ABSTRACT
In 2004, 27,292 patients were added to the deceased donor renal waiting list, while in the same year only 16,004 transplants were performed (1). This discrepancy in organ availability grows annually and has contributed to a kidney waiting list that currently exceeds 60,000 patients. Despite significant efforts to increase deceased donation, the number of kidney transplants from deceased donors increased by a relatively modest 32% from 7061 in 1988 to 9357 in 2004. During this interval, live donation has more than tripled from 1812 in 1988 to 6648 in 2004 (Fig. 1). Of these live donors, a growing number are not related to their recipient (35% in 2004), and some donors even present without an intended recipient. There were two transplants from living nondirected donors (LNDD, also referred to as altruistic, Good Samaritan, anonymous or benevolent community donations) in 1998; six years later, this number had increased to 86 transplants (Fig. 2). Clearly, expanding live donation is the most promising approach to reducing the disparity between organ supply and demand. In this chapter, we discuss several approaches to expanding live donation. Many willing live donors are excluded from donation to an intended recipient because of blood type or tissue incompatibility. In the United States, based on distribution of blood group antigens, there is a 35% chance that any two individuals will be ABO incompatible (ABOi). In addition, exposure to human leukocyte antigen (HLA) from transfusions, pregnancies, or previous transplants can lead to sensitization and a positive crossmatch (+XM). In both cases, the incompatibility results from circulating preformed antibodies to blood group or HLA antigens that can cause hyperacute rejection and graft destruction (2).
