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Workload generated by a living donor programme for renal transplantation.
R N Saunders1, R Elwell, G J Murphy
1Leicester General Hospital, Leicester, UK.
Summary
Live kidney donation programs have a low transplant yield, especially for unrelated donors. Most referrals do not proceed due to medical or social reasons, creating significant workload and costs.
Area of Science:
- Nephrology
- Transplantation Surgery
- Medical Ethics
Background:
- Live kidney donation involves extensive ethical and medical evaluations.
- Comprehensive work-up is standard for live kidney donors.
- Assessing donor workload and transplant yield is crucial for program efficiency.
Purpose of the Study:
- To determine the workload magnitude of a live donor program.
- To ascertain the renal transplant yield from live donor referrals.
- To analyze the reasons for donor/recipient non-progression.
Main Methods:
- Retrospective assessment of Leicester live donor program referrals (1994-1998).
- Stepwise investigation initiated by nephrology referral.
- Includes counseling, baseline tests, and surgeon assessment of donor renal function and anatomy.
Main Results:
- 150 recipients and 269 potential donors were referred.
- Transplantation proceeded for 27% of related recipients and 10% of unrelated recipients.
- 77% of recipients and 87% of donors failed to proceed due to immunological, medical, or social reasons, with a mean work-up time of 9 months.
Conclusions:
- Live donor referrals yield a low number of transplants, particularly from unrelated donors.
- Most referrals do not proceed for valid reasons, but generate substantial workload.
- Significant staffing and financial implications arise from the extensive donor work-up process.