Use of renal transplants from living donors

Editor—Nicholson and Bradley call for an increase in the donation of organs from living donors. I have held this view for several years. The negative attitudes of the directors of transplant programmes are one of the main causes of the low rate of living donation in Britain. I have suggested a donor charter to ensure that positive attitudes to living donation prevail in a transplant programme. It would include a call for familiarisation with the advantages of living donation, including its ethical acceptability and better results. It would also provide the potential recipient and his or her family with understandable information, which should include the risks involved, the experience of previous successful living donors, and the fact that living donation would enable pre-emptive transplantation before dialysis. In a recent review colleagues and I have provided evidence based justification for living renal donation and discussed the ethical issues involved. We must remember that in much of the developing world most kidney transplants are from living donors; appreciable damage from hyperperfusion does not occur in the remaining kidney when the donor is healthy; and donors themselves benefit by expressing altruism in what is perhaps the most meaningful way possible—by an increase in their self esteem—and by early treatment should they be found to have any undiagnosed medical conditions during the screening process. Fear that living donation will lead to commercialisation is unnecessary. And there is no reason to exclude unrelated living donors other than spouses: it is now quite common to see good friends with enduring bonds of friendship donating to each other in the United States. In Germany a transplant surgeon has even donated anonymously to a needy recipient on the waiting list. In spousal situations the potential for coercion can be overcome by professional psychological evaluation, as has been developed in the Munich model. Eventually tissue engineering or even xenotransplantation may solve the problem of organ shortage, but until then the one realistic method of alleviating suffering, reducing costs, and enabling altruism is to increase living donation. Cadaveric donation will not be adequate even if the highest donation rates (those in Spain) are reproduced elsewhere, especially for countries such as Egypt and the United States, which have high rates of end stage renal failure.