Between January 2000 and December 2007, 786 potential recipients and 1059 potential donors attended our pretransplant unit with the request for a living-donor renal transplant procedure. The recipients brought one potential donor in 77.2% and two or more donors in 22.8% of cases. In the regular living donor program, a compatible donor was found for 467 recipients. Without considering alternative donation, 579 donors would have been refused. Alternative living donation programs led to 114 compatible combinations: kidney-exchange program (35), ABO-incompatible donation (25), anonymous donation (37) and domino-paired anonymous donation (17). Together, the 114 alternative program donations and the 467 regular living donations led to 581 living donor transplantations (24.4% increase). Eventually for 54.9% (581/1059) of our donors, a compatible combination was found. Donor-recipient incompatibility comprised 19.4% (89/458) in the final refused population, which is 8.8% of the potential donor-recipient couples. Without considering alternative donation, 30.1% (174/579) of the refused donors would have been refused on incompatibility and 6.4% (37/579) because they were anonymous. This is 20% of the potential donor population (211/1059). The implementation of alternative living donation programs led to a significant increase in the number of transplantations, while transplantations via the direct donation program steadily increased.

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American Journal of Transplantation
Erasmus MC: University Medical Center Rotterdam

Roodnat, J.I, Kal-Van Gestel, J.A, Zuidema, W.C, van Noord, M.A.A, van de Wetering, J, IJzermans, J.N.M, & Weimar, W. (2009). Successful expansion of the living donor pool by alternative living donation programs. American Journal of Transplantation, 9(9), 2150–2156. doi:10.1111/j.1600-6143.2009.02745.x