Unrelated living kidney donors. An update of attitudes and use among U.S. transplant centers.

A severe shortage of organs is perhaps the most important obstacle facing transplantation today. In an attempt to address this serious problem, several transplant centers have suggested a reconsideration of genetically unrelated living kidney donors. Recently, there have been reports of excellent results using such unconventional donors, and cogent arguments have been made that this approach is ethically acceptable, at least when the donor is motivated by altruism. To see what impact this new information has had on the transplant community, I mailed a questionnaire to all adult renal transplant centers in the United States asking for their views and practices regarding unrelated living kidney donation. Of the 127 (64%) responding, 88% would accept spouses as donors, 63% would accept friends, and 15% would even consider altruistic strangers. When compared with the results of a similar survey completed six years ago, it became clear that support for unrelated living kidney donation had increased, as the great majority of centers now believe that emotionally related donors are acceptable. On the other hand, while more of these donors are being used, they still account for only a small fraction of all kidney transplants. It appears that medical successes and favorable ethical arguments have generated broad support for some types of unrelated living donors, but more in principle than in practice, as there still seems to be some hesitation to actually proceed. It is hoped that dissemination of the favorable attitudes uncovered will reduce anxiety and thereby encourage greater use of unrelated living donors, a large and valuable source of kidneys.