Increasing Living Donor Kidney Transplantation in the UK: A Strategy to Meet the Needs of 2030

  • 1 Rachel K.Y. Hung, MD, is a specialist trainee in renal medicine at King's College London, United Kingdom.
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It is well established that the best treatment for kidney failure is kidney transplantation and that it should be the treatment of choice for all eligible patients. The greatest economic impacts of kidney transplantation, both living and deceased, are savings to the National Health Service (NHS; the universal health service in the United Kingdom) in dialysis costs (1). Living donor kidney transplantation (LDKT) maximizes the opportunity to avoid dialysis via preemptive transplantation. It has a higher success rate of graft survival (as compared to deceased donor kidney transplantation), while adding to the overall supply of organs.

Donation rates have generally plateaued in the last few years. During 2019–2020, LDKT represented 29% of the UK kidney transplant program. In 2020–2021, however, there was an overall decrease in living donors by 58%, with a comparable drop of White and non-White donors, but a 61% decrease in the number of Black and minority ethnic (BAME) living donors (2, 3). Although the drop in donation in 2020 may be explained by the impact of the COVID-19 pandemic and suspension of the UK Live Kidney Shared Scheme (a paired and pooled scheme whereby a willing donor cannot donate to the recipient of his or her choice and instead gives to another recipient in return for a reciprocal donation), the number of living donors from the BAME community has always been lower than that for White and non-White donors (4).

The NHS Blood and Transplant (NHSBT) task force published a report with an action plan to make living donation an expected part of care, where clinically appropriate, for all of society by 2030 (5) (Figure 1). The plan involves execution by the NHSBT, transplant and nontransplant centers, commissioners, and community leaders in a bid to increase the number of living donors and reduce time on the waitlist. In particular, non-directed altruistic kidney donors were found to most benefit long-waiting patients who are immunologically complex and/or from BAME background (5).

To achieve the best overall outcome, the advantages of LDKT must be shared unambiguously with the public. Furthermore, grassroots organizations can help increase awareness of living donation among BAME communities in a culturally relevant way to ensure maximum engagement from the target audiences in order to enable more donations and life-saving transplants in the United Kingdom.

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