Expanding criteria for the use of living donors: what are the limits?

• Published in: Transplantation proceedings Vol. 36; no. 4; pp. 808 - 810
• Main Authors: Garcia, V.D, Garcia, C.D, Keitel, E, Santos, A.F, Bianco, P.D, Bittar, A.E, Neumann, J, Campos, H.H, Pestana, J.O.M, Abbud-Filho, M
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01-05-2004; Elsevier Science
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bioethics; Biological and medical sciences; Brazil; Clinical death. Palliative care. Organ gift and preservation; Histocompatibility Testing; Humans; Living Donors - supply & distribution; Medical sciences; Patient Selection; Brazil; Suboptimal donor; Human; Organization; Living donor; Transplantation; Homotransplantation; Ethics; Organ donation; Treatment; Surgery; Selection criterion; Graft; Limit; Public health; Health Care and Public Health
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2004.03.063

The cadaver organ shortage has pushed the transplant community to extend the boundaries beyond the traditional criteria used for living donor transplantation. This new liberal policy involves: (1) the type of donor, such as emotionally related individuals, the direct or indirect interchange of donors, anonymous as well as rewarded donation; (2) challenging immunological criteria, using incompatible ABO blood types and or transplantation across a positive cross-match; (3) relaxing clinical criteria related to elderly, hypertensive, or obese donors, or patients with nephrolithiasis, fibromuscular renal artery disease, hematuria, or renal cell carcinomas. However, these practices may be dangerous. They must be clearly validated to promote a liberal policy of donor acceptance since it may carry a risk for both the donor and the recipient as well as for society. It is crucial to ensure the physical integrity of the donor as well as to provide guarantees, for instance a 1-year policy of life insurance, an indefinite long-term medical follow-up and the assurance of going to the top of the waiting list if the donor becomes uremic in the future.