9i. Renal transplantation in cats

Policy Type: 
Guidelines
Status: 
Current policy
Manual Reference: 
9i
Date ratified: 
01 March 2010

The New Zealand Veterinary Association acknowledges that its members hold a range of opinions on the acceptability of transplanting a kidney from a healthy source (donor) cat to another cat whose health and survival is compromised by irreversible acute or chronic renal disease.

If a veterinarian, or veterinary centre, does carry out the procedure of renal transplantation in cats, the New Zealand Veterinary Association believes the points below should be taken into account.

 

Background

Renal transplantation in cats is a surgical and medical procedure designed to treat cats with irreversible acute renal failure (e.g. ethylene glycol toxicity) or chronic renal disease that is not responding to appropriate medical management.

The first renal transplantation in a cat was performed in 1984 at the University of California, Davis (UCD), and a transplant programme set up. Since then other centres have developed the expertise to offer the procedure. There have been advances in the surgical procedure and medical management, and further developments can be expected. The University of Wisconsin Transplant Centre has reported mean survival (40 cats) of 70% at 6 months and 50% at 3 years. Heterogeneity in the major histocompatibility complex in cats from different regions may affect rejection rates and explain regional differences in survival rate.

Veterinarians hold differing views as to the fate of the source cat. In many places, owners of recipient cats are expected to adopt the source cat, or organise a home for it, which is seen as a benefit to the cat if it would otherwise have been euthanased. Some transplant programmes are run in conjunction with a pet adoption agency which matches homeless cats as donors to recipient cats with chronic renal disease. In return, the recipient’s owners agree to adopt the source cat for life thereby presumably guaranteeing a good home by virtue of the fact that the owners, who are shouldering the high costs and lifetime obligations of the transplant operation, would provide the source cat with a home that has a high level of commitment to its pets. Source cats are pre-screened for adoptability before being accepted into the transplant programme.

Another view is that the removal of a kidney from a living source cat causes that animal unnecessary pain and suffering, but removal of a kidney during non-recovery surgery from a cat that would otherwise be euthanased is an acceptable source of a kidney for transplantation.

 

Guidelines

The New Zealand Veterinary Association believes the following matters should be considered when a veterinarian contemplates renal transplantation in a cat:

  1. The transplantation centre should assist with selecting a suitable source (donor) cat.
  2. Source cats must not be bred or bought for the purpose of transplantation.
  3. Transplantation centres must give equal consideration to the interests of the source and recipient cats in deciding whether it is appropriate to proceed. In particular, the possibility of reactivation of (potentially fatal) toxoplasmosis in the recipient cat should be considered.
  4. Source cats must be assessed for adequate renal function and infectious diseases, and the necessary compatibility between recipient and source cats.
  5. As with all other veterinary services, the veterinarian(s) performing renal transplantation in cats must have demonstrable competency and capacity to perform the surgery and all activities associated with pre- and post-operative care of both source and recipient cats.
  6. Transplantation centres are expected to keep up to date with developments that improve outcomes, and keep appropriate records of transplantations performed.
  7. The source cat must be treated with compassion and respect. If it is to be re-homed (with the owner of the recipient cat or elsewhere) the veterinarian must take reasonable steps to ensure its long-term welfare can be assured.  If it is being introduced into a household that already has a cat (or cats) the social dynamic may need monitoring and managing. The owner should be informed of the procedure and any possible long-term implications, and should give informed (and written) consent to all procedures.
  8. The owner of the recipient cat must be informed of the potential outcomes for the recipient cat and the ongoing management requirements. As with all other procedures, owners must give informed consent to all aspects of the transplant procedure.
  9. The transplant centre must ensure that satisfactory arrangements for the long-term veterinary care of both the recipient and source cat are in place before surgery is undertaken. As with all other veterinary referral centres, the centre must provide the recipient’s primary practice with aftercare guidelines, and must ensure the veterinarian(s) from the primary practice are willing and able to undertake this aftercare.

 

Further information

 

Policy Files: 
application/pdf icon9i - Renal Transplantation - Mar10.pdf