Correspondence

Renal Transplantation in a Noncompliant Patient

N Engl J Med 1994; 330:371-372February 3, 1994

Article

To the Editor:

The Image in Clinical Medicine entitled “Metastatic Calcification of the Shoulder in Chronic Renal Failure” (Sept. 2 issue)1 leaves readers with the impression that a noncompliant patient who “began to take his phosphate-binding medications irregularly” was an acceptable candidate for transplantation and was therefore “referred for renal transplantation.” Nothing could be further from the truth.

One of the chief relative and absolute contraindications to all types of solid-organ transplantation is demonstrated noncompliance. In an era of shrinking resources and with the shortage of available donor organs, transplantation centers have adopted policies that prevent valuable donor organs from being wasted. These policies have been repeatedly upheld by ethics review boards, institutional review boards, and the appellate process of the courts. The caption accompanying the image leaves the impression that anyone can be an organ-transplant recipient without regard to personal responsibility. Patients as well as doctors are responsible for their actions.

Jonathan S. Bromberg, M.D., Ph.D.
P.R. Baliga, M.D.
Medical University of South Carolina, Charleston, SC 29425

1 References

1. 1

   Rabb H, Ramirez G. Metastatic calcification of the shoulder in chronic renal failure. N Engl J Med 1993;329:695-695
   Full Text | Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: We thank Drs. Bromberg and Baliga for correctly pointing out that a patient who is noncompliant may not be an acceptable candidate for transplantation. Though the patient in question was considered for transplantation at his own request, he did not proceed beyond the initial evaluation. In the legend accompanying the image, we did not elaborate on this point, because we were focusing on the patient's dramatic metastatic calcifications.

Hamid Rabb, M.D.
German Ramirez, M.D.
University of South Florida, Tampa, FL 33612-4745

Citing Articles (1)

Citing Articles

1. 1

   Vivek Kaul, Sandhya Khurana, Santiago Munoz. (2000) Management of Medication Noncompliance in Solid-Organ Transplant Recipients. BioDrugs 13:5, 313-326
   CrossRef