4. DISEÑO DEL ENTORNO VIRTUAL DE APRENDIZAJE “UNIVERSIDAD
4.6. Estructura del Entorno Virtual de Aprendizaje
4.6.2. Bloques del EVA de acuerdo a la metodología PACIE
4.6.2.2. Bloque académico
4.6.2.2.5. Unidad V: Infraestructura como servicio bajo la plataforma
Referral to donor follow-up clinic for life-long annual review Re-appointment in surgical or
medical review clinic
Life-long donor follow-up
Rationale: To provide continuing support to the donor & inform the UK Living Donor Registry
Annual review subject to review according to clinical need
Performed at local transplant/referring centre or GP
Relevant research/audit data collated & data returned to UK Transplant Living Donor Registry by LD Co-ordinatorAnnual review to include assessment of:
General health & lifestyle
Wound +/- complications
Medication/treatment initiated
Renal profile
Full blood count
Dipstick urinalysis +/- mid-stream urine +/- albumin/creatinine ratio
Blood pressure +/- 24hr ABPM / referral to GP for treatment if indicated
Weight & BMIAppropriate referral to be made if further nephrological, urological or surgical opinion is indicated. GP referral to be made for unrelated health problems
Upon discharge from the ward, donors must be provided with:
Appropriate advice about wound care, pain relief & general rehabilitation
Prescribed medication & wound dressings as required
Medical certificate to cover the period of in-patient stay
Discharge summary for GP
Contact numbers for the living donor co-ordinator team
Routine follow-up appointment in surgical OPD clinic with operating surgeon (when possible)187 For donors who travel from overseas to donate, there are implications for long-term follow- up arrangements and access to data once they return to their country of origin, particularly in countries where living donor transplantation is not an established practice or where individuals pay for healthcare. These donors should be provided with written advice about appropriate annual monitoring. However, it is difficult to ensure that robust arrangements are put in place and it is rarely possible to collect accurate data on overseas donors for the UK Living Donor Registry.
10.2 The Unsuitable Donor
An area that is easily overlooked is the care and follow-up of patients who start the donor assessment process but who do not subsequently donate. If this is the result of concerns about the potential donor‟s health, it is essential that appropriate arrangements are made for any necessary further investigation and management. A donor who is unsuitable for other reasons (for example a positive crossmatch) may need emotional support as they could conceive themselves to have “failed” the recipient – and blame themselves inappropriately for any subsequent adverse outcome for the recipient (see Chapter 4).
10.3 Pregnancy following Kidney Donation
Many centres consider women of childbearing age as potential living donors. Pregnancy has a number of well documented effects on the kidney raising the possibility that these may have an adverse effect in an individual with a solitary kidney. The information in this area is relatively limited. A study of 39 pregnancies in 23 women with 32 viable births revealed no significant problems and in particular no significant hypertension or proteinuria (5). Another study of 23 viable births in 14 kidney donors reported no significant problem (3). Two recent reports based upon retrospective Norwegian Registry Data and a large single centre survey in Minnesota, USA have raised concern about the potential for increased maternal complications after donation. Both studies are limited and interpretation is therefore difficult (6). Nevertheless, the presence of a solitary kidney does not appear to pose a significant risk during the course of a normal pregnancy and outcomes for pregnant kidney donors are considered comparable to those in the general population. Anecdotally, this opinion has been corroborated by expert obstetric opinion in the field when seeking advice on how to advise potential kidney donors.
188 Within the UK, there is an opportunity to report births post-donation to the Living Donor Registry as „a significant medical event‟ at each annual review (4). This should be encouraged in order to improve the evidence base. Close follow-up is advisable in donors during pregnancy and periodic assessment should be undertaken of serum creatinine and creatinine clearance in addition to urine culture and blood pressure.
10.4 Renal Failure following Living Kidney Donation
Renal failure after living kidney donation is rare, but there have been occasions (at least one in the UK) where peri-operative complications have resulted in a living kidney donor developing chronic dialysis-dependent renal insufficiency following surgery. In this rare situation, NHSBT has given a formal undertaking that any living kidney donor who develops renal failure as an acute consequence of donation will receive priority for a deceased donor kidney for transplantation.
References
1. Buszta C, Steinmuller DR, Novick AC, et al. Pregnancy after donor nephrectomy. Transplantation 1985; 40: 651-4.
2. The Ethics Committee of the Transplantation Society. The Consensus Statement of the Amsterdam Forum on the Care of the Live Kidney Donor. Transplantation 2004; 78: 491-2.
3. A Report of the Amsterdam Forum on the care of the Live Kidney Donor; Data and Medical Guidelines. Transplantation 2005; 79; S53-S66.
4. Living Donor Registry. www.nhsbt.org.uk
5. Jones JW, Acton RD, Elick B, Granger DK, Matas AJ. Pregnancy following kidney donation. Transplant Proc 1993; 25: 3082.
6. Josephson, MA. Pregnancy after kidney donation: more questions than answers. Nature Reviews, Nephrology 2009; 5: 495-7.
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