Justification for living donor kidney transplantation

From the perspective of a potential kidney transplant recipient: • Kidney transplantation using either live or deceased donors is worthwhile for an individual with renal failure if it significantly improves their quality of life and/or long term survival. • The potential benefit of live donor transplantation needs to be weighed up against the likely outcome with the alternative options. For the individual recipient, factors to consider include the eventual or continuing need for dialysis, the suitability and possible outcome of deceased donor transplantation, as well as the likely waiting time for a deceased donor organ. • When compared with deceased donor transplantation, living donor kidney transplantation is associated with similar or even superior recipient outcomes. Living donor kidney transplantation therefore represents an excellent option for many individuals requiring renal replacement therapy. • In Australasia, while there is a short supply of deceased donor kidneys, live donation can be justified if the risk of harm to an individual donor is very low and there is the likelihood of a benefit for the individual recipient. • For some individuals (i.e. older recipients, those with multiple comorbidities, the immunologically sensitized) live donor kidney transplantation may provide significant benefits over deceased donor transplantation. In some cases, live donation may be the only reasonable transplant option available. • Pre-emptive (i.e. prior to dialysis) live donation is associated with excellent recipient outcomes and should be strongly considered in appropriate recipients who have suitable live donors.