and 19 lungs), corresponding to 3.2 organs/tissues per patient on average. A total of 21.7% of the patients were not valid. There were no differences between the valid and non-valid patients in terms of age and gender. The causes of non-donation included extracorporeal circuit failure (6.3%), family refusal (15.6%), patient refusal expressed in life (4.7%), legal denial (1.6%), biological causes (51.6%), and others (20.3%). Cardiac compressors were used in 85 cases, yielding 92 kidneys, 41 corneas, 30 bone tissues, 19 livers and 9 lungs, corresponding to 2.1 organs/tissues per patient on average. This program affords a very important number of organs for transplantation. Further studies are needed to assess the efficacy of mechanical cardiac compressor use in generating more organs.

A systematic review and meta-analysis of clinical trials of thyroid hormone administration to brain dead potential organ donors*

To review all published clinical studies of thyroid hormone administration to brain-dead potential organ donors. A search of PubMed using multiple search terms retrieved 401 publications including 35 original reports describing administration of thyroid hormone to brain-dead potential organ donors. Detailed review of the 35 original reports led to identification of two additional publications not retrieved in the original search. The 37 original publications reported findings from 16 separate case series or retrospective audits and seven randomized controlled trials, four of which were placebo-controlled. Meta-analysis was restricted to the four placebo-controlled randomized controlled trials. Whereas all case series and retrospective audits reported a beneficial effect of thyroid hormone administration, all seven randomized controlled trials reported no benefit of thyroid hormone administration either alone or in combination with other hormonal therapies. In four placebo-controlled trials including 209 donors, administration of thyroid hormone (n=108) compared with placebo (n=101) had no significant effect on donor cardiac index (pooled mean difference, 0.15 L/min/m²; 95% confidence interval -0.18 to 0.48). The major limitation of the case series and retrospective audits was the lack of consideration of uncontrolled variables that confound interpretation of the results. A limitation of the randomized controlled trials was that the proportion of donors who were hemodynamically unstable or marginal in other ways was too small to exclude a benefit of thyroid hormone in this subgroup. The findings of this systematic review do not support a role for routine administration of thyroid hormone in the brain-dead potential organ donor. Existing recommendations regarding the use of thyroid hormone in marginal donors are based on low-level evidence.

Assessment of Hepatic Arterial Anatomy Prior to Organ Recovery

Iatrogenic hepatic arterial injury during organ recovery increases ischaemic times and risk of hepatic artery thrombosis. A review of CT imaging prior to organ recovery would alert retrieving surgeons to the presence of anatomical variants. This study aimed to identify the proportion of donors with coincidental CT scans for review and the ability of organ retrieval surgeons to interpret these images. Consecutive organ donors with coincidental abdominal contrast enhanced CT scans were assessed by review of an electronic radiology database. These images, with additional cases, were blindly reviewed by organ recovery surgeons to assess their ability to define anatomy. 13/156 donors had coincidental imaging for review. Using 23 CT sequences, the median positive and negative predictive value of surgeons to correctly describe right hepatic arterial anatomy was 0.83 and 0.94, of the left hepatic anatomy was 0.75 and 0.94 respectively. The availability of CT imaging for review prior to donation is low. However, when available, surgeons can correctly define hepatic arterial anatomy in the majority of cases. A practice of routinely reviewing available imaging prior to organ recovery would be expected to decrease iatrogenic arterial injury.

Clinical and epidemiological profile of blood donors with positive serology for viral hepatitis in southern Brazil

Positive serological tests for hepatitis viruses B and C at blood banks are an important reason for blood deferral. Additionally, high residual risk for transfusing hepatitis-contaminated blood has been estimated in southern Brazil. This study aimed to identify risk factors for positive serological tests for viral hepatitis (VH) in blood donors (BD). A case-control study included consecutive BD with positive serology for VH, between 2008 and 2009. Cases and controls (BD with negative serology for VH) were paired 1:1 by sex and donation date. Assessment of clinical and epidemiological characteristics related to viral hepatitis was conducted. Among 1,282 blood donors (641 cases and 641 controls), those with positive serology for viral hepatitis had higher mean age (p<0.001); higher proportion of replacement donation (p<0.001); first donation (p<0.001); and interviewer deferment (p=0.037), compared to controls. Furthermore, donors with positive tests were less regular donors (p<0.001), had less previous history of rejection (p=0.003) and showed lower hematocrit median before donation (p=0.019). Multivariate analysis demonstrated that age (OR=1.056, 95%CI 1.042-1.069, p<0.001), replacement donation (OR=1.545, 95%CI 1.171-2.038, p=0.002) and first donation (OR=9.931, 95%CI 7.486-13.173, p<0.001) were independently associated with positivity of serological tests for viral hepatitis. Specific characteristics of blood donors were associated with positive serology for viral hepatitis. These peculiarities should be taken into account when assessing candidates for blood donation.

