Unconventional living kidney donors--attitudes and use among transplant centers

The organ shortage remains a major barrier to renal transplantation in the United States today. The use of unconventional living donors, including genetically unrelated adults and related minors, could help increase the number of kidneys available for transplantation. Although these donor sources had generally been discarded, recent developments (including improved success and the demonstration of minimal risk) have caused some to reconsider this policy. Therefore, we surveyed all U.S. transplant centers regarding their attitudes toward unconventional living kidney donors. Of the nearly 60% responding: 76% would consider using spouses and 48% would even consider adult friends; 64% would consider using monozygotic twin minors and 43% would consider closely related non-twin minors; the mean minimum donor age accepted was 16 +/- 3 years, and the range was wide. On the other hand, many centers expressed reservations about these donor sources and indicated that such donors are seldom used. We conclude that under certain circumstances many U.S. transplant centers would consider accepting unconventional living kidney donors. Yet, at the same time, the centers appear uneasy about actually using these donors and no clear consensus exists. Our data indicate a need to openly readdress these issues.