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Discovering Misattributed Paternity in Living Kidney Donation: Prevalence, Preference, and Practice

Young, Ann1,2; Kim, Sang Joseph3; Gibney, Eric M.4; Parikh, Chirag R.5; Cuerden, Meaghan S.1,2; Horvat, Lucy D.1,2; Hizo-Abes, Patricia1; Garg, Amit X.1,2,6for the Donor Nephrectomy Outcomes Research (DONOR) Network

doi: 10.1097/TP.0b013e3181a4eae5
Editorials and Perspectives: Forum

When evaluating a living kidney donor and recipient with a father-child relationship, it may be discovered that the two are not biologically related. We analyzed data from the United Network for Organ Sharing and the Canadian Organ Replacement Registry to determine how frequently this occurs. We surveyed 102 potential donors, recipients, and transplant professionals for their opinion on whether such information should be disclosed to the donor-recipient pair. We communicated with transplant professionals from 13 Canadian centers on current practices for handling this information. In the United States and Canada, the prevalence of father-child living kidney donor-recipient pairs with less than a one-haplotype human leukocyte antigen match (i.e., misattributed paternity) is between 1% and 3%, or approximately 0.25% to 0.5% of all living kidney donations. Opinions about revealing this information were variable: 23% strongly favored disclosure; whereas, 24% were strongly opposed to it. Current practices are variable; some centers disclose this information, whereas others do not. Discovering misattributed paternity in living donation is uncommon but can occur. Opinions on how to deal with this sensitive information are variable. Discussion among transplant professionals will facilitate best practices and policies. Strategies adopted by some centers can be considered.

1Division of Nephrology, University of Western Ontario, London, ON, Canada.

2Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada.

3Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada.

4Division of Nephrology, Virginia Commonwealth University, Richmond, VA.

5Section of Nephrology, Yale University, New Haven, CT.

This work was supported in part by Health Resources and Services Administration contract 231-00-0115. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, or does mention of trade names or organizations imply endorsement by the US Government. Parts of this material are based on data and information provided by the Canadian Institute for Health Information, obtained through the CIHI Graduate Student Data Access Program. However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors and not those of the Canadian Institute for Health Information.

Funding support was provided by an Ontario Graduate Scholarship and a Schulich Graduate Scholarship from the University of Western Ontario (A.Y.), a Schulich Graduate Scholarship and a research award from the Lawson Health Research Institute (L.D.H.), and Clinician Scientist Awards from the Canadian Institutes of Health Research (S.J.K., A.X.G.).

The authors declare no conflict of interest.

6Address correspondence to: Amit Garg, M.D., Ph.D., London Kidney Clinical Research Unit, Room ELL-101, London Health Sciences Centre, 800 Commissioners Road East, London, ON, Canada N6A 4G5.

E-mail: amit.garg@lhsc.on.ca

Received 6 October 2008.

Accepted 1 March 2009.

© 2009 Lippincott Williams & Wilkins, Inc.