Improving on-line information for potential living kidney donors
2007; Elsevier BV; Volume: 71; Issue: 10 Linguagem: Inglês
10.1038/sj.ki.5002168
ISSN1523-1755
AutoresErike Moody, Kristin K. Clemens, Leroy Storsley, Amy D. Waterman, Chirag R. Parikh, Amit X. Garg,
Tópico(s)Organ Transplantation Techniques and Outcomes
ResumoIndividuals who consider becoming living kidney donors often search the internet for reliable information before contacting the transplant center. The quality of such information requires due consideration. Using the search engines Google and Yahoo and the WebMD information portal, two reviewers independently abstracted data on the classification, readability, and general quality of websites. The coverage and accuracy of each site's discussion of the risks, benefits, and process of living donation was also assessed against a checklist of recommended information. Eighty-six unique websites on living kidney donation were found. Most were created by transplant programs and transplant organizations. Although the content of most sites was accurate, almost all (98%) were written above the recommended patient reading level (i.e., fifth grade). On average, each site covered 38% of the recommended information on living donation (range 8–76%). Educational topics of potential long-term medical risks, psychological risks, and expected benefits to the donor were often missing. The most visited websites were often not ranked among the best sites to provide information. By better understanding the nature of on-line information, transplant professionals can direct their patients to the best available websites. Local educational efforts, including the effective use of internet resources, will ensure living donation and complete understanding of the risks by potential donors and recipients. Individuals who consider becoming living kidney donors often search the internet for reliable information before contacting the transplant center. The quality of such information requires due consideration. Using the search engines Google and Yahoo and the WebMD information portal, two reviewers independently abstracted data on the classification, readability, and general quality of websites. The coverage and accuracy of each site's discussion of the risks, benefits, and process of living donation was also assessed against a checklist of recommended information. Eighty-six unique websites on living kidney donation were found. Most were created by transplant programs and transplant organizations. Although the content of most sites was accurate, almost all (98%) were written above the recommended patient reading level (i.e., fifth grade). On average, each site covered 38% of the recommended information on living donation (range 8–76%). Educational topics of potential long-term medical risks, psychological risks, and expected benefits to the donor were often missing. The most visited websites were often not ranked among the best sites to provide information. By better understanding the nature of on-line information, transplant professionals can direct their patients to the best available websites. Local educational efforts, including the effective use of internet resources, will ensure living donation and complete understanding of the risks by potential donors and recipients. With growing transplant lists and a relative shortage of available organs from deceased donors, health-care practitioners continue to encourage the practice of living kidney donation. Living donor transplantation has a shorter waiting time and better graft and recipient survival compared with deceased donor transplantation.1.Terasaki P.I. Cecka J.M. Gjertson D.W. Takemoto S. High survival rates of kidney transplants from spousal and living unrelated donors.N Engl J Med. 1995; 333: 333-336Crossref PubMed Scopus (1013) Google Scholar, 2.Terasaki P.I. Cecka J.M. Gjertson D.W. et al.Risk rate and long-term kidney transplant survival.in: Cecka J.M. Terasaki P.I. Clinical transplants. LA, UCLA Tissue Typing Laboratory1996: 443-458Google Scholar, 3.2001 Report, Volume 1. Dialysis and Renal Transplantation, Canadian Organ Replacement Register, Canadian Institute for Health Information, Ottawa, Ontario2001Google Scholar As many recipients are afraid to ask family or friends to donate because of concerns about pressuring or harming the health of a loved one,4.Waterman A.D. Stanley S.L. Covelli T. et al.Living donation decision making: recipients’ concerns and educational needs.Prog Transplant. 