Nephron. Physiology
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Nephron. Physiology · Jan 2009
ReviewThe challenge of doing what is right in renal transplantation: balancing equity and utility.
Arguably the greatest challenge faced by the transplant community is the disparity between the number of persons waiting for a solid organ transplant and the finite supply of donor organs. For renal transplantation the gap between supply and demand has risen annually reflecting the increasing prevalence of end-stage renal disease versus the relatively static deceased donor organ pool. Maximising the benefit from this scarce resource raises difficult ethical issues. ⋯ The philosophies of equity (a fair opportunity for everyone in need to receive a transplant) and utility (optimal profit from each organ) are often competing. National allocation schemes and local policies regarding assessment of potential recipients and acceptance of organs are designed to balance these ethical principles in a standardized and socially acceptable manner. The ongoing debate surrounding these issues and modifications to such policies reflect the evolving clinical picture of renal transplantation and the challenge in maintaining equipoise between renal transplant utility and equity.
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In nephrology research, both observational studies and randomized controlled trials (RCTs) are commonly applied. Clinicians using the evidence from epidemiological studies should be aware of the specific qualities and limitations of each study design. ⋯ Conversely, observational study designs, including case reports, case series, cross-sectional studies, case-control studies and cohort studies, are usually more useful than RCTs for non-therapeutic research questions. In conclusion, both observational studies and RCTs fulfill a complementary and valuable role in nephrology.