Residual renal function after living related kidney donation. Is it enough? An early report

The utilization of living's kidneys as renal replacement for Chronic Renal Failure (CRF) patients was debated for long time. However, the lack of renal pool in one hand and the proper employment of modern investigatory armamentarium in another hand could justify such donation. Living related donors (LRD) are subjected to extensive non invasive investigations to assess their general fitness for donation and split renal function. The impact of uni-nephrectomy on the renal function was studied in 25 LRD. Serum Creatinine (S. Cr.) Creatinine Clearance (Cr. Cl.) and renographic clearance tests for total and split renal function and renal volume using ultrasound were determined before and 3 months after donation. An initial increase in s.cr was seen in 76% of donors, but all levels are within normal range. Total kidney function by cr.cl showed significant drop by 36% of the pre donated value. Remaining kidney clearance increased by 5% to 64% with an average of 34% of the pre donated level as measured by Tc 99m DTPA renography. Following nephrectomy, compensatory hypertrophy of the remaining kidney attributed to an increase in the renal volume of 15%. In conclusion, kidney donation from living's is safe. Cr. clearance using the chemical method is a good screening test for potential LRD and for monitoring the renal function after donation. Renographic clearance using Tc 99m DTPA is as excellent useful test for split renal function in LRD work up. Long-term follow up might be needed.     

Should health care professionals encourage living kidney donation?

Living kidney donation provides a promising opportunity in situations where the scarcity of cadaveric kidneys is widely acknowledged. While many patients and their relatives are willing to accept its benefits, others are concerned about living kidney programs; they appear to feel pressured into accepting living kidney transplantations as the only proper option for them. As we studied the attitudes and views of patients and their relatives, we considered just how actively health care professionals should encourage living donation. We argue that active interference in peoples’ personal lives is justified – if not obligatory. First, we address the ambiguous ideals of non-directivity and value neutrality in counselling. We describe the main pitfalls implied in these concepts, and conclude that these concepts cannot account for the complex reality of living donation and transplantation. We depict what is required instead as truthful information and context-relative counselling. We then consider professional interference into personal belief systems. We argue that individual convictions are not necessarily strong, stable, or deep. They may be flawed in many ways. In order to justify interference in peoples’ personal lives, it is crucial to understand the structure of these convictions. Evidence suggests that both patients and their relatives have attitudes towards living kidney donation that are often open to change and, accordingly, can be influenced. We show how ethical theories can account for this reality and can help us to discern between justified and unjustified interference. We refer to Stephen Toulmin’s model of the structure of logical argument, the Rawlsian model of reflective equilibrium, and Thomas Nagel’s representation of the particularistic position.     

Organ donation after assisted death: Is it more or less ethically-problematic than donation after circulatory death?

A provocative question has emerged since the Supreme Court of Canada’s decision on assisted dying: Should Canadians who request, and are granted, an assisted death be considered a legitimate source of transplantable organs? A related question is addressed in this paper: is controlled organ donation after assisted death (cDAD) more or less ethically-problematic than standard, controlled organ donation after circulatory determination of death (cDCDD)? Controversial, ethics-related dimensions of cDCD that are of relevance to this research question are explored, and morally-relevant distinctions between cDAD and cDCD are identified. In addition, a set of morally-relevant advantages of one practice over the other is uncovered, and a few potential, theoretical issues specifically related to cDAD practice are articulated. Despite these concerns, the analysis suggests a counterintuitive conclusion: cDAD is, overall, less ethically-problematic than cDCDD. The former practice better respects the autonomy interests of the potential donor, and a claim regarding irreversibility of cessation of the donor’s circulatory function in the cDAD context can be supported. Further, with cDAD, there is no possibility that the donor will have negative sensory experiences during organ procurement surgery. Although the development of appropriate policy-decision and regulatory approaches in this domain will be complex and challenging, the comparative ethical analysis of these two organ donation practices has the potential to constructively inform the deliberations of relevant stakeholders, resource persons and decision makers.     

Mortality after spousal loss: are there socio-demographic differences?

This study evaluates the effect of spousal death on mortality among Israeli adults and examines differences in this effect by duration of bereavement, age, sex, education, ethnic origin, household size, and number of children. Data are taken from the Israel Longitudinal Mortality Study which is based on a linkage of records from a 20% sample of the 1983 census to records of deaths occurring during the period 1983-1992. The study population comprised 49,566 men and 41,264 women, of whom 4,402 (9%) and 11,114 (27%), respectively, were bereaved during the follow-up period. Excess mortality among the bereaved was evident among both men and women, especially after bereavement of short duration. During the first 6 months, the excess mortality was about 50% among women and about 40% among men. For men, the effect of bereavement on mortality decreased linearly with age, with a relative risk of 3 among younger men during early widowhood. Bereavement had a greater impact on the more educated men. The effect of bereavement did not vary by ethnic origin or household size.     

