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Invited Critique |

Is It Safe to Donate a Kidney?  Comment on “Early Clinical and Economic Outcomes of Patients Undergoing Living Donor Nephrectomy in the United States”

Lloyd E. Ratner, MD
Arch Surg. 2010;145(4):362. doi:10.1001/archsurg.2010.15.
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Approximately 6000 live donor nephrectomies are performed in the United States annually. Donor safety is of paramount importance. Therefore, there is a need to collect, analyze, and track donor morbidity and mortality to ensure patient safety. Reliable data confirming living kidney donor safety are important to be able to provide educational information for prospective donors and their families.

To my knowledge, Friedman et al are the first to report the use of a population-based approach to obtain this information by analyzing data derived from International Classification of Diseases, Ninth Revision codes in the HCUP-NIS. This is a laudable effort. Of 6320 living donations, there were no donor deaths, an 18.4% complication rate, and a mean (SD) duration of hospitalization of 3.3 (0.3) days. However, there are a number of important limitations to this approach. First, complications are not segregated by severity. Second, there is no consistency in how centers define their complications. Third, the data cannot be wholly verified for accuracy because they are derived from billing information and not confirmed by clinicians. As the name of the database implies, only in-patient data have been examined. The more difficult topic of the long-term consequences of living kidney donation is not addressed.

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