LIVING UNRELATED (PAID) KIDNEY-TRANSPLANTATION IN THIRD-WORLD COUNTRIES - HIGH-RISK OF COMPLICATIONS BESIDES THE ETHICAL PROBLEM

Due to inadequate cadaveric and living related organ supply, many end- stage renal disease patients go to third-world countries for living un related (paid) kidney transplantation. Thirty-four patients who have h ad transplantations in two centres in India before coming to our centr e for post-transplant care and follow-up are reported in this study. I n the post-transplant phase at our centre, the mean follow-up period o f the patients was 209.7 +/- 137.3 (range 6-450) days. Fourteen of the m, having an uneventful course, were followed on an outpatient clinic basis. The rest of the patients were hospitalized because of the follo wing surgical and/or medical complications during admission: urinary f istula in two patients; lymphocele in three patients; urinary tract ob struction in two patients; decubitus ulcer in one patient; severe woun d infection in one patient; subacute myocardial infarction in one pati ent; acute irreversible vascular rejection in two patients; urinary tr act infection in two patients; pneumonia in two patients; congestive h eart failure and severe electrolyte disturbance in two patients; post- transplant diabetes mellitus and ketoacidosis in one patient; cyclospo rin nephrotoxicity in two patients; cyclosporin nephro-, hepato-, and neurotoxicity in one patient. Plasmodium falciparum malaria in three p atients, generalized mucormycosis infection in one patient, and genito urinary aspergillosis in one patient were seen during the first month. Hepatitis B virus infection followed by chronic active hepatitis was diagnosed in two patients, 2 and 4 months after the operation; and Kap osi's sarcoma was noted in another two patients, 1 and 5 months after the operation. One of the patients died as a result of disseminated mu cormycosis and another one as a result of pneumonia. Transplant nephre ctomy was performed in the case of two other patients because of irrev ersible symptomatic rejection. A possible cause of the above-cited hig h incidence of complications was thought to be the inadequate evaluati on of the donors and the patients in the preoperative period. Furtherm ore, many of the patients were sent to their countries without treatme nt of postoperative-period complications. It was concluded that living unrelated (paid) kidney transplantation in developing countries carri ed high risks of medical and/or surgical complications, beside the eth ical problems.