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Probe commercial organ transplant claims, urge doctors

TheStar Online - http://thestar.com.my/news/story.asp?file=/2011/9/28/nation/9586539&sec=nation

By AUSTIN CAMOENS
austin@thestar.com.my

KUALA LUMPUR: Doctors from the Malaysian Transplant Association (MTA) and Malaysian Nephrology Association (MNA) have called on the police to investigate allegations that a Malaysian hospital is involved in commercial organ transplants.

MTA president Datuk Dr Harjit Singh said that recent media reports alleging Malaysia to be among several South-East Asian countries involved in commercial organ transplants had to be investigated.

He said the Malaysian Government had adopted the Istanbul Declaration regarding commercial organ transplants and is also a signatory to the World Health Organisation’s Guiding Principle on Organ Transplantation.

“Our national transplant policy cle-arly states that commercial and forced organ transplants are illegal,” he said.

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Health Ministry looks into so-called Bangladeshi connection

The Star Online - (http://thestar.com.my/news/story.asp?file=/2011/9/27/nation/9582086&sec=nation)

KUALA LUMPUR: The Health Ministry will liaise with the Home Ministry and police concerning allegations that Malaysia is being probed over illegal kidney trade in Bangladesh.

Health director-general Datuk Dr Hasan Abdul Rahman said Malaysia took a serious view of recent press reports on the alleged involvement of Malaysian hospitals in the illegal activity.

“Malaysia, being a member of the World Health Organisation and a signatory to the Declaration of Istanbul on Organ Trafficking and Transplant Tourism, is committed to ensuring that such illegal practices are not undertaken in this country,” he said in a statement yesterday.

Dr Hasan reiterated that his ministry was committed to upholding the highest ethical and professional standards in organ donation and transplantation in the country.

He said transplants from unrelated donors needed to be vetted by the independent Unrelated Transplant Approval Committee but from records, there were no such requests or applications.

“To further regulate transplants in the country, the ministry is currently drafting a new comprehensive Transplantation Bill,” he said.

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Should there be an expanded role for palliative care in end-stage renal disease?

Curr Opin Nephrol Hypertens. 2010 Jul 16.

Kurella Tamura M, Cohen LM.

http://www.hemodialysis.com/should_there_be_an_expanded_role_for_palliative_care_in_end-stage_renal_disease.html

Abstract

PURPOSE OF REVIEW: In this review, we outline the rationale for expanding the role of palliative care in end-stage renal disease (ESRD), describe the components of a palliative care model, and identify potential barriers in implementation.

RECENT FINDINGS: Patients receiving chronic dialysis have reduced life expectancy and high rates of chronic pain, depression, cognitive impairment, and physical disability. Delivery of prognostic information and advance care planning are desired by patients, but occur infrequently.

Furthermore, although hospice care is associated with improved symptom control and lower healthcare costs at the end of life, it is underutilized by the ESRD population, even among patients who withdraw from dialysis.

A palliative care model incorporating communication of prognosis, advance care planning, symptom assessment and management, and timely hospice referral may improve quality of life and quality of dying. Resources and clinical practice guidelines are available to assist practitioners with incorporating palliative care into ESRD management.

SUMMARY: There is a large unmet need to alleviate the physical, psychosocial, and existential suffering of patients with ESRD. More fully integrating palliative care into ESRD management by improving end-of-life care training, eliminating structural and financial barriers to hospice use, and identifying optimal methods to deliver palliative care are necessary if we are to successfully address the needs of an aging ESRD population.

Enjoy this beautiful tradtional Sarawak Sape music by Tan Nyan

To All

MALAYSIANS

"Happy Malaysia Day"

Best Wishes and Warmest Regards

MalayianKidneySPA

Palliative care in end-stage kidney disease




ROBERT G FASSETT^1,2,3,*, 

 

IAIN K ROBERTSON⁴, 

 

ROSE MACE⁶, 

 

LOREN YOUL⁵, 

 

SARAH CHALLENOR⁶, 

 

ROSALIND BULL⁵

1. ^{1Renal Research, Royal Brisbane and Women's Hospital}
2. ^{2School of Medicine, The University of Queensland, Brisbane}
3. ^{3School of Human Movement Studies, The University of Queensland, St. Lucia, Queensland, Schools of}
4. ^{4Human Life Sciences}
5. ^{5Nursing and Midwifery, University of Tasmania}
6. ^{6Renal Unit, Launceston General Hospital, Launceston, Tasmania, Australia}