A Coordination Game Model of Charitable Giving and Seed Money Effect

If potential donors for a charity project possess the warm-glow properties in their preferences, we can represent their behavior with a coordination game. Accordingly, we construct a simultaneous incomplete information game model of charitable giving based on a simple global coordination game. We demonstrate that merely by the effect of seed money to shift the threshold requirement of the donations for project success downwards, the proportion of donors and the total amount of donations strictly and continuously increase with the amount of seed money. This result is partially compatible with the field experimental evidence in List and Lucking-Reiley [List, J. A., Lucking-Reiley, D., 2002. The Effects of Seed Money and Refunds on Charitable Giving: Experimental Evidence from a University Capital Campaign. Journal of Political Economy 110 (1), 215-233].

Postoperative Middle Cerebral Artery Peak Systolic Velocity Changes Confirm Physiological Principles of the Sequential Laser Technique for Twin-Twin Transfusion Syndrome

Introduction: Treatment of the twin-twin transfusion syndrome (TTTS) via sequential selective laser photocoagulation of communicating vessels (SQLPCV) mandates ablation of donor-to-recipient arteriovenous anastomoses first. It is hypothesized that SQLPCV facilitates intraoperative transfusion to the donor, thereby minimizing donor hypovolemia and anemia. We sought to determine if postoperative changes in fetal middle cerebral artery-peak systolic velocities (MCA-PSV) support this hypothesis. Materials and Methods: Patients undergoing preferential SQLPCV for TTTS had MCA-PSV measured 1 day before surgery and on postoperative day 1 (POD-1). Fetal anemia was defined as an MCA-PSV ≧1.5 multiples of the median (MoM). Exclusions included: POD-1 demise, missing MCA-PSV data, or gestational age <18 weeks. Results: Study criteria were met by 139 patients. Mean MCA-PSV in recipients increased from 0.97 to 1.15 MoM postoperatively (p < 0.0001). Donor mean MCA-PSV remained stable at 1.00 MoM preoperatively and 0.98 MoM postoperatively (p = 0.272). Nine fetuses, 6 donors and 3 recipients, had preoperative anemia; SQLPCV was not attempted in the 3 anemic recipients. Postoperatively, the proportion of donors with anemia remained stable (increase 3.6%, p = 0.419), and the proportion of recipients with anemia increased (increase 12.2%, p = 0.009). Discussion: Our findings confirm the presumed physiological basis for the SQLPCV treatment of TTTS.

More and better donors for cardiac transplantation

Cardiac transplantation is unrivalled as a treatment for end-stage heart failure. Nothing else offers the degree of improvement in both symptoms and survival. Whilst transplantation can never be the solution to the epidemic of advanced heart failure, for the fortunate few recipients it is very effective, and outcomes continue to improve. The inexorable decline in transplant activity is thus doubly frustrating. In the EuroTransplant area there were 782 cardiac transplants in 1997, falling to 577 ten years later. Lung, liver, kidney, and pancreas transplants all increased in this period.1 Over the same time period there was an almost catastrophic fall in UK activity, from 220 to 127.2 Overall numbers of organ donors remain largely unchanged, but the demographics—age and disease profile—are unhelpful to cardiac transplantation. In 2009 the typical donor is a middle-aged female dying of an intracerebral haemorrhage perhaps related to untreated hypertension. Concomitant left ventricular hypertrophy and coronary artery disease exclude use of the heart when other organs will still function well after transplant. As the proportion of donors with usable hearts falls below 20%, optimization of as many ‘marginal’ organs as possible is essential. To an extent, because of the damaging effects of brainstem death and subsequent ischaemia and reperfusion, all donor hearts are ‘marginal’—they all show some dysfunction. Primary graft failure is by far the most common cause of early death after a transplant, and is difficult to manage satisfactorily. There is therefore benefit … *Corresponding author. Tel: +44 (0) 191 223 1450, Fax: +44 (0) 191 223 1152, Email: j.h.dark{at}ncl.ac.uk

