Report From a Multidisciplinary Symposium on the Future of Living Kidney Donor Transplantation

Area of Science:

• Nephrology
• Transplantation Surgery
• Medical Ethics

Background:

• Living donor kidney transplantation is the preferred treatment for end-stage renal disease.
• Despite its benefits, living donor kidney transplantation rates have plateaued in the U.S. for over 20 years.

Purpose of the Study:

• To examine the reasons for the lack of growth in living donor kidney transplantation.
• To identify strategies for improving living donor kidney donation rates.

Main Methods:

• A virtual symposium convened experts to discuss barriers and potential solutions.
• Reviewed ethical principles, donor incentives, living donor exchanges, and deceased donor kidney limitations.
• Examined survey data on public support for donor compensation.

Main Results:

• Ethical considerations regarding donor compensation and the limits of altruism were debated.
• Potential for donor incentives to save lives (up to 40,000 annually) and reduce taxpayer costs was discussed.
• Voter support for donor compensation was confirmed by survey data.
• Barriers to living donation include donor evaluation hurdles and donor expenses.

Conclusions:

• Increasing living kidney donation requires removing artificial barriers in donor evaluation and ensuring donors incur no costs.
• Expanding living donor chains and affirming the safety of live kidney donation are crucial.
• Without changes to current standards, living kidney donation will not reach its full life-saving potential.