Living donors: con.

I HAVE NEVER YET won a debate with Felix Rapaport, partly because of my own ineptitude and perhaps partly because I would not want to win at the expense of such an old and good friend. Thus, I will summarize Felix's case for him although he has already eloquently done so. In brief, living donors are convenient, they provide a better biologic match on the average than can be achieved with cadaveric donors, and this fact alone meant in the precyclosporine days that the quality of life would be substantially better than with a cadaveric kidney. Matching truly counts with intrafamilial transplantation, thereby fulfilling the expectations about typing that many of us hoped for 20 years ago. The possibility that the kidney supply can be increased by living donation may be illusory as I will discuss. Finally, the prospect of manipulation of the recipient immune system using donor blood or tissues may be important, as exemplified by the preoperative donor-specific blood transfusion practices pioneered by Salvatierra and his associates working with Terasaki and now affirmed by Belzer at the University of Wisconsin. Since it is really not my task to glorify the opposition, I now am forced to turn, however briefly, to the countervailing arguments against the use of living donors. The most compelling argument against living donation is that it is not completely safe for the donor. A number of deaths have occurred, at least 20 to my certain knowledge. It would do no good and much harm for me to show a slide of