Unrelated Living Donors:
Time to Reclaim a
Andrew S. Levey, Susan Hou,
and Harry L. Bush Jr.
Before dialysis therapy was routinely available in the United States, both related and unrelated living donors were accepted for renal transplantation. By 1965, data from the Registry in Human Kidney Transplantation indicated that the success of kidney transplantation from unrelated living donors and from cadaveric donors was similar. 1 With the increasing availability of dialysis, most centers discouraged transplantation from poorly matched living donors on the premise that a cadaveric kidney provides an equal benefit to the recipient, without risk to a living donor. In the past twenty years, the results of transplantation have improved to such an extent that today this therapy is a safe, effective, routine treatment for end-stage renal disease. Nevertheless, living persons who are not related to the recipient are still rejected as potential kidney donors. It is now time to reevaluate the ethical and medical justifications for this policy. For the reasons outlined below, we suggest that transplantation from unrelated living donors is an acceptable practice and that for many patients on dialysis, it may be the preferred treatment.
There has been a spectacular improvement in the outcome of cadaveric kidney transplantation from unrelated donors as a result of advances in immunologic management, including HLA matching, blood transfusions, and immunosuppression with cyclosporine. 2,3,4 Patient survival after one year is now approximately 90 percent and is equal to or greater than survival in patients on dialysis. First-year graft survival is 75 to 85 percent in many centers, and the quality of life for patients with functioning grafts is superior to the quality of life for patients on dialysis. 5,6 Thus, cadaveric transplantation____________________