Psychological and Ethical Aspects of Living Kidney Donation

The preferable treatment option for patients with end stage renal failure is a kidney transplantation. However, there is a shortage of deceased donor kidneys for transplantation. In the Netherlands, average waiting times for deceased donor kidney transplantation have increased, and range from 2 years for patients with blood type AB to 5 years for patients with blood type O. Patients waiting for a deceased donor kidney are dependent on dialysis treatment. Although dialysis is a life saving treatment, patients on dialysis are confronted with lowered quality of life and an increased risk of morbidity and mortality: approximately 25% of all patients die while waiting for a transplant. Living kidney donation offers a realistic alternative to patients with end stage renal failure. In living kidney donation, a living donor donates one of his/her kidneys to the patient. Donor risks for potential life threatening or severe complications are reported to be approximately 0.2% , and donor mortality risks are estimated at 0.03%. The quality of life of living donors after donation is likely to return to pre-donation levels , and is reported to be even higher than that of the general population. Since the first living kidney donation from a mother to her son in the Netherlands in 1966, the number of living kidney donations has increased to 275 for the year 2005. This means that in the Netherlands currently over 40% of all kidneys transplanted come from living donors. In the past, only the patients’ close relatives were considered suitable as living donors for immunological reasons, but over the last decades non-related living donor kidneys have proved to give similar good outcomes. In addition, surgical techniques have improved, resulting in better outcomes for living kidney donors. At present the laparoscopic donor nephrectomy is advocated as the preferable surgical approach, because of the beneficial effect on the quality of life and the earlier return to work of the donors. It is partly because of these findings that the practice of living kidney donation has rapidly developed over the past decade.