Living donor kidney transplantation in a global environment.

Live donor kidney transplantation has become a widely sought treatment by patients with end-stage renal failure. As the outcome for the genetically and emotionally related live donor transplants is the same, this review considers live kidney transplantation from the broad scope of current international practice. Unrelated live donor transplantation can now be performed for incompatible donor recipient pairs via a simultaneous paired kidney donation. However, acceptance of the scientific data that an unrelated live donor transplant can now be performed successfully should not be misconstrued as an acceptance that an unrelated kidney may be purchased via a vendor sale. At a recent World Health Organization (WHO) conference of Middle East transplant professionals a statement of unequivocal opposition to commercialism was drafted. In the United States, the Institute of Medicine has recently published a significant report that affirms the legal prohibition of organ sales. These documents are in accord with the guiding principles of the WHO and the membership policy of The Transplantation Society. The person who gives consent to be a donor should be competent, willing to donate, free of coercion, medically and psychosocially suitable, and fully informed of the risks and benefits as a donor. With these principles established, the Amsterdam Forum has set forth a comprehensive list of medical criteria that is now used internationally in the evaluation of potential kidney donors. Guidelines of a psychosocial evaluation are also presented in this report for individuals who come forward through internet solicitation and other public appeals. It is now evident that the annual number of available deceased donors will not resolve the ongoing shortage of organs. Nevertheless, live donor kidney transplantation may not be the realistic final solution to an international public health epidemic of renal failure that is the result of an aging population of patients that have had inadequate preventive medical care.