The Living Related Donor

  • Lois L. Bready
Part of the Developments in Critical Care Medicine and Anesthesiology book series (DCCA, volume 14)


Although survival rates for cadaveric renal transplants have improved markedly, the best results are still obtained from transplantation of a kidney obtained from a well-matched living related donor (LRD) [1, 2]—ideally, an identical twin. Living related donor transplants average approximately 25% of all renal allografts in the United States, although the percentage varies widely [3, 4]. New immunosuppressive agents, particularly cyclosporine, have improved the survival of grafts and patients in cadaveric kidney transplantation but have not diminished the difference in graft survival statistics between LRD and cadaver donors [5]. Other advantages of LRD renal transplantation include the ability to schedule surgery electively, enabling thorough medical evaluation and preparation of both donor and recipient. The allograft is generally a healthy, functioning, anatomically normal kidney. The circumstances surrounding its retrieval are usually more controlled, and the warm ischemic interval is likely to be shorter than with a cadaveric graft. It would be desirable not to subject the LRD to the potential morbidity and mortality of donor nephrectomy. However, the supply of cadaver renal allografts in the United States is insufficient [3, 6, 7]. Newly treated cases of end-stage renal disease (ESRD) in the United States total approximately 90/million population/year, but the incidence of cadaver kidney procurement is only about 20/million population/year [3, 4, 8]. Occasionally, living nonrelated renal transplants have been performed [9]. Initial data suggested that the success of kidney transplantation from unrelated living donors and from cadaveric donors was similar [10, 11], and the practice of kidney transplantation from unrelated living donors is uncommon today in the United States. With few cadaveric kidneys available and improved results of immunosuppression, there may be an increase in the practice of kidney transplantation from unrelated living donors in the future [11].


Kidney Donor Donor Nephrectomy Dependent Lung Unilateral Nephrectomy Living Related Donor 
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© Martinus Nijhoff Publishing, Boston 1987

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  • Lois L. Bready

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