Kidney transplantation from living donors : where do we stand ?

In 2002, in France 4.8% of kidney transplants were harvested fromliving donors. Despite the penury of organs from brain death donorsand the steady growth of the average age of donors, this percentagehas remained stable since 1975.Only 50% of the 36 French kidney transplantation teams performthat kind of surgery, considering that 5 teams performed 55% of the108 kidney transplantations from living donors performed in 2002.However, the benefit of such a surgery is now generally acknowledgedfor the recipient. Indeed, the estimation of graft half-lifetimeis 12 years in case of organs from brain death donors, 20 years incase of organs from a semi-identical HLA relative, and 36 years incase of organs from an HLA identical sibling.In our country, transplantation performed from living donors hasbeen limited mostly because of a very constraining legal procedurelimiting transplantations to direct relatives, and because of the fearthat donors may later develop medical or surgical pathologies witha risk of threatening their future health.However, all research papers and studies over the past fifteen yearshave demonstrated that apart from perioperative mortality (0,03%),there is neither mid-term nor long-term negative effect to donate akidney.As far as kidney transplantation from living donors is concerned,the debates currently focus on the surgical issue of comparing thebenefits and drawbacks of both incisional and coelioscopical surgery.The ethical debate focuses on the propositions made to the legalsystem to extend the pool of potential donors. The review of theresearch studies examining the future of donors emphasizes theglobal insufficiency of their follow-up, only 50% of them having aregular check up on their single kidney.