Bone marrow harvest versus peripheral stem cell collection for haemopoietic stem cell donation in healthy donors

Haemopoietic stem cells can be collected from a donor either as a bone marrow harvest or by peripheral blood collection. Both techniques have risks for the donor. The aim of this review was to identify the adverse effects of haemopoietic stem cell donation and to compare the tolerability and safety of the two methods. We searched bibliographic databases including the Cochrane Central Register of Controlled trials (CENTRAL) (The Cochrane Library 2008, issue 2), MEDLINE and EMBASE up to May 2008. We also searched reference lists of articles and contacted experts in the field. Randomised controlled trials enrolling haemopoietic stem cell donors and evaluating the different methods of donating haemopoietic stem cells were eligible. Two authors independently screened studies for inclusion. We extracted data and evaluated methodological quality. Quantitative analysis was not possible for most outcomes, but where used we preferred random-effects models due to the variability between the included studies. Six trials (807 donors) were eligible: all were substudies, or constituent parts of, larger randomised controlled trials of bone marrow and peripheral blood stem cell allogeneic transplantation. No included trial was designed solely to measure and assess the experience of stem cell donors. The donors in all studies were related to the stem cell recipient. Overall, both types of donors experienced pain subsequent to donation, and psychological morbidity. The trend was for bone marrow donors to experience more pain at the donation site, more overall adverse events, and more days of restricted activity. They were also more likely to require hospitalisation than peripheral blood stem cell donors. In contrast, peripheral blood stem cell donors experienced more pain prior to donation, which may be related to the pre-donation administration of granulocyte colony stimulating factor (G-CSF). The methodological quality of the studies was poor and indicated limitations due to the risk of selection and attrition bias. The proportion of donors from the parent trial not included in the donor substudies was also inadequately explained. The different short-term morbidities associated with each type of haemopoietic stem cell donation were clear, with bone marrow donors experiencing more pain and more restriction post-donation than peripheral blood donors. However, the studies were limited by their methodological quality, failure to provide long-term follow up (for which larger numbers of donors would be required) and a failure to apply consistent measures of quality of life in a way which allows more meaningful evaluation across studies.

The American Red Cross donor hemovigilance program: complications of blood donation reported in 2006

The American Red Cross (ARC) initiated a comprehensive donor hemovigilance program in 2003. We provide an overview of reported complications after whole blood (WB), apheresis platelet (PLT), or automated red cell (R2) donation and analyze factors contributing to the variability in reported complication rates in our national program. Complications recorded at the collection site or reported after allogeneic WB, apheresis PLT, and R2 donation procedures in 36 regional blood centers in 2006 were analyzed by univariate and multivariate logistic regression. Complications after 6,014,472 WB, 449,594 PLT, and 228,183 R2 procedures totaled 209,815, 25,966, and 12,282 (348.9, 577.5, and 538.3 per 10,000 donations), respectively, the vast majority of which were minor presyncopal reactions and small hematomas. Regional center, donor age, sex, and donation status were independently associated with complication rates after WB, PLT, and R2 donation. Seasonal variability in complications rates after WB and R2 donation correlated with the proportion of donors under 20 years old. Excluding large hematomas, the overall rate of major complications was 7.4, 5.2, and 3.3 per 10,000 collections for WB, PLT, and R2 procedures, respectively. Outside medical care was recorded at similar rates for both WB and automated collections (3.2 vs. 2.9 per 10,000 donations, respectively). The ARC data describe the current risks of blood donation in a model multicenter hemovigilance system using standardized definitions and reporting protocols. Reported reaction rates varied by regional center independently of donor demographics, limiting direct comparison of different regional blood centers.

Open-identity donor insemination in the United States: is it on the rise?

Information about US donor insemination programs was reviewed to determine whether an increasing number are offering open-identity donation. Results indicate that indeed, numbers are rising and that the ratio of open-identity to anonymous sperm donors in a program increases the longer that the program has offered an open-identity option.

