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  • Review Article
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Live donor nephrectomy for kidney transplantation

Nature Clinical Practice Urology volume 5, pages 203–210 (2008)Cite this article

Abstract

The number of patients with end-stage renal disease is increasing substantially every year around the world. Renal transplantation is the best treatment option to improve survival and quality of life. Although the numbers of living, related and deceased transplant donors has also increased, this growth is insufficient to keep up with the expansion rate of the renal failure population. The introduction of laparoscopic donor nephrectomy has gained widespread acceptance by physicians and patients, and seems to be better than open donor nephrectomy in terms of reduced postoperative pain, quick recovery and improved cosmetic outcomes. Evidence strongly suggests that graft survival is similar in recipients of kidneys from living related and unrelated donors. Fortunately, this information has raised awareness of the suitability of potential live, unrelated donors, including spouses, friends, or even anonymous donors. In this Review we touch on sociological aspects of living related kidney transplantation and review the available and proposed methods of increasing the live donor pool, including organ exchange and desensitization protocols for ABO-incompatible and cross-match-positive donor pairs.

Key Points

  • Renal transplantation yields the optimum survival and quality of life in patients with end-stage renal disease; however, the donor population is insufficient to meet the growing need for organs

  • Laparoscopic donor nephrectomy has gained widespread acceptance with surgeons and potential donors, and is better than open donor nephrectomy in terms of reduced postoperative pain, quick recovery and improved cosmetic outcomes

  • Kidney donation carries notable psychological and sociological burdens; education and support for donors and recipients regarding potential pitfalls can ensure a smooth transition into normal life

  • Various programs are available worldwide that aim to overcome the problems facing ABO-incompatible or cross-match-positive donor–recipient pairs, including organ exchange and desensitization protocols involving aggressive plasmapheresis, high-dose immunosuppression and/or splenectomy

  • Some important ethical concerns about the different approaches to widening the donor pool remain to be resolved

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Authors and Affiliations

  1. A Sener is the Multi-Organ Transplant Fellow in the Division of Transplantation and M Cooper is an Associate Professor of Surgery and Director of Clinical Research at the University of Maryland Medical Center, Baltimore, MD, USA.,

    Alp Sener & Matthew Cooper

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Correspondence to Matthew Cooper.

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Sener, A., Cooper, M. Live donor nephrectomy for kidney transplantation. Nat Rev Urol 5, 203–210 (2008). https://doi.org/10.1038/ncpuro1047

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