The living kidney donor: giving life, avoiding harm

During the past 12 years, the time spent on the waiting list for renal transplantation rose progressively in the Eurotransplant area and specifically in Germany, whilst during the same time period, unfortunately, the number of cadaveric kidneys available for transplantation did not increase (Table 1). In the face of a crushing organ shortage, nephrologists in Mid Europe have resorted increasingly to living‐related or unrelated kidney donation in order to increase the number of grafts available. In our unit in Heidelberg, the proportion of living‐related renal allografts increased from 11% in 1991 to 21% in 2001. In contrast, in Scandinavia, there has been a long tradition of living‐related renal transplantation dating back more than 30 years. Single centre reports from Sweden have summarized outcomes of no less than 177 living donor nephrectomies from 1996 to 2001 accounting for 40% of all transplanted kidneys (I. Fehrman‐Ekholm, personal communication). The same trend is now also seen in the USA where in the past 2 years more living‐related allografts were transplanted, compared with cadaveric renal allografts [1].