Non-directed kidney donations

November 15, 2003

As the annual cases of patients suffering from End-Stage Renal Disease (ESRD) skyrocket, kidney transplantation centers are developing new programs for kidney donors, referred to as "non-directed donation" programs. These programs are responding to the unsolicited requests of living donors who have come forward to donate a kidney to anyone on the transplant waiting list, much as a blood donor gives to anyone in need of a blood transfusion. This topic will be discussed by Arthur J. Matas, MD, Professor of Surgery at the University of Minnesota Medical School and a leading expert on kidney transplantation at the American Society of Nephrology's (ASN) transplantation news briefing, during ASN's 36th Annual Meeting and Scientific Exposition, from 12:15 pm- 1:15 pm on Friday, November 14 in Room 12 of the San Diego Convention Center.

Since October 1997, when the United Network for Organ Sharing (UNOS) Ethics Committee endorsed non-related living donations as ethically acceptable, transplant centers have begun increasing efforts to accept and accommodate offers from donors volunteering to donate an organ to a recipient unknown to them.

"Traditionally, transplant programs have not accepted potential donors who have come forward and offered to donate to anyone on the waiting list for a number of reasons, including suspicion of the potential donor's motivation," says Matas. These suspicions arose from the concern that donors would face the same health risks but none of the benefits of seeing a family member or friend benefit from their kidney.

Transplant centers began responding to non-directed donor requests by developing a policy of evaluation and allocation. Interested donors undergo a substantial psychological and medical evaluation spanning several weeks before being considered as a serious donor candidate. During this important process, transplant centers work with potential donors to ensure that they wish to donate an organ for altruistic reasons.

"Non-directed donations have the potential to save lives, but nephrologists and donors must address a variety of ethical, moral, and practical considerations," states Matas. Ethical considerations include: how to best allocate these kidneys; whether donors should be allowed to "direct" their kidneys only to children; whether these kidneys should only be allocated to patients at the donor's hospital or to a wider geographical area; and if donors must continue to bear the brunt of expenses incurred like travel and lost wages during recovery. These important questions will be addressed by Dr. Matas during ASN's clinical nephrology conference (CNC) entitled, "Expanding the Donor Pool" on Saturday, November 15 from 10:00 am-Noon in San Diego.

End Stage Renal Disease (ESRD) affects more than 458,000 within the United States alone and claims more than 72,000 lives every year, according to the National Institutes of Health (2000). Kidney transplantation is one of the primary treatments of renal disease. Since healthy people can function fully with only one kidney, the possibility of receiving a kidney from a living donor is feasible and carries little risk for a healthy donor.

In the past, the only kidney transplants with good success rates were those from very closely matched blood relatives. However, modern immunosuppression drugs have improved overall results so much that tissue matching for kidney transplants is less important than it used to be. Transplants from living donors are often more successful because there is less kidney damage from a living donor's kidney compared to a deceased's one, especially given that the living donor's organ is transplanted to the recipient in a shorter timeframe than a deceased organ. Last year, there were over 14,000 kidney transplants performed in the United States; approximately 6,200 of these were living donor transplants.

As the largest nephrology meeting of its kind, Renal Week 2003 is expected to draw more than 11,000 nephrologists to reveal the latest findings in renal research and in the care of patients with kidney and related disorders. The ASN is a not-for-profit organization of 9,000 physicians and scientists dedicated to the study and practice of nephrology and committed to providing a forum for discussion about the latest research and clinical findings on kidney diseases.
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American Society of Nephrology

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