Increasing the Pool of Transplantable Kidneys Through Unrelated Living Donors and Living Donor Paired Exchanges

Renal transplantation is the best therapy for eligible patients with end-stage renal disease (ESRD). Unfortunately the ability to perform this procedure is limited by a severe shortage of transplantable kidneys. One of the most successful approaches to this serious problem has been to expand the pool of living donors. This has been accomplished primarily by lifting restrictions on the use of genetically unrelated volunteers. As a result, acceptable living kidney donors now include individuals who are related to their recipients only through emotional bonds (e.g., spouses) and, at some centers, even people who are not related to their recipients at all. Living donor paired kidney exchanges provide a novel means for increasing further the number of kidneys available for transplantation. Each of these approaches will be reviewed.