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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2020  |  Volume : 31  |  Issue : 2  |  Page : 566-567
Author's reply

Renal Transplant Unit, National Institute of Solid Organ and Tissue Transplantation, Dow University of Health Sciences, Ojha Campus, Karachi, Pakistan

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Date of Web Publication09-May-2020

How to cite this article:
Khan MT. Author's reply. Saudi J Kidney Dis Transpl 2020;31:566-7

How to cite this URL:
Khan MT. Author's reply. Saudi J Kidney Dis Transpl [serial online] 2020 [cited 2021 Jun 23];31:566-7. Available from: https://www.sjkdt.org/text.asp?2020/31/2/566/284042

To the Editor,

This is in response of objection which is raised by our countryman on our article name“Living unrelated kidney donor transplantation: Legalization in exceptional circumstances” appeared in Saudi J Kidney Dis Transpl 2019;30(5):1111-7.[1]

We are very happy that he raised valid objections and we would try to address one by one. Overall what impression we have got from his article is that unrelated kidney transplant should be legally allowed, and there should be appropriate remuneration, health insurance, and other incentives for all donors. This donor incentive system is working successfully in Saudi Arabia and Iran where no middle man is involved and all the prospective donors are referred to a government regulator Saudi Center for Organ Transplantation for approval and a similar organization is functional in Iran. We believe that if we allow unrelated transplant without regulation, this will lead to exploitation of the most vulnerable people in the society for the benefit of the privileged. In our opinion, unrelated transplant should only be done in inevitable circumstances. It should never be allowed except approved by a special board which should very strictly assess the need for such an option.

Objection 1. First objection he raised about the title of article legalization of unrelated kidney transplant in exceptional circumstance. What are these circumstances?

Answer: Exceptional circumstances mean ABO incompatibility, cross-matching compatibility, familial disease like focal segmental glomerulosclerosis, and autosomal polycystic kidney disease in which we cannot get an organ from family members or family member already donated to other family member and left with no option.

Objection 2. In our article, we said transplant is the best modality for chronic renal failure (CRF) patients, especially with comorbid, but according to responder, this is the best modality for all who are considered fit.

Answer: Yes, he is right; transplant is best for all patients who are considered fit, but we want to emphasize that patients with multiple comorbidities such as dilated uremic cardio- myopathy with ejection fraction <30% and diabetes and severe protein-energy malnutrition patients do well when transplanted rather than to continue dialysis. The published articles of Omrani et al[2] and Rangel et al[3] also verified our opinion.

Objection 3. In our article, we talk about an ethical backlash to a living donor, converting a healthy person into a patient.

Answer: Again, a responder is right that previous studies showed that there is very little chance for a donor to develop hypertension, diabetes mellitus, and chronic renal failure in long-term follow-up, but recent studies have shown that donors as compared to the general population are at increased risk for ESRD, but the ratio is low.[4]

Objection 4. In our article, we said that immunological incompatibility is a barrier in kidney transplant.

Answer: Here, we mean that immunological incompatibility is not a barrier or hindrance in kidney transplantation, but it means that ABO incompatibility or human leukocyte antigen incompatibility with high donor-specific anti- HLA antibody; we need desensitization protocol due to which the cost of transplant increased 2-3 fold and not every patient can afford it in Pakistan. In the same context of immunological incompatibility, if we opt swapping which is a new modality in Pakistan (not in affluent countries) is also not easy due to strict criteria and non-acceptance of this type of transplant by families. Moreover, kidney swapping is only possible in A and B blood group not in O.

Objection 5. We ask why there is remuneration for unrelated kidney donors.

Answer: We believe that if financial remuneration is allowed, then it becomes trade of organ sale in Pakistan as we have seen in past where Pakistan became one of the leading centers for organ trafficking due to lack of bylaws and huge number of underprivileged population, also to get financial remuneration prospective donor can hide appropriate information. Hence, we believe instead of financial remuneration some other form of incentive should be given like lifetime medical insurance of donor and his whole family.

Objection 6: Finally, he said we should ask what a CRF patient should do if he has no family donor, should he continue dialysis till his death sentence is carried out.

Answer: This is what we are asking in our article what should patients do if he has no family donor and the answer is legalized unrelated transplant in special circumstances in which they can do transplant in dedicated transplant center rather than to do illegal transplant in low-resource settings.

   References Top

Hamid RB, Khan MT. Living-unrelated kidney donor transplantation: Legalization in exceptional circumstances? Saudi J Kidney Dis Transpl 2019;30:1111-7.  Back to cited text no. 1
[PUBMED]  [Full text]  
Omrani H, Rai A, Daraei Z, Sadeghi M. Study of echocardiographic changes after kidney transplantation in end-stage renal disease patients. Med Arch 2017;71:408-11.  Back to cited text no. 2
Rangel EB, de Sa JR, Melaragno CS, et al. Kidney transplant in diabetic patients: modalities, indications and results. Diabetol Metab Syndr 2009:1:2.  Back to cited text no. 3
Muzaale AD, Massie AB, Wang MC, et al. Risk of end-stage renal disease following live kidney donation. JAMA 2014;311:579-86.  Back to cited text no. 4

Correspondence Address:
Muhammad Tassaduq Khan
Renal Transplant Unit, National Institute of Solid Organ and Tissue Transplantation, Dow University of Health Sciences, Ojha Campus, Karachi
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DOI: 10.4103/1319-2442.284042

PMID: 32394940

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