Transplant Unit

Organ shortage

At the end of June 1999, there were 4,717 people waiting for kidney transplants in the United Kingdom, but it was only possible to carry out 635 kidney transplants from donors who had died during the first six months of the year. There is a severe shortage of kidneys available compared to the number of people on the waiting list.

Increasingly popular solution

One increasingly popular solution to this shortage of cadaveric kidneys for transplant is to carefully consider living donors who volunteer to help. Most living kidney donors are close blood relatives of recipients. This is known as living related renal transplantation. It is also now becoming normal to allow spouses to donate to their partners, and that is known as living unrelated renal transplantation. During the first six months of 1999 there were 109 living donor renal transplants performed in Britain. Addenbrooke's Transplant Unit performed 16 renal transplants from living donors in 1998.

Quality

Living donor transplants are, on average, more successful than cadaveric kidney transplants. Kidneys from living donors almost invariably start working immediately after the operation, and grafts tend to last longer than those from cadaveric donors. Compared to cadaveric transplantation, the results tend to be of higher quality.

Risks and benefits

A living donor transplant is only carried out after the transplant team is satisfied that the donor and recipient have been fully informed about the risks and benefits of the procedure. Many potential donors volunteer to be assessed, but in many cases it is not possible to proceed. This can be for the simple reason of blood group or tissue type incompatibility, but also the assessment may uncover medical issues which could make the operation too risky for the donor. For details of tests involved see Living Donor Assessment

Psychosocial implications

The psychological and social implications of becoming involved in living donor transplantation should not be underestimated. It is vital that the parties involved have time to reflect on their plans and discuss them with their family and friends. Potential donors should not be put under pressure of any kind to donate. Equally, potential recipients must be allowed to decide for themselves whether they want to accept their donor's offer. For a research-based analysis of several important issues involving living donor transplants, see Issues in living donor renal transplantation.

Results

Data from UNOS, the United Network for Organ Sharing in the United States puts living donor renal transplantation into perspective. These figures do not show results from transplants at Addenbrooke's.