2006; 16: 17-24Crossref PubMed Google Scholar,5.Pradel F.G. Mullins C.D. Bartlett S.T. Exploring donors’ and recipients’ attitudes about living donor kidney transplantation.Prog Transplant. 2003; 13: 203-210Crossref PubMed Scopus (72) Google Scholar potential donors often initiate the discussion with the potential recipient.5.Pradel F.G. Mullins C.D. Bartlett S.T. Exploring donors’ and recipients’ attitudes about living donor kidney transplantation.Prog Transplant. 2003; 13: 203-210Crossref PubMed Scopus (72) Google Scholar,6.Cabrer C. Oppenhaimer F. Manyalich M. et al.The living kidney donation process: the donor perspective.Transplant Proc. 2003; 35: 1631-1632Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar Before this discussion, many potential donors may seek out information from the internet or other educational sources to address their concerns about the procedure, including the risks of donation on future health, occupation, and lifestyle.7.Hiller J. Sroka M. Weber R. et al.Identifying donor concerns to increase live organ donation.J Transpl Coord. 1998; 8: 51-54Crossref PubMed Scopus (33) Google Scholar The internet also provides the opportunity for prospective donors to speak to actual living donors by listserve or email. The act of contacting the transplant center for assessment is usually an indication that the potential donor has already resolved their main concerns with the donation process and is ready to proceed.8.Waterman A.D. Covelli T. Caisley L. et al.Potential living kidney donors’ health education use and comfort with donation.Prog Transplant. 2004; 14: 233-240Crossref PubMed Scopus (46) Google Scholar In general, approximately 5% of internet users, or six million people, go online for health information every day.9.Fox S. Rainie L. Pew Internet & American Life Project Vital Decisions. How Internet users decide what information to trust when they or their loved ones are sick. 2002http://www.pewinternet.org/Google Scholar Unfortunately, despite efforts toward standardization,10.HON code of conduct (HONcode) for medical and health Web sites. 2007http://www.hon.ch/Google Scholar health information on the Web remains highly unregulated and varies in its quality, accuracy, and readability.11.Berland G.K. Elliott M.N. Morales L.S. et al.Health information on the internet: accessibility, quality, and readability in English and Spanish.JAMA. 2001; 285: 2612-2621Crossref PubMed Scopus (885) Google Scholar As patients also vary in their access and use of the internet as a vehicle for education; frequent users are more likely to be Caucasian and highly educated.12.Dickerson S. Reinhart A.M. Feeley T.H. et al.Patient internet use for health information at three urban primary care clinics.J Am Med Inform Assoc. 2004; 11: 499-504Crossref PubMed Scopus (166) Google Scholar For patients with renal disease, about 22% of transplant-eligible dialysis patients reported having access to and using the internet to learn about living and deceased donation.13.Waterman A.D. Stanley S.L. Barrett A.C. et al.Renal patients’ use of the internet to learn about transplantation.Transplantation. 2006; 82: 594Google Scholar Some analyses of the quality of chronic kidney disease websites have also occurred.14.Calderon J.L. Zadshir A. Norris K. Structure and Content of Chronic Kidney Disease Information on the World Wide Web: Barriers to public understanding of a pandemic.Nephrol News Issues. 2004; 18 (78–79, 81–84): 76PubMed Google Scholar Yet, little is known about the quality of internet information on living kidney donation. Thus, we evaluated the quality of websites discussing living donation, identified sites which provided the most comprehensive, accurate and readable information for prospective donors, and described site characteristics which were associated with better information. The three keyword searches resulted in 6 370 000 hits using Google, 2 226 000 using Yahoo, and 694 100 using WebMD. Of these, the first available 450 English websites were retrieved (i.e., the first 50 from each search), with 55% of the initial websites