Chronic kidney disease (CKD) affects an estimated 37 million Americans, and over 500,000 are receiving dialysis or have received a kidney transplant. The demand for kidney transplants far exceeds the supply of deceased donor organs, leaving many patients waiting for a life-saving transplant.
Living Donor Programs
To address the shortage, efforts have been made to expand the donor pool by promoting living donor programs. Living donors are typically family members or close friends who elect to donate a kidney to a patient in need.
Paired Exchange Programs
In paired exchange programs, two incompatible donor-recipient pairs are matched. Each donor donates a kidney to the recipient of their matched pair, rather than to their intended recipient.
Expanded Criteria Donors
Expanded criteria donors are those who have risk factors that would typically exclude them from donation, such as older age, high blood pressure, or diabetes. Recent studies have shown that kidneys from expanded criteria donors can function well in the long term.
Safety and Outcomes
Numerous studies have demonstrated that expanding the donor pool through living donor programs is generally safe. Studies have shown comparable outcomes in patients who received kidneys from living donors compared to deceased donors in terms of survival, graft function, and quality of life.
Risks to Donors
The most common risk to living donors is surgical complications, which occur in about 10% of donors. Other potential risks include infections, bleeding, and kidney dysfunction. However, the long-term health of most donors is not significantly affected.
Long-Term Outcomes
Studies have shown that kidneys from expanded criteria donors have similar survival rates to kidneys from standard criteria donors. However, there may be slightly increased risks of graft failure, especially in older donors or those with diabetes.
Conclusion
Expanding the kidney donor pool through living donor programs has been a valuable strategy to increase access to life-saving transplants. Paired exchange programs and expanded criteria donors have helped to expand the pool of eligible donors, while maintaining generally good outcomes.
As research continues and surgical techniques improve, it is likely that the safety and success rates of expanding the donor pool will continue to increase. This will provide hope to countless patients who are waiting for a kidney transplant.
Kind regards F. Hillsom.
