Why Living Donation?
Over the last decades, the number of living donations has markedly increased; there are a number of factors responsible for this. In former times, transplantation was a somewhat risky undertaking which was suitable only for relatively healthy patients. Thus, although there were postmortem donors and this was a sought after resource, waiting time was relatively short as the proportion of donors was rather high in comparison to the few potential recipients. Furthermore, dialysis was so demanding that elderly patients were hardly ever considered for the treatment. At present, not only has the quality of dialysis improved but also medical progress in general, so that survival on dialysis has improved remarkably and elderly patients are put on dialysis in most countries.[1,2] Nowadays, seniors are the fastest growing part of the dialysis population.
On the other hand, the number of potential postmortem donors decreased not only due to better medical therapies but also due to other circumstantial measures. In most European countries, seatbelts are now required when driving a car, or a helmet when riding a motorcycle. Further developments in intensive care and modes of dialysis enable a larger quantity of otherwise potential donors to survive or a donation becomes impossible due to serious infections as a result of a long duration on the intensive care ward.
This is not to say that there have been no successes in the promotion of donation after death, particularly in the south of Europe. In Croatia, for example, a few years ago there was a rather small number of cadaveric donors but now they are even ahead of Spain thanks to new legislation and a lot of political efforts. However, even in these countries, the number of deceased donors is not sufficient as the dialysis-dependent population is increasing even faster.
With these facts in mind, the waiting times for a graft are getting longer and longer despite huge efforts to increase the rate of post-mortem donation, like the senior programme of Eurotransplant. Thus, more and more patients will not live long enough to receive a graft.
As we know that transplantation improves survival, given the right choice of organ and recipient, patients need a solution and the best solution available is living donation. Thus, it is no wonder that living donation is rapidly growing in most countries.
Nephrol Dial Transplant. 2012;27(6):2166-2170. © 2012 Oxford University Press