Living unrelated donors in renal transplantation
- John Vella, MD, FACP, FRCP, FASN
John Vella, MD, FACP, FRCP, FASN
- Associate Professor of Medicine
- Tufts University School of Medicine
- Section Editor
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Medical Director and Co-Director of the Comprehensive Transplant Center, Department of Internal Medicine, Division of Nephrology
- Johns Hopkins Medical School
The widening gap between the demand and supply of donor kidneys has led to a call for an expansion in the potential donor pool. Efforts have been made to increase the number of available grafts retrieved by expanding the donor criteria. Such efforts include using donors at the extremes of age, double kidney transplants from marginal donors, extended-criteria donors, and the use of living kidney donors [1-4]. Living kidney donation rates continue to fall, a trend that began in 2003 with a subsequent 15 percent decline to date. While the number of transplants as a result of kidney paired donation (KPD) networks has steadily increased from 19 in 2003 to 228 in 2008 to 525 in 2012, this has not kept pace with the overall decline in living kidney donation (figure 1) [5,6]. This trend is in the presence of a rapidly growing waiting list, longer times to transplant, and very modest increases in deceased donation rates over the past 10 years. Reasons for the decline in living donation (primarily driven by decreases in living related donation) may be due to a number of factors that include an aging transplant candidate population and concurrent medical unsuitability of prospective donors as well as financial disincentives .
Kidney donation by biologically unrelated persons has been attempted in different areas of the world, including the Middle and Far East [8-10]. These donations have received adverse publicity because of a combination of factors, including [10-13]:
●Unresolved ethical issues including donor payment and possible coercion
●Unacceptably high donor and recipient morbidity and mortality
●Poor allograft survival rates
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