Intraoperative blood loss is a risk factor for complications in donors after living donor hepatectomy

Complications in a donor are a distressing but inevitable occurrence, since graft procurement is a major undertaking. Although the technique for procurement has some similarities to hepatic resection, a donor is very unlike a patient with malignancy. The risk factors identified in these patients cannot be extrapolated to donors. Donor hepatectomy carried out from June 1995 to March 2005 in Chang Gung Memorial Hospital, Kaohsiung Medical Center was reviewed with the aim of identifying risk factors for complications. There were 204 living donor liver transplants, with 205 donor hepatectomies, as 1 living donor liver transplantation was a dual graft. Ten donors (4.88%) suffered complications. There was no difference in terms of age, gender, body weight, operation, and parenchymal time between those who had complications and those who did not. There was also no difference in liver function tests between the 2 groups of donors, but the total bilirubin was significantly higher in donors with complications. The graft weight and remnant liver volume were also similar. The proportion of donors with fatty liver was the same between the 2 groups. The mean blood loss in donors with complications was 170 +/- 79 mL, and that for donors without complications was 95 +/- 77 mL. There was a statistically significant greater blood loss in donors with complications (P < 0.05). The number of segments removed in donors with complications was also higher compared to donors without complications (P < 0.03). Using multivariate analysis, intraoperative blood loss and the number of segments removed were found to be independent risk factors for donor complications. Intraoperative blood loss during graft procurement must be kept low to minimize complications in donors.

Heterogeneous Human NK Cell Responses to Plasmodium falciparum-Infected Erythrocytes

Human NK cells can respond rapidly to Plasmodium falciparum-infected RBC (iRBC) to produce IFN-gamma. In this study, we have examined the heterogeneity of this response among malaria-naive blood donors. Cells from all donors become partially activated (up-regulating CD69, perforin, and granzyme) upon exposure to iRBC but cells from only a subset of donors become fully activated (additionally up-regulating CD25, IFN-gamma, and surface expression of lysosomal-associated membrane protein 1 (LAMP-1)). Although both CD56dim and CD56bright NK cell populations can express IFN-gamma in response to iRBC, CD25 and LAMP-1 are up-regulated only by CD56dim NK cells and CD69 is up-regulated to a greater extent in this subset; by contrast, perforin and granzyme A are preferentially up-regulated by CD56bright NK cells. NK cells expressing IFN-gamma in response to iRBC always coexpress CD69 and CD25 but rarely LAMP-1, suggesting that individual NK cells respond to iRBC either by IFN-gamma production or cytotoxicity. Furthermore, physical contact with iRBC can, in a proportion of donors, lead to NK cell cytoskeletal reorganization suggestive of functional interactions between the cells. These observations imply that individuals may vary in their ability to mount an innate immune response to malaria infection with obvious implications for disease resistance or susceptibility.

The mantra of blood safety: time for a new tune?

The mantra of blood safety: time for a new tune?

Impact of laser coagulation in severe twin-twin transfusion syndrome on fetal Doppler indices and venous blood flow volume.

To evaluate the impact of fetoscopic laser coagulation of placental anastomoses in severe twin-twin transfusion syndrome on fetal Doppler indices and umbilical vein blood flow volume as calculated with Doppler and two-dimensional ultrasound. Thirty-two cases of second-trimester severe twin-twin transfusion undergoing laser therapy were examined with serial ultrasound before and 1, 3 and 5 days after therapy. Pulsatility indices in the umbilical artery and ductus venosus were measured. Blood volume flow at the level of the intra-abdominal umbilical vein was calculated by means of Doppler and two-dimensional ultrasound. The development of hydropic signs in donors was recorded. Perinatal outcome in terms of neonatal survival was recorded for all cases. In recipients, ductus venosus pulsatility index decreased progressively after therapy and, by day 5, median pulsatility index was significantly lower than that before therapy (0.97 vs. 0.82, P < 0.0001). Umbilical vein blood flow volume in recipient twins showed no significant variations before and after laser. In donors, umbilical artery pulsatility index decreased significantly by the first day following therapy (2.1 vs. 1.6, P < 0.0001). Previously absent or reverse umbilical end-diastolic flow reappeared after therapy in 46% (7/15) of donors. Ductus venosus pulsatility index in donors increased significantly by day 1 after therapy (0.99 vs. 1.35, P < 0.0001) but, over days 3 and 5, it returned towards preoperative values. Umbilical vein flow volume measurements (mL/min/kg) in the donor increased by approximately 50% the day after treatment (151 vs. 232, P < 0.0001) and remained elevated. Umbilical vein flow volume before laser therapy was significantly lower in donors compared to recipients (151 vs. 260, P < 0.0001), but the difference was non-significant after treatment (240 vs. 267). One or more hydropic signs developed in eight (25%) donors during the 5 days' observation after therapy. Laser therapy induced important changes in fetal hemodynamic parameters, resulting in a reversion of the disturbances associated with severe twin-twin transfusion syndrome. The recipient twin showed a progressive improvement of previous signs of right cardiac overload. The donor experienced a substantial increase in umbilical vein blood volume flow accompanied by a transitory state of relative right overload, which may explain the development of transient hydropic signs in a proportion of donors.

