Living Donor Kidney Transplantation: Current Practices, Emerging Trends and Evolving Challenges PDF

Preface

Living donor kidney (LDK) transplantation has become the definitive approach to the treatment of end-stage renal failure, providing a better quality of life and the best opportunity for survival when compared with dialysis or transplantation from a deceased donor. The number of live kidney donors is increasing rapidly worldwide and, since 2001, has surpassed the number of deceased donors in the USA. Several factors have influenced this change. The advent of laparoscopic nephrectomy has reduced the morbidity of the nephrectomy procedure, making more donors receptive to an interruption of the healthy course of their lives. Just as importantly, seminal outcome data reported by Terasaki and Cecka enabled an expansion of LDK transplantation irrespective of the human leukocyte antigen (HLA) match or the donor–recipient relationship. Now, even blood type disparity or a positive crossmatch between the donor and the recipient is no longer the insurmountable biological obstacle to successful transplantation that it was just a decade ago. Any person who is well and willing to donate may now be a live kidney donor.

This year marks the fiftieth anniversary of the first successful kidney transplantation between identical twins. In a relatively brief period, LDK transplantation has progressed from an experimental modality to standard treatment. Francis Moore recognized early on that LDK transplantation would challenge the medical dictum to ‘first do no harm', but also predicted that it would persevere: ‘the living human donor provides by far the best tissue'. Indeed, the advantages of LDK transplantation are now readily apparent and the procedure is increasingly accepted even as our understanding of donor risk is becoming better defined.

This compendium brings a timely reflection of the modern day practice of LDK transplantation, assembled by an outstanding group of experts. The authors convey the nuances of the current situation, the responsibility of the medical community to the live kidney donor as a patient and the potential for complacency regarding donor risk. Their perspective is consistent with principles highlighted at a recent international forum on the care of the live kidney donor (Amsterdam, 2004) that emphasized ethical principles of voluntarism, informed consent and medical follow-up. These principles must dictate medical practice in LDK transplantation for the foreseeable future.

Perhaps future generations of physicians will understand the profound dilemma that permeates our current experience. There is an insufficient supply of organs and a demanding remedy that rationalizes potential harm to a well individual. Human live donor transplantation cannot be the ultimate solution to the ever-increasing need for organs. Nevertheless, there is a visionary sensibility to be underscored. Until primum non nocere can be restored to the pedestal of medical care by the use of an alternative source of organs (not derived from humans), this book comprehensively records the best practices currently available.