In the tradition of the medical profession, upon finishing the medical degree we pronounce and/or sign the Hippocratic oath, which dates from the beginning of the Christian era and is embodied in the shape of a cross in an 11th century Byzantine document that is in the library vatican. In this oath, the doctor agrees to venerate and respect his teachers, teach the art of medicine, treat all patients equally, maintain medical secrecy and not do anything that harms the sick. “Primun non nocere” “First do no harm”.
The doctor must be sure that what he is going to do to a patient, from prescribing a medication to extensive surgery, is because it is more likely to do him good than harm. Any medical intervention, no matter how small, carries a risk, so doing it means that the potential benefit outweighs the risk.
Therefore, there should not be a situation in which a doctor agrees to put at risk an individual who is greater than the benefit they may receive, and even less so, someone healthy. But, there is an exception: the donation of a kidney. The surgeon removes a kidney from a healthy individual and the recipient of the kidney is the recipient. The donor is exposed to a risk, for the benefit that the recipient will have. In an altruistic act of the highest level, which usually occurs and is accepted as reasonable between immediate family members. Parents, children or siblings who donate a kidney for a relative with end-stage chronic kidney disease.
The risk of complications from a nephrectomy in a healthy individual is quite low. Once the surgery is over, the big question to be resolved is that we do not harm the donor in the long term. With the decades that we have practiced kidney donation, we know that this is not the case. Survival, disease, and state of health of kidney donors is identical to that of their age group, so we can say without a doubt that donating a kidney has no long-term negative consequences.
But there is a group of patients in which this is not yet clear. These are patients living with HIV. What happens if an individual living with controlled HIV has a relative living with HIV, who developed kidney failure for some reason and needs a kidney? Can you donate your kidney? This doubt has no answer, but questions do. HIV itself can cause nephropathy that damages the kidney. The antiretrovirals that people living with HIV must take can also damage the kidneys. But, just for this reason, deciding that you can’t is arbitrary and discriminating.
Women and children from the ‘Maiti Nepal’ rehabilitation home light candles in the shape of the international AIDS symbol on Wednesday, on the eve of World AIDS Day, in Kathmandu, Nepal.
A recent study published in the Lancet Regional Health Americas sheds light on this (doi.org/10.1016/j.lana.2023.100553). This work reports the detailed and prospective study of three people with HIV who decided to donate a kidney. The first requirement, of course, was that all the parameters with which we measured the activity of the HIV infection showed that they had it under control. The second, that they did not have any other disease that could put them at risk in the long term. The result was that the state of health and renal function at four years of follow-up in the three donors was similar to that observed in other donors. The literature review shows another three or four similar reported cases.
The work suggests that an individual living with HIV can be a kidney donor for another individual living with HIV and in need. Although this study alone cannot define a categorical policy in this regard, it seems to me that it opens the possibility of avoiding a discriminatory effect, for fear of breaking the promise of “Primun non nocere”.
Dr. A.S. Gerardo Shrimp
National Institute of Medical Sciences and Nutrition Salvador Zubirán and
Biomedical Research Institute, UNAM
2023-09-04 16:42:30
#Kidney #donation #HIV
