Ferreira-Hermosillo Aldo, Valdez-Martínez Edith, Bedolla Miguel
Unidad de Investigación en Endocrinología Experimental, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Cuauhtémoc 330, colonia Doctores, 06729 Mexico City, Mexico.
BMC Med Ethics. 2014 Jun 16;15:45. doi: 10.1186/1472-6939-15-45.
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.
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.
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.
在墨西哥，糖尿病是终末期肾病的主要病因，部分患者可能符合肾移植条件。由于文化因素，器官供应有限。此外，关于器官捐赠缺乏标准化的临床指南。这些问题凸显了尽管潜在活体供者存在糖尿病前期状况仍被选中这一事实所引发的矛盾。本文运用不伤害原则、自主原则、公正原则以及宪法保障的健康权，呈现、审视并讨论了将糖尿病前期患者视为潜在肾供者所引发的伦理考量。
糖尿病是肾脏捐赠的绝对禁忌证。然而，墨西哥最常用的移植方案并未将糖尿病前期视为排除标准。糖尿病前期患者存在众所周知的代谢改变，如果接受此类供者，可能会影响移植的长期效果。即便如此，由于供者候选人不足，许多糖尿病前期患者最终仍被纳入。家庭和医院都面临着在受者的临床状况以及病情发展使其不再符合移植条件之前迅速接受糖尿病前期供者的需求；然而，在使用可能因糖尿病前期而受损的肾脏时，通常既不考虑供者的长期健康，也不考虑受者的长期健康。考虑到伦理影响以及临床和流行病学证据，我们得出结论，糖尿病前期患者并非合适的肾供者候选人。墨西哥卫生机构应重新审视其移植方案，并考虑这一建议。
我们认为，在墨西哥，如果活体供者基于社会可接受的规范而非现代医学所理解的知情同意做出捐赠决定，那么使用已知患有糖尿病前期或有2型糖尿病、肥胖、高血压或肾衰竭家族史的活体供者的肾脏这一决定应被视为不道德。