found to be duplicates, indicating that the search strategies successfully identified the most commonly visited websites. After removing duplicates and excluding ineligible websites (Figure 1), 86 websites were reviewed. These 86 unique sites, ranked by their link popularity, are listed in Table 1.Table 1Living kidney donation websites ranked by link popularity (the general quality of each websiteaThe general quality of each website was assessed using the DISCERN survey (Materials and Methods section). is presented along with the coverage of recommended living donor informationbThe coverage of each website was defined by the percentage of checklist items covered from Table 1 (Materials and Methods section).)RankURLGeneral quality (out of 5)Content coverage (%) 1www.kidney.org/transplantation/livingDonors/index.cfm4.575 2www.aish.com/societyWork/society/Desperate_for_a_Donor.asp2.321 3www.transplantweek.org/members/faq.htm3.951 4www.kidneywdc.org/organ_and_tissue_donation.cfm3.322 5www.livingdonorsonline.org/kidney/kidney.htm4.470 6Renux.dmed.ed.ac.uk/EdREN/3.535 7www.angelfire.com/md2/Kidney3.333 8www.nlm.nih.gov/medlineplus/ency/article/003005.htm2.916 9www.sbhcs.com/SERVICES/renal/donor/index.html2.83010www.mayoclinic.org/kidney-transplant/livingdonor.html3.64011www.kidney.org.uk/living-donor4.26712www.nzkidneyfoundation.co.nz/main/article_000118.html2.51913www.giftoflife.on.ca/page.cfm?id=13451415-652C-4A85-9BE9-063A0CD442AC&languageID=13.96714www.transplantliving.org/livingdonation/default.aspx4.55115www.mayoclinic.com/health/kidney-donation/AN002013.72216www.kidneytransplant.org/conventionallivedonorkidneydonation.html3.32517www.optn.org/about/donation/livingDonation.asp4.03318www.shareyourlife.org/become_livingdonor.html3.23319www.wrtc.org/living_kidney_donation.cfm3.13220www.columbiasurgery.org/pat/kidneypancreastx/donation.html3.23521www.pennhealth.com/transplant/kidney/living.html4.14522www.umm.edu/transplant/kidney/qanda.html3.43323www.fairviewtransplant.org/kidney/kidney_living_donor.asp3.65424www.ehow.com/how_10829_be-kidney-donor.html2.51425www.hotlib.com/articles/show.php?t=Keyhole_Surgery:_An_Innovative_Boon_For_Live_Kidney_Donors2.51326www.torontotransplant.org/patients/livingDonorKidney.cfm2.11827kidneytransplant.upmc.com/LivingKidneyDonor.htm2.73328www.kidney.ab.ca/organdonation/livingdonation.html2.82429www.donors1.org/newsletters/living_donation.html2.32930www.livingkidneydonor.com2.41631www.bchealthguid.org/kbase/frame/tv720/tv7207/frame.htm3.82432www.yesutah.org/donations/kidney.php2.43233www.ochsner.org/transplant/kidney-pancreas_donor.html3.63534www.stanfordhospital.com/clinicsmedServices/COE/transplant/kidneytransplant/serviceskidneylivingdonor.html2.21035www.uktransplant.org.uk/ukt/how_to_become_a_donor/living_kidney_donation/questions_and_answers.jsp4.56036www.cdhb.govt.nz/nephrology/kidney-donation.htm3.85437www.cpmc.org/advanced/kidney/patients/topics/living_donation.html4.45238www.vcuhealth.org/transplant/transplant_kidney_living/transplant_kidney_living.htm3.14039www.talktransplant.com/Kidney/Pre-transplant/Types_of_donor.aspx4.66240www.csmc.edu/634.html2.11941www.goaskalice.columbia.edu/2114.html2.72242www.mc.uky.edu/transplant/kidney_donor.htm3.83643www.upstate.edu/uh/surgery/transplant/qa_livingkidney.php3.43844www.cincinnatichildrens.org/health/info/urinary/kidney-transplant/preparing/donor.htm3.13345www.cambridge-transplant.org.uk/research/nursing/livingdonorissues.htm4.36246www.medizin.fu-berlin.de/transplantation/txehome.htm2.52447www.sentara.com/Sentara/Services/Transplant/LivingKidneyDonation/2.83848www.sharp.com/services/index.cfm?id=23783.43049news.bbc.co.uk/1/hi/health/620606.stm2.51950www.cbsnews.com/stories/2004/11/03/health/main653217.shtml2.72551www.house.gov/mcdermott/kidneycaucus/livdon.html3.53252www.harthosp.com/transplant/llkd.asp1.71353www.rogosin.org/LaparoscopicDonorBrochure.pdf3.13854www.findarticles.com/p/articles/mi_qa4117/is_200409/ai_n945826993.62455www.brighamandwomens.org/transplantsurgery/Livingdonation/livingdonationprogram.aspx2.72256www.umc-cares.org/med_serv/transplant/faqs.asp2.41957www.ahsc.arizona.edu/opa/news/oct03/kidney.htm1.91958www.health-alliance.com/transplant/lap_living_kidney_donation.html2.43659www.medicinenet.com/script/main/art.asp?articlekey=543473.