The Living Kidney Donor

The Living Kidney Donor

The use of living donors for kidney transplantation in the United States has become increasingly common, with recipients of a living donor kidney demonstrating better outcomes and shorter waiting times. Substantial differences exist between transplant centers in their choice of protocols and exclusion criteria for potential living donors.

The expansion of kidney transplantation from living donors over the last several decades has included greater racial and ethnic diversification of the donor population. In the United States, the fraction of non-white living kidney donors rose from 24 percent in 1988 to 30 percent in 2011, representing more than 1700 donors. Currently, 12 percent of living kidney donors in the United States are African American and 13 percent are Hispanic.

In 1995, Ratner, Kavoussi, and colleagues at Johns Hopkins University revolutionized live kidney donor transplantation through the development of the laparoscopic donor nephrectomy (1). Since then, the number of live donor transplants in the United States doubled, the number of live donors who are not biologically related to the recipient rose by more than fivefold, and the proportion of donor nephrectomies performed laparoscopically (or laparoscopically assisted) neared 100 percent.

The increasing prevalence of end stage renal disease (ESRD) has led to a steady growth in the kidney transplant waiting list, rapidly outpacing the availability and transplantation of organs from deceased donors. Interestingly, although overall living donation rates have remained relatively static over the last several years the one exception is a rise in the number of living non-spouse unrelated donors, including altruistic donors.

Transplantation from a living kidney donor provides the best outcomes in recipients with end stage renal disease. However, our knowledge regarding the effects of kidney donation on long-term mental and physical health of the living donor remains incomplete. Published data are largely derived from single-center retrospective studies in young, healthy, and mostly white populations (1), whereas donors in today’s environment are increasingly older, larger, racially diverse, and medically complex (2).