State of Living Kidney Donation in Europe

Uwe Heemann; Lutz Renders

Disclosures

Nephrol Dial Transplant. 2012;27(6):2166-2170. 

In This Article

Influence of Current Health Policy in Europe

For the time being, living donation is a national programme. The major reason for this is the current health policy within Europe. While some countries have a state insurance covering everyone in the same way paid by taxes or common health insurance, some have individual solutions. In those countries with a general health policy, it is rather easy to support the donor; all costs are covered. In other systems, it is the health insurance of the recipient which covers the costs. Thus, in some situations, the donor is in doubt which health insurer is covering which part of his problems. The donor may sometimes even have a problem getting covered at all; in Germany, for example, living donation is considered a cosmetic operation, so that costs for the treatment of problems arising from donation long term such as hernia operation or even dialysis may not be covered.

Furthermore, there may be financial damage to the donor by higher costs for insurances or loss of work or even a prolonged recovery.[12] The way to deal with these issues differs from country to country. In some countries, such as Denmark, there may be a law by which insurers are required to offer identical policies to donors as to non-donors. Why such a law is not implemented in all countries is a matter of debate as discrimination for race, religion, sex or age are not allowed within the European community, enforcing similar policies in all matters of private and social life.

Although the current incentive to increase the rate of postmortem donation made by the European Union (EU) is a step to strengthen transplantation in general, we can observe that in countries with a high rate of postmortem donation, the rate of living donors is relatively low. In these countries, the acceptance of donors is more selective than in countries with a low rate of postmortem donors (Table 1).[13]

Today, the steps being taken to strengthen donor rights are somewhat small and half-hearted. The only step taken by the EU is the implementation of a donor registry.

However, it has not been explicitly stated for what period a donor has to be followed. In some countries, the follow-up stops with release from the hospital, in some after 1, 2 or 3 years. Only in very few countries are donors mandatorily followed for life. As the overall numbers are small, it is unlikely that, with such perfunctory measures, we will be able to adequately advise transplant centres and donors about the real risk of donation in the near future.

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