92160www.health.nsw.gov.au/pubs/2004/pdf/kidney_donation.pdf4.65261www.unos.org/ContentDocuments/Living_Donation_Facts.pdf3.23662www.aurorahealthcare.org/services/transplant/living-kidney-donor.asp3.62763www.healthatoz.com/healthatoz/Atoz/ency/kidney_transplantation.jsp3.92464www.hopkinsmedicine.org/Transplant/Programs/kidneypancreas/livingdonor2.32565www.multiline.com.au/~donor/livemain.html2.82966www.sleh.com/sleh/downloads/KidneyDonationHandbook.pdf3.24067www.uwmedicine.org/Facilities/UWMedicalCenter/CommunityAndNews/Publications/Summer2003/Organ.htm1.77968www.cdha.nshealth.ca/patientinformation/nshealthnet/0654.pdf3.93869www.lhsc.on.ca/programs/nephrology/pdf/ldonors.pdf4.54870www.medicalcenter.osu.edu/patientcare/hospitalsandservices/programs/transplant/faq/3.73871organtransplant.mc.duke.edu/PDFs/Living_Donor_Kidney_FactSheet.pdf3.63872www.aanet.org/nkf/Atkins_pages.pdf4.14673www.calgaryhealthregion.ca/publicaffairs/news/kidneytransplant_mar172006.pdf2.31974www.legacyhealth.org/BODY.CFM?id=7912.41175www.lhsc.on.ca/programs/nephrology/pdf/papers/paper1.pdf3.84176www.transplant.bc.ca/living_kidney_main.htm3.53577barnesjewish.org/groups/default.asp%3FNavID%3D30032.42778www.health.uab.edu/show.asp?durki=429433.33579www.health.ucsd.edu/specialties/transplant/kidney/3.31980www.lifelinkfound.org/alivinggift.pdf4.15681www.daat.ac.il/daat/kitveyet/assia_english/drukker-1.htm3.31882www.dhmc.org/webpage.cfm?site_id=2&org_id=132&morg_id=0&sec_id=0&gsec_id=36393&item_id=363933.13683www.kidney.org.au/renal_resources/html/Live_Kidney_Donation_FS.html4.04984www.manchestereveningnews.co.uk/news/health/s/167/167967_mum_to_be_first_live_kidney_donor.html2.31985www.ucsfhealth.org/adult/edu/livingdonorrenaltran214b.pdf3.34986www.webmd.com/hw/health_guide_atoz/tv7207.asp3.422a The general quality of each website was assessed using the DISCERN survey (Materials and Methods section).b The coverage of each website was defined by the percentage of checklist items covered from Table 1 (Materials and Methods section). Open table in a new tab Of the 86 websites, 46% (n=40) were affiliated with university or hospital transplant programs, 28% (n=24) with provincial/state, national or international transplant organizations, 4% (n=3) with government organizations, and none with commercial companies. Six percent (n=5) were news articles, 5% (n=4) were journal articles, 2% (n=2) were personal webpages, and 9% (n=8) did not fall under any of these categories. Despite the dynamic nature of information about living donation and health information in general, only 35 sites (41%) provided a date of last revision. Over half of the sites (67%) provided a privacy policy detailing the information, if any, collected by the site and the ability of the site owner to track user access. Most often no personal information was collected from these sites. Access to a message board was available to users at nine sites (11%) and 14% of websites displayed the Health on the Net (HON) seal of approval. Most sites contained disclaimers stating that the information presented by the website was in no way a supplement for physician's opinion. Few sites provided a list of questions for patients to ask their family doctor or transplant team. Based on the Flesch–Kincaid grade level scores, almost all sites (98%) were written above the recommended reading level (i.e. fifth grade) for public comprehension, with 76% written above the tenth grade level. Only three websites contained content written below the sixth grade level. On a scale from 0 (practically unreadable) to 100 (easy for any literate person), results of the Flesch Reading Ease scores ranged from 14 to 72, with only 29% of websites having a Flesch Reading Ease score above 50. The reading level of written information on most of the websites did not differ by website affiliation. The general quality of living donor information provided by websites was moderate; with an overall mean DISCERN score for all sites approximating 3 out of a possible 5. The quality scores of individual websites varied widely, ranging from 1.7 to 4.6. The DISCERN score for each of the 86 websites is presented in Table 1. The quality of information on sites differed by affiliation analysis of variance (ANOVA, P=0.02). Provincial, national, or international