Deaths from chronic renal failure under the age of 50. Medical Services Study Group of the Royal College of Physicians.

From a survey of the West Midlands and Mersey Regions and the Grampian Health Board, we found that in 1978 and 1979 some 122 patients with chronic renal failure died in hospital under the age of 50. Of these, 69 had been given dialysis or transplantation, or both, while for many reasons the remainder had been considered unsuitable. While the criteria varied, the reasons given for non-acceptance of cases seemed sound, and in no instance during this particular period was a patient denied dialysis because of a shortage of machines. We think that the public should be aware of these findings and not led to think that if only enough dialysis machines were available death from renal failure would be a rarity.     

Death certification and epidemiological research. Medical Services Study Group of the Royal College of Physicians of London.

The cause of death shown on 191 death certificates was compared with the cause indicated by the hospital case notes, the consultants'' opinions, and the necropsy findings. All 191 deaths occurred among medical hospital patients aged under 50. In 39 cases there was a major discrepancy between the two sources over the cause of death and in another 54 ther was a minor but epidemiologically important difference. Death certificates are not primarily intended for epidemiological research, but researchers often rely on them. This and other studies have shown, however, that death certificates are often inaccurate records of the cause of death--even coroner''s certificates issued after a coroner''s necropsy. The accuracy of death certificates might be improved if coroners consulted clinicians more closely and if senior hospital staff completed hospital death certificates.     

Donation of kidneys. Medical Services Study Group of the Royal College of Physicians.

A survey of deaths from medical causes among hospital inpatients aged under 50 years in three health regions provided details of 1168 such deaths not caused by renal failure. Kidneys for transplantation were obtained from only 20 of these patients. In another 18 cases permission was refused or donation was impracticable. Ninety-eight of the deaths were due to subarachnoid haemorrhage and 38 to primary cerebral tumour, yet kidneys were obtained from only 11 and one of these patients respectively. Patients dying from subarachnoid haemorrhage are particularly suitable for donating their kidneys, but there is still a shortage of kidneys for transplantation because they are not harvested efficiently. Doctors seem to be reluctant to ask relatives'' permission to remove kidneys, and the arrangement of a donation is time consuming. Because transplant surgery is recognised as a specialist sphere, surgeons in other specialties may be reluctant to remove kidneys and come to rely on one transplant team covering a wide area. In an area such as Grampian, where a small population is served by one hospital containing all the major units, including accident and emergency and renal departments, it may be easier to arrange prompt donation and transplantation.