Live Donor Transplantation
The organ donor shortage has reached crisis proportions. The number of Americans waiting for organ transplants more than tripled from 21,914 in 1990 to 72,110 at the end of 1999. Over the same period, cadaveric and living donor transplants increased at a far slower rate annually. Various strategies have been proposed over the last decade to solve this worldwide problem. Live donor transplantation has emerged as perhaps the most viable alternative to significantly decrease the desperate shortage of organs for kidney and liver transplantation. In areas where live donation has been promoted, it has been successful in increasing the donor pool.

Although live donor transplantation has been performed for kidney, liver, lung and small bowel transplantation, this innovation has been applied much more widely in kidney transplantation. In some centers, up to 50% of kidney transplants are from live donors. Initially, live donors were restricted to directed donors or relatives of the recipient, but nondirected donation from genetically unrelated, emotionally related individuals and even complete strangers (in the case of kidney transplantation) are being considered as potential donors at present. In June 2000, more than 100 representatives from the transplantation community convened to evaluate live donor transplantation. In addition to standard living-related or living-unrelated donation, 2 additional types of live donor transplantation were proposed to optimize the live kidney donor pool: paired exchange and listed-paired exchange. Paired exchange donation is exchange of live donor kidneys between pairs of individuals with incompatible ABO blood types. In list-paired exchange, the incompatible live donor would provide an allograft to a patient on the cadaver waiting list in exchange for a priority allograft to the donor's incompatible recipient from the cadaver donor pool.

A consensus statement developed at this meeting was published in the December 13, 2000 issue of JAMA. This important document includes practice guidelines for healthcare professionals caring for transplant donors and recipients. The statement underscores the importance of assuring that the live organ donor is competent, willing to donate free of coercion, medically and psychologically suitable, and fully informed of the risks and benefits of being a donor. The statement also emphasizes the need to inform the recipients about the risks, benefits, and treatment alternatives available to them. Furthermore, the benefits to both parties -- the donor and the recipient -- must outweigh the associated risks.

The American Society for Transplant Surgeons (ASTS) held its First Annual Winter Symposium, "Living Donor Adult Kidney and Liver Transplantation," February 15-17, 2001. The focus of this symposium was one of the most important issues in transplantation, live donor adult-to-adult transplantation. Live donor transplantation emerged as a clinical strategy first in pediatric transplantation because of the disparate wait by children for cadaveric donor organs. However, as the burden of the organ shortage became even greater in adults, live donor transplantation became an indication for adults as well.

Made possible thanks to an unrestricted educational grant provided by Roche.