transplant organizations had significantly higher mean DISCERN scores than news articles (average 3.5 vs 2.5, ANOVA Tukey HSD, P=0.05). The quality of website content was also found to be higher when the HON seal was present compare with when it was absent (3.7 vs 3.2; t-test P=0.01). In examining individual questions on the DISCERN scale, 59% of sites failed to state clearly their purpose and target audience. Although the websites, in general, included links to multiple sources of additional information for further exploration of living donation (average score of 4.4 out of 5), most failed to provide references and scientific support for the information presented (average score of 2.2 out of 5). Coverage and accuracy of information on the risks, benefits, and process of donation: the percentage of living donor checklist items covered on each website is presented in Table 2, and a summary of the coverage and accuracy of specific topics is presented in Table 2. On average, websites covered 24 of the recommended 63 items (38%). The topics most covered included general information about living donation (100% coverage), followed shortly by the risks and benefits for the recipient (92% coverage) and an explanation of the donor evaluation process (92% coverage). The least covered topics were donor benefits (41% coverage) and the voluntary nature of donation (42% coverage). There was no association between the link popularity ranking and the level of coverage of living donor information provided by each website (r=0.12). For each of the topics on the living donor checklist, the content presented on the sites was 88–100% accurate (Table 2).Table 2Website coverage and accuracy of recommended information on living donation topicsOf websites that covered the topic:Amount of coverage (%)aThe amount of coverage was defined by the mean percentage of checklist items covered by websites under each topic in Table 3.Accuracy (%)bAccuracy was defined by the mean percentage of items, covered by websites under each topic in Table 3, which were described correctly.Topics in living kidney donationNo. of sites which covered topic (n, (%))Minimal ( 80%)>50% incorrect50–90% correct>90% correctGeneral information about kidney failure and treatments86 (100%)12970000100Short-term medical risks to donor75 (87%)16393690298Long-term medical risks to donor41 (48%)275617001288Psychological risks and long-term course39 (45%)4143880298Benefits to donor35 (41%)68266000100Risks and benefits to recipient79 (92%)166024000100Financial considerations52 (60%)334023400100Voluntarism36 (42%)393619600100Donor evaluation process79 (92%)105633100100a The amount of coverage was defined by the mean percentage of checklist items covered by websites under each topic in Table 3.b Accuracy was defined by the mean percentage of items, covered by websites under each topic in Table 3, which were described correctly. Open table in a new tab The nature of website coverage for each of the recommended checklist items varied. For example, the advantages of living donation over dialysis and deceased donor transplantation were expressed on many sites in different ways. Better graft and patient survival, shorter waiting time, better quality of life, and the convenience of elective surgery were most frequently reported (described in 50–68 sites (58–79%)). Ninety-two percent of sites (n=79) covered the various types of living donation available, with living-related (n=78) and living-unrelated (n=78) donation being the most common types described, whereas 39 websites described non-directed or stranger donation as an option for living donors. Almost 80% of the websites (n=67) described the tests involved in the donor evaluation process. More than two-third of the sites (n=63) compared the laparoscopic technique with the traditional open surgery. However, only half (n=42) of the websites listed contraindications that may prevent a potential donor from donating, with diabetes being the reason most often stated (n=35). Fifteen percent of sites (n=13) described the possible need for the donor to quit smoking or lose weight before surgery. Over 90% of the websites contained information pertaining to the risks and possible outcomes for the recipient of a living kidney transplant. The risks to the recipient of