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British researchers say caution towards living donation in UK must end to ease donor shortage.

British researchers are calling for an increase in the number of living kidney donors as a way to shorten transplant waiting times. Currently, only one-third of UK patients awaiting kidney transplants can expect to receive organs within 1 year.

"The traditional attitude toward living donors in the United Kingdom [has] been understandably cautious," wrote Michael Nicholson, MD and J. Andrew Bradley MD in the February 13 issue of the British Medical Journal. "However, the severe shortage of cadaveric kidneys and the success of living donor programs in other countries [has] led many British transplant surgeons and nephrologists to reconsider their views."

Live donors account for only 5% to 10% of kidney transplants in the UK and Ireland, whereas 30% and 45% of kidney transplants in the United States and Norway, respectively, come from live donors. This geographic difference, the researchers note, significantly effects outcome. The half-life of a cadaveric kidney is about 8 years, which compares poorly with averages of 12 and 26 years for living donor kidneys matched for 1 and 2 haplotypes, respectively.

Nicholson and Bradley point out that the increasing safety of nephrectomy for live donors is another argument for living donation. Reports in the medical literature indicate that perioperative mortality associated with live kidney donation is only about 0.03% in the UK. Laparoscopic nephrectomy (kidney removal) appears to further decrease the mortality rate and, in some locations, has increased the rate of live kidney donation by up to 85%.

In the United States, although the number of living donations from related and unrelated donors is increasing, efforts to reduce kidney transplant waiting times continue to focus on cadaveric donation, said Caroline Halal, director of programs for the American Kidney Fund. According to UNOS spokesman Bob Spieldenner, in 1997, approximately 35,000 patients were on US waiting lists for new kidneys, and 11,470 received transplants. Of these, 3,820 organs came from living donors. "The system is really set up for cadaveric donors," he said. There's no one out there in the US really pushing living donors."

Spieldenner added that, for the most part, live donors have "...some type of relationship..." with the kidney recipient. But he noted that over the past few years, live donors have evolved from being primarily direct family members of the recipient to spouses, friends, and even coworkers. And he said that US physicians do discuss living kidney donation, but on an individual basis. Without live donation, patients in the United States can wait "...a year to 3 years for a kidney," Spieldenner said, and perhaps even longer, if the patient is difficult to match.
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Comment:British researchers say caution towards living donation in UK must end to ease donor shortage.
Publication:Transplant News
Geographic Code:4EUUK
Date:Mar 31, 1999
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