An ethical appraisal of living-anonymous kidney donation using Adam Smith’s Theory of Moral Sentiments

Ethical debates continue to shape organ transplant policies, particularly for kidneys. Facing organ shortages, governments have created incentives targeting prospective living-anonymous donors - socially and biologically unrelated to the recipient. However, these policies may transform altruistic exchanges of tissues into trades of commodities.We use Adam Smith's concept of sympathy to outline a new approach to transplantation ethics. This is accomplished using a case study analysis of six countries with established living-anonymous kidney donation practices – Iran, Israel, the Netherlands, Saudi Arabia, the United Kingdom, and the United States. An ethical test was also developed from ethnographies of donors and Smith's Theory of Moral Sentiments. The case study analysis considered the role of religious and historic norms, media campaigns, adherence to the 2008 Declaration of Istanbul guidelines for each case, and how each factor related to Smith's sympathy, categorizing the countries into four tiers of altruism. Iran occupied the least altruistic tier, followed by the Netherlands, the UK and the US, and Saudi Arabia and Israel. The ethical test identified a similar ranking. Our findings suggest that a highly-selected cohort of states with established living-anonymous kidney donation programs may already utilize a Smithian approach for recruiting donors, and that socially-valued government incentives can preserve altruism. The ethical test could become a useful instrument to assess the altruism of emerging incentive policies.     

Does health status improve after re-assumption of ABM employment?

Due to structural problems of the East German economy the level of unemployment will probably remain high for the next ten years. Thus, thousands of health-employment-schemes are established to reduce negative social and financial consequences of unemployment for those groups that are most affected. In this study the effects of temporary re-employment on health within the bounds of a job-creating measure are examined. By questionnaire employees of two firms in Magdeburg that exclusively occupies former unemployed men and women were asked about their subjective health status and changes in health status since re-employment. 217 employees filled the questionnaire (response rate: 50%; mean age: 45 years, mean duration of former unemployment: 18 months). About one half of the employees (48%) report positive effects on health after re-employment. This percentage is highest in the age group 50 years and older. The frequency of health impairments remained unchanged for half of the workers, the rest mainly stated fewer impairments. Poor working conditions or physical overtaxing decreases the positive effects of re-employment. Employees who had a positive attitude towards their work report on positive effects on health and other aspects of life more than average. CONCLUSIONS: Negative consequences of unemployment on physical and psychological health are well understood. On the other hand, our study demonstrates positive effects on health and a reduction of health impairments by temporary job-creating measures. This is influenced by the working conditions and the social environment of the employees. Further investigation are needed for detailed medical evaluation of job-creating schemes.     

Live kidney donation: are concerns about long-term safety justified?—A methodological review

Live kidney donors are exhaustively screened pre-donation, creating a cohort inherently healthier at baseline than the general population. In recent years, three renowned research groups reported unfavourable outcomes for live kidney donors post-donation that contradicted their previous studies. Here, we compared the study design and analysis of the most recent and previous studies to determine whether the different outcomes were due to methodological design or reflect a real potential disadvantage for living kidney donors. All six studies on long-term risk after live kidney donation were thoroughly screened for the selection of study population, controls, data quality, and statistical analysis. Our detailed review of the methodology revealed key differences with respect to selection of donors and compared non-donors, data quality, follow-up duration, and statistical analysis. In all studies, the comparison group of non-donors was healthier than the donors due to more extensive exclusion criteria for non-donors. Five of the studies used both restriction and matching to address potential confounding. Different matching strategies and statistical analyses were used in the more recent studies compared to previous studies and follow-up was longer. Recently published papers still face bias. Strong points compared to initial analyses are the extended follow-up time, large sample sizes and better analysis, hence increasing the reliability to estimate potential risks for living kidney donors on the long-term. Future studies should focus on equal selection criteria for donors and non-donors, and in the analysis, follow-up duration, matched sets, and low absolute risks among donors should be accounted for when choosing the statistical technique.     

