Living-Donor Kidney Transplantation

Abstract

The first successful living-donor kidney transplant was performed 50 yr ago. Since then, in a relatively brief period of medical history, living kidney transplantation has become the preferred treatment for those with ESRD. Organ replacement from either a live or a deceased donor is preferable to dialysis therapy because transplantation provides a better quality of life and improved survival. The advantages of live versus deceased donor transplantation now are readily apparent as it affords earlier transplantation and the best long-term survival. Live kidney donation has also been fostered by the technical advance of laparoscopic nephrectomy and immunologic maneuvers that can overcome biologic obstacles such as HLA disparity and ABO or cross-match incompatibility. Congressional legislation has provided an important model to remove financial disincentives to being a live donor. Federal employees now are afforded paid leave and coverage for travel expenses. Candidates for renal transplantation are aware of these developments, and they have become less hesitant to ask family members, spouses, or friends to become live kidney donors. Living donation as practiced for the past 50 yr has been safe with minimal immediate and long-term risk for the donor. However, the future experience may not be the same as our society is becoming increasingly obese and developing associated health problems. In this environment, predicting medical futures is less precise than in the past. Even so, isolated abnormalities such as obesity and in some instances hypertension are no longer considered absolute contraindications to donation. These and other medical risks bring additional responsibility in such circumstances to track the unknown consequences of a live-donor nephrectomy.

Evaluating potential live-renal donors: Causes for rejection, deferral and planned procedure type, a single-centre experience

“…In most cases, the task of finding a donor is left to the chronically ill recipient. 5 By making the donation process more transparent, we hope that patients in need of transplant organs will be more likely to ask friends and family to donate, and that more potential donors will come forward.…”

“…A 2007 survey of transplant centres demonstrated that older, more obese, hypertensive and non-related patients are more likely to be accepted as donors compared to the previous decade. [3][4][5] Long-term health outcomes for extended-criteria donors are less clear. 4 In an attempt to make the donor screening process consistent, several consensus statements outlining the medical and psychosocial evaluation exist.…”

“…3,4,7 The use of computed tomographic angiography (CTA) to assess the quality of donor kidneys and the renal vasculature is part of the donor workup. 3,5,8 There are inherent risks associated with the medical and radiological evaluation itself, including incidental pathological findings and the emotional impact of being turned down for donation. 7 One review of 1600 potential donors demonstrated that 49% were excluded for medical and ethical reasons.…”

Barriers to Living Donor Kidney Transplantation among Black or Older Transplant Candidates

“…Demographically, our center's waiting list closely resembles the national waiting list. Furthermore, most centers evaluate and select their transplant candidates (40) and living donors (16,18) using similar, albeit not identical, criteria. In any case, studies of the barriers to LDKT are almost necessarily single-center studies because large registry data sets lack the granularity of information needed to examine donor recruitment and conversion.…”

Key issues in transplant tourism

“…Even the most welldeveloped deceased-donor programs (e.g., the Spanish program) can barely cover 50% of its waiting list because the demand for deceased-donor organs far exceeds supply. LURD transplantation (Table 1) [30,31] is amenable to donor recruitment by undesirable or illegal practices such as coercion or commercialisation [32][33][34] . Commercial LURD transplantation is made possible because a high proportion of the population in developing countries live below the poverty line and some believe that selling an organ can positively change their circumstances [28,35] .…”