CRD summary

The review concluded that some studies did achieve good outcomes for commercial kidney transplants but, due to the lack of details, it was not possible to infer if the donor hospital, surgical technique or immunosuppressive regimen were a factor. The authors' conclusions reflected the data presented, but the potential for bias in the review means their reliability is unclear.

Authors' objectives

To evaluate outcomes in recipients and donors of commercial kidney transplants.

Searching

MEDLINE, the Cochrane Library, CINAHL, TRIP (Turning Research into Practice), SUMSearch and InfoRetriever were searched for studies published from 1990. Search terms were reported. In additional reference lists of retrieved articles, the Internet was searched for relevant articles.

Study selection

Studies which evaluated the medical outcomes of commercial transplantation were eligible for inclusion. Case reports and abstracts were excluded.

In the included studies, commercial kidney transplant was compared with unspecified, non-commercial, live-related transplant donors and cadaver transplant. Recipients of transplants came from Taiwan, Malaysia, Canada, USA, UK, Australia, Israel, Turkey, Macedonia, Kosovo, Saudi Arabia, Iran, Kuwait, United Arab Emirates, Oman and Qatar. The country/region providing donor transplant included China, Pakistan, Iran, India, Iraq, Nepal, Egypt, South Asia, East Asia and the Middle East. Immunosuppressive protocols varied between studies. Details of recipient or donor characteristics were not reported. Outcomes reported were patient survival, graft survival, infections and surgical problems.

The authors did not state how papers were selected for the review, or how many reviewers performed the selection.

Assessment of study quality

The authors did not state that they assessed validity.

Data extraction

Data were extracted on patient and graft survival, infections and surgical problems.

The authors did not state how many reviewers performed the data extraction.

Methods of synthesis

Data on outcomes were grouped by geographical areas (recipients' country of origin), and by "good" and "poor" outcomes according to the geographical location of the donor hospital. Data were combined in a narrative synthesis.

Results of the review

Twenty-nine studies (n=4,364 participants) were included in the review. Sample sizes ranged from 5 to 1,499.

Outcomes in recipients of commercial kidney transplants (28 studies): A small number of studies found that commercial transplants were comparable to non-commercial transplants in terms of patient and graft survival. However, it was not possible to state if the donor hospital, surgical technique or immunosuppressive regimen was a factor. The majority of studies showed inferior patient and graft survival rates, but it was not possible to ascertain the variables leading to poor outcomes.

Outcomes of commercial kidney transplant in donors (four studies): Three studies (n=844 participants) reported that, for a large number of participants, no economic improvements had been made in the lives of the donors. Three studies (n=844 participants) reported that a large proportion of participants reported a decline in their health status after kidney donation.

Where reported there was a higher incidence of potentially life threatening post-transplant infections, and post-operative complications in commercial recipients.

Authors' conclusions

The majority of the studies showed inferior patient and graft outcomes for commercial kidney transplant recipients. There was a higher incidence of unconventional and life-threatening infections, and an increased incidence of postoperative surgical interventions, in commercial recipients.

CRD commentary

The inclusion criteria were broadly defined in terms of intervention, but not explicitly defined in terms of participants, outcomes or study design. Several relevant sources were searched, but search dates were not reported. It was unclear whether any efforts were made to reduce publication or language bias. Methods used to select studies or extract data were not reported, so it was unclear whether attempts were made to reduce reviewer error and bias. Validity was not assessed, so results from these studies and any synthesis may not be reliable. In addition, the authors did not report the study designs of the included studies. A narrative synthesis was appropriate given the differences between studies. The authors' conclusions reflected the data presented, but the potential for bias in the review means their reliability is unclear.

Implications of the review for practice and research

Practice: The authors stated that a database of patients in Western countries who have obtained their kidneys through commercial transactions should be established to allow identification of centres where kidneys have been obtained and help identify surgical, medical and immunosuppressive protocols for recipients and donors. Liaison between recipient and donor hospitals is also required to enable modern surgical and medical practices to be implemented. Improved emotional and psychological support should be provided to both recipient and donor.

Research: The authors did not state any implications for research.

Funding

Not stated.

Bibliographic details

Sajjad I, Baines LS, Patel P, Salifu MO, Jindal RM. Commercialization of kidney transplants: a systematic review of outcomes in recipients and donors. American Journal of Nephrology 2008; 28(5): 744-754. [PubMed: 18434713]

Original Paper URL

http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ArtikelNr=128606&Ausgabe=237338&ProduktNr=223979

Indexing Status

Subject indexing assigned by NLM

MeSH

Graft Survival; Humans; Kidney Transplantation; Postoperative Complications; Tissue Donors; Treatment Outcome

AccessionNumber

12009100021

Database entry date

02/12/2009

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.