Do changes in spousal employment status lead to domestic violence? Insights from a prospective study in Bangalore,India

The prevalence of physical domestic violence – violence against women perpetrated by husbands – is staggeringly high across the Indian subcontinent. Although gender-based power dynamics are thought to underlie women's vulnerability, relatively little is known about risk and protective factors. This prospective study in southern India examined the association between key economic aspects of gender-based power, namely spousal employment status, and physical domestic violence. In 2005–2006, 744 married women, aged 16–25, residing in low-income communities in Bangalore, India were enrolled in the study. Data were collected at enrollment, 12 and 24 months. Multivariable logistic regression models were used to examine the prospective association between women's employment status, their perceptions of their husband's employment stability, and domestic violence. Women who were unemployed at one visit and began employment by the next visit had an 80% higher odds of violence, as compared to women who maintained their unemployed status. Similarly, women whose husbands had stable employment at one visit and newly had difficulty with employment had 1.7 times the odds of violence, as compared to women whose husbands maintained their stable employment. To our knowledge, this study is the first from a developing country to confirm that changes in spousal employment status are associated with subsequent changes in violence risk. It points to the complex challenges of violence prevention, including the need for interventions among men and gender-transformative approaches to promote gender-equitable attitudes, practices and norms among men and women.     

The Role of Response Perceptions in Couples’ Ongoing Cancer-Related Disclosure

In efforts to better understand the intricate nature of response, we tested a four-dimension structure of response patterns (measured as support, reciprocity, emotional reaction, and avoidance) as well as four single dimension models within the context of couples managing cancer. All models incorporate dyadic data, including both patient and partner perceptions that relational quality influences response patterns, and response patterns influence ongoing disclosure (measured as breadth and depth). Participants were 95 dyads in which one partner had been diagnosed with cancer. We conducted multilevel analyses using an actor-partner interdependence model. Results supported the four-dimension model as well as individual dimension models. All response types predict within person disclosure. However, only reciprocity predicts the other person’s disclosure, and only patient’s reports of partner reciprocity predict partner disclosure.     

Can Interventions that Strengthen Couples’ Relationships Confer Additional Benefits for their Health? A Randomized Controlled Trial with African American Couples

Prevention Science - This study examined the effects of the Protecting Strong African American Families (ProSAAF) prevention program on adults’ self-reported health outcomes...     

Gay Male Couples’ Attitudes Toward Using Couples-Based Voluntary HIV Counseling and Testing

Many men who have sex with men acquire HIV from their primary male partners while in a relationship. Studies with gay couples have demonstrated that relationship characteristics and testing behaviors are important to examine for HIV prevention. Recently, couples-based voluntary HIV counseling and testing (CVCT) has become available to male couples throughout the U.S. However, HIV-negative couples’ attitudes toward using CVCT and how their relationship characteristics may affect their use of CVCT remain largely unknown. This information is particularly relevant for organizations that offer CVCT. To assess couples’ attitudes, and associated factors toward using CVCT, a cross-sectional study design was used with a novel Internet-based recruitment method to collect dyadic data from a national sample of 275 HIV-negative gay couples. Multivariate multilevel modeling was used to identify factors associated with differences between and within couples about their attitudes towards using CVCT. Findings revealed that couples were “somewhat” to “very likely” to use CVCT. More positive attitudes toward using CVCT were associated with couples who had higher levels of relationship satisfaction and commitment toward their sexual agreement and among those who had at least one partner having had sex outside of the relationship. Less positive attitude toward using CVCT was associated with couples who had higher levels of trust toward their partners being dependable. Differences within couples, including age between partners, whether sex had occurred outside of the relationship, and value toward a sexual agreement also affected their attitudes toward using CVCT. Providing additional testing methods may help HIV-negative gay couples better manage their HIV risk.     

Predictors of family communication of one’s organ donation intention in Switzerland

Objectives  

Family members continue to play a prominent role in decisions to donate organs at the time of death. Prior knowledge of the deceased’s intention to donate was identified as an important influential factor in the donation decision-making process. This study examined what factors lead to family communication of a person’s wish regarding organ donation.     

The role of heterogeneity of patients’ preferences in kidney transplantation

We elicit time and risk preferences for kidney transplantation from the entire population of patients of the largest Italian transplant centre using a discrete choice experiment (DCE). We measure patients’ willingness-to-wait (WTW) for receiving a kidney with one-year longer expected graft survival, or a low risk of complication. Using a mixed logit in WTW-space model, we find heterogeneity in patients’ preferences. Our model allows WTW to vary with patients’ age and duration of dialysis. The results suggest that WTW correlates with age and duration of dialysis, and that accounting for patients’ preferences in the design of kidney allocation protocols could increase their welfare. The implication for transplant practice is that eliciting patients’ preferences could help in the allocation of “non-ideal” kidneys.     