Increased transplantation of kidneys with multiple renal arteries in the laparoscopic live donor nephrectomy era: surgical technique and surgical and nonsurgical donor and recipient outcomes.

For anatomical and technical reasons, many transplant centers restrict laparoscopic live donor nephrectomy (in contrast with open live donor nephrectomy) to left kidneys. This change in surgical practice increases procurement and transplantation rates of live donor kidneys with multiple renal arteries (RAs), without affecting donor and recipient outcomes. Retrospective review at an academic tertiary care referral center comparing laparoscopically procured single vs multiple-RA kidney grafts (April 1997 to October 2000). Seventy-nine consecutive left laparoscopic live kidney donors and 78 transplant recipients. Donor and recipient complications and postoperative length of stay; cold and warm ischemia time; operating time; short-term and long-term graft function; and survival. We noted multiple RAs in 21 (27%) of all kidneys. The proportion of donors with 1 or more perioperative complications was 19% in the single-RA group vs 10% in the multiple-RA group (P was not significant). For the recipients, we noted no significant differences between groups with respect to surgical complications, quality of early and late graft function, rejection rates, graft losses (all immunologic), and graft survival. Cold and warm ischemia time and length of stay were similar for donors and recipients in both groups. Median operating times were significantly longer for the multiple-RA vs single-RA group (difference, 41 minutes for donors and 45 minutes for recipients; P<.02). While the introduction of laparoscopic live donor nephrectomy has significantly increased the number of grafts with multiple RAs (compared with historical open controls), this change in practice is safe for both donors and recipients from a patient outcome-based perspective. However, from an economic perspective, the longer operating time associated with multiple-RA grafts provides strong added rationale for optimization of surgical instruments and techniques to make right-sided laparoscopic nephrectomy a routine intervention.

Donor Insemination and Human Immunodeficiency Virus Transmission

Objective: To describe cases of AIDS attributed to donor insemination identified through national human immunodeficiency virus (HIV)/AIDS surveillance and to compare the number identified through surveillance with our estimate of the number of women infected as a result of donor insemination before the initiation of donor screening.Methods: We reviewed national HIV/AIDS surveillance data on women reported through December 1996 and described characteristics of documented and possible cases attributed to donor insemination. We estimated the number of women infected before the initiation of widespread screening of donors using assumptions about the number of women inseminated each year, the average number of inseminations, the proportion of donors who were men who had sex with men, the prevalence of HIV among such men, and the rate of transmission per HIV-infected exposure.Results: A total of six documented and two possible cases of donor insemination–associated AIDS have been reported to the Centers for Disease Control and Prevention as of December 1996. An estimated eight to 141 women were infected through donor insemination in the United States between 1980 and 1984. Reasons for this discrepancy are discussed.Conclusion: Based on surveillance case reports and on our estimate, the total number of women infected as a result of donor insemination before screening was recommended is low. Current sperm bank practices to prevent HIV infection will be strengthened further by a pending proposal from the Food and Drug Administration requiring infectious disease screening and testing of semen donors. The most likely source of risk of new infections associated with donor insemination is self-insemination. (Obstet Gynecol 1998;91:515–8.)