Nephrology, 16: 4–12. doi: 10.1111/j.1440-1797.2010.01409.x  (http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1797.2010.01409.x/full)

Abstract

Patients with end-stage kidney disease have significantly increased morbidity and mortality. While greater attention has been focused on advanced care planning, end-of-life decisions, conservative therapy and withdrawal from dialysis these must be supported by adequate palliative care incorporating symptom control. With the increase in the elderly, with their inherent comorbidities, accepted onto dialysis, patients, their nephrologists, families and multidisciplinary teams, are often faced with end-of-life decisions and the provision of palliative care. While dialysis may offer a better quality and quantity of life compared with conservative management, this may not always be the case; hence the patient is entitled to be well-informed of all options and potential outcomes before embarking on such therapy. They should be assured of adequate symptom control and palliative care whichever option is selected. No randomized controlled trials have been conducted in this area and only a small number of observational studies provide guidance; thus predicting which patients will have poor outcomes is problematic. Those undertaking dialysis may benefit from being fully aware of their choices between active and conservative treatment should their functional status seriously deteriorate and this should be shared with caregivers. This clarifies treatment pathways and reduces the ambiguity surrounding decision making. If conservative therapy or withdrawal from dialysis is chosen, each should be supported by palliative care. The objective of this review is to summarize published studies and evidence-based guidelines, core curricula, position statements, standards and tools in palliative care in end-stage kidney disease.

The role of palliative care in end-stage kidney disease (ESKD) is well developed in the UK, USA, Italy and Canada.^1–9 Palliative care in ESKD is important in the contexts of conservative therapy (choosing a non-dialysis pathway), withdrawal of therapy and in symptom control. Advanced care directives and end-of-life decisions overarch these pathways. There is a recognized need for education regarding provision of palliative care in dialysis patients.¹⁰ However, there is no clear pathway to palliative care,¹¹ considerable variation in the provision of palliative care services for ESKD patients¹² and little evidence upon which to develop standards of renal palliative care in ESKD.¹³ There has been an increase in the elderly accepted onto dialysis in Australia. In 2004, 244 (445 per million population) new patients were accepted on dialysis in the 75–79 year age group. This increased to 277 (504 per million) in 2008. In the 80–84 year age group 103 (267 per million) started dialysis in 2004, which increased to 187 (442 per million) in 2008 and in the >85 year group 32 (107 per million) started dialysis in 2004, which increased to 58 (159 per million) in 2008.¹⁴ Despite this, the Caring for Australasians with Renal Impairment (CARI) Guidelines do not address palliative care.¹⁵ In addition, many elderly assessed for dialysis either do not progress¹⁶ or die before they would have required dialysis therapy.¹⁷

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Minocycline-EDTA Lock Solution Prevents Catheter-Related Bacteremia in Hemodialysis

1. Rodrigo Peixoto Campos*§, 
 
2. Marcelo Mazza do Nascimento†,
 
3. Domingos Candiota Chula‡ and 
4. Miguel Carlos Riella*†

1. ^*Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil;
2. ^†Division of Nephrology, Hospital Universitário Evangélico de Curitiba, Curitiba, Brazil;
3. ^‡Clínica de Doenças Renais do Novo Mundo, Curitiba, Brazil;
4. ^§Division of Nephrology, Hospital São Lucas, Campo Largo, Brazil

JASN Aug 18, 2011 ASN.2010121306;published ahead of print August 18, 2011

Abstract:

There is growing concern about the development of antibacterial resistance with the use of antibiotics in catheter lock solutions. The use of an antibiotic that is not usually used to treat other serious infections may be an alternative that may reduce the clinical impact should resistance develop. We conducted a randomized controlled trial to compare a solution of minocycline and EDTA with the conventional unfractionated heparin for the prevention of catheter-related bacteremia in hemodialysis patients during a period of 90 d. The study included 204 incident catheters (27.8% tunneled); 14 catheters were excluded because of early dysfunction and 3 because of protocol violations. We observed catheter-related bacteremia in 19 patients in the heparin group (4.3 per 1000 catheter-days) and in 5 patients in the minocycline-EDTA group (1.1 per 1000 catheter-days; P = 0.005). We did not detect a significant difference in the rate of catheter removal for dysfunction. Catheter-related bacteremia-free survival was significantly higher in the minocycline-EDTA group than in the heparin group (P = 0.005). In conclusion, a minocycline-EDTA catheter lock solution is effective in the prevention of catheter-related bacteremia in hemodialysis patients