Living kidney donation is an import

Living kidney donation is an important treatment option for kidney failure that clearly benefits many families and society. The ethical practice of living kidney donation requires that professionals in the transplantation field provide donors with up-to-date, accurate information about risks (including pregnancy risks2)
and acknowledge the limitations of what is known. In theory, randomized trials could generate estimates of donor risk that are less prone to bias; however, randomized trials of donation are not ethically feasible. An alternative approach would be to perform a large, multicenter, prospective cohort study in which carefully selected donors and nondonors are enrolled over a period of several years and then followed for a decade, with adjudicated pregnancy outcomes, but this approach would also face many logistical challenges. An increased risk of gestational hypertension and preeclampsia among kidney donors is biologically plausible3,4,6,7 and has been identified in two previous studies in Norway12 and the United States13 and now in Canada. Although there is some uncertainty regarding the true magnitude of risk, having reviewed all the evidence and associated limitations, we believe it is conscionable to act. Information on this potential risk should be included in clinical practice guidelines, shared in the informed-consent processes for potential donors and their recipients when a woman has reproductive potential, and used to guide the care of pregnant donors. Our study and others show that probabilities of the most serious maternal and fetal outcomes remain low and are not significantly increased after donation.12,13 It is unknown whether the same holds true in countries in which women lack access to a similar quality of health care. For this reason, there may be a role for government programs to cover the costs of recommended pregnancy care for donors who lack health insurance, including any costs related to the treatment of hypertension.37,38

Results (Indonesian) 1:

Hidup ginjal sumbangan adalah pilihan pengobatan penting untuk gagal ginjal yang jelas manfaat banyak keluarga dan masyarakat. Praktik etis hidup ginjal sumbangan memerlukan bahwa profesional di bidang transplantasi menyediakan donor dengan akurat, up-to-date informasi tentang risiko (termasuk kehamilan risks2) and acknowledge the limitations of what is known. In theory, randomized trials could generate estimates of donor risk that are less prone to bias; however, randomized trials of donation are not ethically feasible. An alternative approach would be to perform a large, multicenter, prospective cohort study in which carefully selected donors and nondonors are enrolled over a period of several years and then followed for a decade, with adjudicated pregnancy outcomes, but this approach would also face many logistical challenges. An increased risk of gestational hypertension and preeclampsia among kidney donors is biologically plausible3,4,6,7 and has been identified in two previous studies in Norway12 and the United States13 and now in Canada. Although there is some uncertainty regarding the true magnitude of risk, having reviewed all the evidence and associated limitations, we believe it is conscionable to act. Information on this potential risk should be included in clinical practice guidelines, shared in the informed-consent processes for potential donors and their recipients when a woman has reproductive potential, and used to guide the care of pregnant donors. Our study and others show that probabilities of the most serious maternal and fetal outcomes remain low and are not significantly increased after donation.12,13 It is unknown whether the same holds true in countries in which women lack access to a similar quality of health care. For this reason, there may be a role for government programs to cover the costs of recommended pregnancy care for donors who lack health insurance, including any costs related to the treatment of hypertension.37,38