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Open Access Debate

Ethical issues relating to renal transplantation from prediabetic living donor

Aldo Ferreira-Hermosillo1*, Edith Valdez-Martínez2 and Miguel Bedolla3

Author Affiliations

1 Unidad de Investigación en Endocrinología Experimental, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Cuauhtémoc 330, colonia Doctores, 06729 Mexico City, Mexico

2 Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXI, Cuauhtémoc 330, colonia Doctores, 06729 Mexico City, Mexico

3 Policy Studies Center of the College of Public Policy, The University of Texas in San Antonio, 501 W. Cesar Chavez Blvd, San Antonio, TX 78207, USA

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BMC Medical Ethics 2014, 15:45  doi:10.1186/1472-6939-15-45

Published: 16 June 2014

Abstract

Background

In Mexico, diabetes mellitus is the main cause of end − stage kidney disease, and some patients may be transplant candidates. Organ supply is limited because of cultural issues. And, there is a lack of standardized clinical guidelines regarding organ donation. These issues highlight the tension surrounding the fact that living donors are being selected despite being prediabetic. This article presents, examines and discusses using the principles of non-maleficience, autonomy, justice and the constitutionally guaranteed right to health, the ethical considerations that arise from considering a prediabetic person as a potential kidney donor.

Discussion

Diabetes is an absolute contraindication for donating a kidney. However, the transplant protocols most frequently used in Mexico do not consider prediabetes as exclusion criteria. In prediabetic persons there are well known metabolic alterations that may compromise the long − term outcomes of the transplant if such donors are accepted. Even so, many of them are finally included because there are not enough donor candidates. Both, families and hospitals face the need to rapidly accept prediabetic donors before the clinical conditions of the recipient and the evolution of the disease exclude him/her as a transplant candidate; however, when using a kidney potentially damaged by prediabetes, neither the donor’s nor the recipient’s long term health is usually considered.

Considering the ethical implication as well as the clinical and epidemiological evidence, we conclude that prediabetic persons are not suitable candidates for kidney donation. This recommendation should be taken into consideration by Mexican health institutions who should rewrite their transplant protocols.

Summary

We argue that the decision to use a kidney from a living donor known to be pre-diabetic or from those persons with family history of T2DM, obesity, hypertension, or renal failure, should be considered unethical in Mexico if the donor bases the decision to donate on socially acceptable norms rather than informed consent as understood in modern medicine.

Keywords:
Renal transplantation; Living donors; Organ donor; Prediabetes; Diabetes mellitus; Clinical ethic; Mexico