Expansion Of Live Renal Donation

The frontier of laparoscopic donor nephrectomy is now focused on safely broadening the donor pool (99). Acceptable candidates may now include older donors, unrelated donors, on call emergency donors for recipients needing concomitant pancreas transplantation (100), obese donors (101), voluntary prisoners, paired-exchange donors, and Good Samaritan donors. Table 4 shows the remaining contraindications for live renal donation, although some of these contraindications may be overcome.

Patients who may ultimately be significantly harmed by the donor surgery or suffer long-term consequences from having a solitary kidney must be protected. There have been five known donor deaths (87) (personal communication), due to embolism, hemorrhage, respiratory failure, or undetermined cause. Reporting to United Network for Organ Sharing is voluntary and, therefore, it is possible that underreporting exists.

In expanding the spectrum of donors, there are controversial areas. Clearly, the demand for kidneys is growing at a far greater rate than the supply. While the cadaver pool has remained stable, living donor nephrectomy has grown steadily. Since 2001, live donor renal transplants have exceeded cadaveric transplants according to United Network for Organ Sharing reports.

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