Effective optimization of living donor kidney transplantation activity ensuring adequate donor safety

Results of kidney transplantation are excellent, but the number of patients on the waiting lists far exceeds the number of available organs. Living kidney donation must be considered as an important part of organ transplantation programmes. In the European Union countries, nearly 20% of all kidney transplants in 2010 were done with organs from living donors. However, the proportion of live donor kidney transplantation between EU countries varies greatly: from 3% to 54% of all kidney transplantations. Multiple initiatives have been undertaken in most of the European countries to increase the number of living donor kidney transplantations. In some countries widening of the donor pool has nearly reached the limits by accepting altruistic donors, paired and group exchanges, and even by performing live donor kidney transplantation in highly immunized recipients. There is a great need to optimize living donor kidney transplantation programmes by using a new strategy of: a. Detailed and adequate medical and psychosocial evaluation, ensuring that the need to increase programme activity will not overshadow the most important principle--donor safety. b. Total removal of all disincentives and financial obstacles that discourage potential donors, and provision of financial coverage for the follow-up. c. Sufficient detailed information about the option of living donor kidney transplantation, its results, and donor safety, delivered to relatives of patients with end-stage renal disease and to the patients themselves.