major surgery were generally well-described, but few described the small possibility of death (n=2; 2% of sites). Over a quarter of the sites explained the possibility of the recipient returning to dialysis owing to graft rejection or the recurrence of disease (n=28; 32%). In contrast, the sites varied considerably in their discussion of living donors’ short- and long-term medical risks. Sixty-seven percent of sites (n=59) described at least one immediate short-term medical risk to the donor, whereas the remaining sites did not describe any. The most common surgical risks described were pain, wound infection, bleeding or laceration, and blood clotting (described in 21–50 sites (24–57%)). Of the 86 websites, 38 (44%) made no mention of any long-term donor risks and another eight (9%) denied there were any long-term risks. One site mentioned the existence of long-term risks, but did not discuss them further. Of the remaining 39 sites discussing long-term donor risks, risks described included high blood pressure or hypertension (n=34), proteinuria (n=15), kidney failure or injury (n=20). Twenty sites described uncertainty in the current scientific knowledge of known long-term risks. Only 39% of sites (n=34) stressed the importance of donors receiving post-transplant follow-up care to maintain good long-term health, with 24 sites describing the tests that should be conducted during follow-up, including blood pressure and kidney function tests. Many of the sites reported that donors might experience a loss of income (n=43; 49%) and might have to pay travel-related expenses (n=38; 44%) and accommodation costs (n=25; 29%). The risks to social relationships among donor, recipient, and family were rarely mentioned (n=10; 11%), as was the likelihood for increased donor self-esteem after nephrectomy (n=8; 9% of sites). Thirty-five percent of sites (n=30) described the benefit to the donor from seeing a positive change in the recipient's condition. The extent of coverage of written information did not differ by website affiliation. Many living donors initiate the conversation about donation with their potential recipients themselves5.Pradel F.G. Mullins C.D. Bartlett S.T. Exploring donors’ and recipients’ attitudes about living donor kidney transplantation.Prog Transplant. 2003; 13: 203-210Crossref PubMed Scopus (72) Google Scholar and have already decided to donate before they ever contact the transplant center.8.Waterman A.D. Covelli T. Caisley L. et al.Potential living kidney donors’ health education use and comfort with donation.Prog Transplant. 2004; 14: 233-240Crossref PubMed Scopus (46) Google Scholar The 24-h availability of the internet makes it a natural source of information for family members and friends to learn about living donation. For those potential recipients or donors who elect not to pursue this treatment option, internet could represent their only source of information. This critical assessment of 86 websites found considerable variability in the quality, comprehensiveness, and readability of information about living kidney donation. Potential donors who use the internet as a source of transplant information are often more comfortable with the procedure than individuals who do not conduct such research.8.Waterman A.D. Covelli T. Caisley L. et al.Potential living kidney donors’ health education use and comfort with donation.Prog Transplant. 2004; 14: 233-240Crossref PubMed Scopus (46) Google Scholar The challenge for potential living kidney donors lies not with finding information on the internet, but rather with finding high quality, comprehensive sources. Although most websites covered topics accurately, much of the information currently available online is still incomplete. Less than 50% of websites described any potential long-term risks associated with the donation process or the need for regular follow-up to maintain long-term good health after donation. Most websites did not provide references and scientific support for the information presented. With this level of variability, individuals choosing not to present to the transplant center may decide against donation based on incomplete information. Conversely, potential donors who do come forward may be unrealistically positive about the procedure because they are unaware