Living Donor Kidney Transplantation in the United States-Looking Back, Looking Forward

Division of Nephrology, Tufts Medical Center, Boston, MA 02111, USA.
American Journal of Kidney Diseases (Impact Factor: 5.76). 09/2011; 58(3):343-8. DOI: 10.1053/j.ajkd.2011.06.007
Source: PubMed

ABSTRACT There is a desperate need for kidney donors. Twenty-five years ago, we urged more widespread acceptance of unrelated living donors for kidney transplantation. Since then, 2 of us have donated a kidney to an unrelated recipient. In our view, the major challenges for living donor transplantation today are to improve access to this extraordinary gift of life and ensure its safety. Our perspective is that altruism is the motivation for most living kidney donors and the decision to donate represents a shared responsibility among the donor, the donor's physician, and the team of professionals at the transplant center. Thus, sound knowledge of the benefits and risks to donors and recipients is required for informed decisions, and all parties share in the responsibility for the outcomes after living kidney donation. We encourage our colleagues and agencies within the US Department of Health and Human Services to accept the responsibility to do their utmost to provide access to this life-enhancing procedure and systematically evaluate the safety of kidney donation as it evolves to meet the needs of more of our patients.

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    ABSTRACT: The Declaration of Istanbul is the first document that has been established by the international transplant community that defines and prohibits transplant commercialism and organ trafficking. Its Custodian Group has successfully led various countries to implement legislation against trafficking and commercialism. The question arises, however, whether efforts to prohibit organ trade are realistic and effective. The Declaration differentiates trafficking from commercialism, yet it does not mention how both acts should be approached by policy. Policies that address transplant commercialism work differently from policies that tackle organ trafficking. There is considerable room for improvement in the current prohibitive approach to commercialism and organ trafficking. The Custodian Group and World Health Organization (WHO) should address commercialism by encouraging the expansion of living donation in the same manner as they encourage deceased donation. Furthermore, the Custodian Group and the WHO can improve their strategy to combat organ trafficking by raising awareness for enforcement. To achieve a consistent and effective prohibition of trafficking, legislation and law enforcement must go hand in hand. Ideally, this can best be achieved by close collaboration between the medical field and (international) criminal justice agencies.
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    American Journal of Kidney Diseases 02/2012; 59(2):317; author reply 317. DOI:10.1053/j.ajkd.2011.11.032 · 5.76 Impact Factor
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