Methodological Considerations in Couples’ Fertility Intentions: Missing Men and the Viability of Women’s Proxy Reports

Introduction Recent efforts show potential to advance research on unintended childbearing by taking a couple-level approach. However, this work has neither adequately addressed methodological concerns stemming from the challenges associated with male fertility data nor considered the viability of women’s proxy reports of fathers intentions. Methods Data from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B) were used to assess the implications of low response rates among men on couples’ unintended childbearing. Then, the accuracy of women’s proxy reports of fathers intentions was assessed. Weighted logistic regression analyses were conducted to determine how women’s characteristics were associated with men’s survey participation whereas weighted multinomial logistic regression analyses were applied to determine how women’s characteristics were linked with the accuracy of her proxy report. Results Almost half (46%) of women cannot be matched with data from the child’s father, and this discrepancy is most problematic for women who are black, foreign-born, less educated, and unmarried at birth. Women’s proxy reports appear viable as 75% of women’s reports are consistent with men’s responses. Yet, proxy reports underestimate disagreement in couples’ intentions as mothers who intended the birth are at an increased risk of “inaccurately” reporting that fathers share their intentions. Discussion Direct approaches to couples’ intentions yield privileged samples and systematically omit women at the greatest risk of an unintended birth. However, proxies underestimate disagreement in couples’ intentions—a key contribution to the couple approach. Accordingly each approach has its own merits which must be considered in light of specified research questions.     

Supplementing living kidney transplantees’ medical records with donor- and recipient-narratives

Norway provides total social welfare coverage for organ transplantations, including free immunosuppressive medication and prepaid life-long follow up for both recipients and donors. Despite these benefits the proportion of living kidney donors (LKD) has in recent years declined from around 40% (2011) of all kidney transplantations to 24% (2016). This study suggests harnessing patient- and donor-narratives as a tool for addressing the current fall in donation rates. The hospital records of 18 recipient/donor dyads were compared with patient and donor accounts elicited in semi-structured interviews. Narratives afford a pertinent supplement to the primarily biomedical and technical information stored in medical records. Even in condensed form, the messages embedded in narratives contribute to a ‘thicker’ understanding of the complexity of living kidney donation (LKD)-decisions. Narratives represent a source of education for referring-nephrologists wishing to deepen their evaluation skills and avoid making decisions based on insufficient insight into patients’ and potential donors’ values and life-situation. Recipients’ and donors’ unedited accounts of their motivations, worries, doubts and expectations afford a revealing and edifying supplement to the primarily biomedical and technical information stored in medical records. In narratives, the predicaments and dilemmas surrounding LKD become visible and debatable and can serve as support for future donors, recipients and the nephrologists responsible for evaluation–conclusions. Generating narratives raises a number of practical, epistemic and normative challenges.     

An Examination of Gay Couples’ Motivations to Use (or Forego) Pre-exposure Prophylaxis Expressed During Couples HIV Testing and Counseling (CHTC) Sessions

Prevention Science - While many gay couples perceive themselves to have little risk for HIV transmission, research estimates that 35–68% of new HIV infections are transmitted within main...     

Men’s,but not Women’s,Sociosexual Orientation Predicts Couples’ Perceptions of Sexually Dimorphic Cues in Own-Sex Faces

Previous research suggests that people’s perceptions of own-sex individuals can change according to within-individual variation in their romantic partners’ sexual strategies. For example, men are more likely to perceive other men’s faces as looking particularly dominant during the fertile phase of their partner’s menstrual cycle, when women tend to be more open to uncommitted sexual relationships. By contrast, little is known about how relatively stable between-individuals differences in partners’ openness to uncommitted sexual relationships (i.e., their sociosexual orientation) predict perceptions of own-sex individuals. The revised Sociosexual Orientation Inventory (SOI-R) assesses individuals’ openness to uncommitted sexual relationships and shows high test–retest reliability over long periods of time. Consequently, we tested whether the SOI-R scores of men and women in heterosexual romantic couples predicted their perceptions of own-sex faces displaying exaggerated sex-typical cues. Men’s, but not women’s, SOI-R was positively correlated with the extent to which both the man and woman within a couple ascribed high dominance and attractiveness to own-sex faces with exaggerated sex-typical cues. In other words, individuals in couples where the man reported being particularly open to uncommitted sexual relationships were more likely to ascribe dominance and attractiveness to own-sex individuals displaying a putative cue of good phenotypic condition. These findings suggest that both men’s and women’s perceptions of potential competitors for mates are sensitive to the male partner’s sexual strategy. Such individual differences in perceptions may benefit men’s ability to compete for extra-pair and/or replacement mates and benefit women’s mate guarding behaviors.     

Linking Sexual Mindfulness to Mixed-Sex Couples’ Relational Flourishing,Sexual Harmony,and Orgasm

Archives of Sexual Behavior - Marriage is an important adult relationship, and recent research indicates that sexual mindfulness, awareness and non-judgment, may be an important tool in helping...