of possible long-term medical risks or associated financial costs. This study was one of the first to conduct a detailed, rigorous assessment of websites on living donation. Our method of selecting websites was objective and many of the popular websites reviewed were similarly identified by different search strategies. We used accepted methods to evaluate the general quality and readability of each website, and developed the recommended checklist of information about living kidney donation from valid sources (Table 3). Data abstraction was performed independently in duplicate, and proved reliable, minimizing any potential bias arising from subjectivity in this task.Table 3Checklist of recommended information about living kidney donation1. General information about kidney failure and treatments: Function of the kidneys Dialysis and transplant: two main treatment options for patients with kidney failure Two types of dialysis: peritoneal dialysis and hemodialysis, dialysis can be performed at home or in-centre The two types of transplantation: deceased and living donation; types of living kidney donation (i.e. living related, stranger) Transplantation costs the health care system less compared to dialysis33.Whiting J.F. Kiberd B. Kalo Z. et al.Cost-effectiveness of organ donation: evaluating investment into donor action and other donor initiatives.Am J Transplant. 2004; 4: 569-573Crossref PubMed Scopus (73) Google Scholar Benefits of living kidney donation (decreased rejection, improved graft survival, convenience, no time on waiting lists)34.Tarantino A. Why should we implement living donation in renal transplantation?.Clin Nephrol. 2000; 53: 55-56PubMed Google Scholar,35.Davis C.L. Delmonico F.L. Living-donor kidney transplantation: a review of the current practices for the live donor.J Am Soc Nephrol. 2005; 16: 2098-2110Crossref PubMed Scopus (252) Google Scholar Living donation surgical techniques; laparoscopic and open surgery36.Dasgupta P. Challacombe B. Compton F. Khan S. A systematic review of hand-assisted laparoscopic live donor nephrectomy.Int J Clin Pract. 2004; 58: 474-478Crossref PubMed Scopus (15) Google Scholar, 37.Lennerling A. Blohme I. Ostraat O. et al.Laparoscopic or open surgery for living donor nephrectomy.Nephrol Dial Transplant. 2001; 16: 383-386Crossref PubMed Scopus (47) Google Scholar, 38.Rocca X. Espinoza O. Hidalgo F. Gonzalez F. Laparoscopic nephrectomy: safe and comfortable surgical alternative for living donors and for good results of graft function.Transplant Proc. 2005; 37: 3349-3350Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar2. Short-term medical risks to donor: General anesthetic and death owing to surgery35.Davis C.L. Delmonico F.L. Living-donor kidney transplantation: a review of the current practices for the live donor.J Am Soc Nephrol. 2005; 16: 2098-2110Crossref PubMed Scopus (252) Google Scholar,39.Matas A.J. Bartlett S.T. Leichtman A.B. Delmonico F.L. Morbidity and mortality after living kidney donation, 1999–2001: survey of United States transplant centers.Am J Transplant. 2003; 3: 830-834PubMed Google Scholar Surgical complications: such as infection, laceration, and pulmonary embolism40.Johnson E.M. Remucal M.J. Gillingham K.J. et al.Complications and risks of living donor nephrectomy.Transplantation. 1997; 64: 1124-1128Crossref PubMed Scopus (217) Google Scholar Length of hospital stay,40.Johnson E.M. Remucal M.J. Gillingham K.J. et al.Complications and risks of living donor nephrectomy.Transplantation. 1997; 64: 1124-1128Crossref PubMed Scopus (217) Google Scholar length of daily and physical activity limitations41.Peters T.G. Repper S.M. Vincent M.C. et al.One hundred consecutive living kidney donors: modern issues and outcomes.Clin Transplant. 2002; 16: 62-68Crossref PubMed Scopus (18) Google Scholar3. Long-term medical risks to donor: Some uncertainty about outcomes19.Ommen E.S. Winston J.A. Murphy B. Medical risks in living kidney donors: absence of proof Is not proof of absence.Clin J Am Soc Nephrol. 2006; 1: 885-895Crossref PubMed Scopus (72) Google Scholar Risk of: increased blood pressure from baseline,16.Boudville N. Prasad G.V. Knoll G. et al.Meta-analysis: risk for hypertension in living kidney donors.Ann Intern M
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