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Emotionally‐Related Kidney Donation: An Underutilized Resource

Renal transplantation is the preferred mode of therapy for patients with end-stage renal disease (ESRD). Transplantation, when compared with dialysis, offers improvement in life-span and quality and does so in a costeffective manner. In the developing world, where maintenance dialysis is beyond the means of most patients, transplantation is the only hope of avoiding death from renal failure. The Achilles’ heel of kidney transplantation is the marked shortage of cadaveric organs, which causes prolonged waiting periods for patients on dialysis. In March 1997, more than 33,000 patients were awaiting a kidney transplant within the United States according to the United Network for Organ Sharing (UNOS). Nationally, the number of patients awaiting kidney transplants is growing rapidly and has far outpaced the supply of kidneys, which appears to have leveled off at just over 10,OOO annually. In 1994 UNOS reported that the median waiting time for a patient listed for a kidney transplant was 842 days and today it can only be longer (1). Despite attempts to improve organ procurement through increased awareness, as well as the use of so called “marginal donors” (non-heart beating, elderly and pediatric donors) it is unlikely that a significant impact on the patients’ waiting time can be achieved in the near future. While attempts to improve the procurement of cadaveric kidneys and their efficient utilization must continue, the time has come to cautiously promote the use of genetically unrelated but “emotionally related” donors as a means of increasing the number of kidney