ABSTRACT
The major advantage of extrarenal living donor transplantation is that it may actually save the life of a patient awaiting a vital organ. When viewed in this context, living extrarenal donation is vastly superior to the only other alternative, that is, death. Traditionally, very close rela tives have been the source of extrarenal living donor organs, given the importance of preserving the life of a loved one. Parents, in general, have been the source for liver and lung transplants. In many cases, the donors have been willing to undergo extreme risk for the sake of their family members. It is not uncommon to hear a family member or other loved one say that they would be willing to die so that their loved one can live or stop dialysis treatments. This sensitive context makes the evaluation of emotionally committed donors particularly difficult. When members of the transplant team are not willing to tolerate the level of risk the donor accepts, the prospect of certain death or life-long dialysis is understandably poorly tolerated by the potential donor and recipient. The psychosocial issues involved and the ethics of decision-making in these complex situations continues to evolve. (Chapters 2, 35, and 36) The level of risk acceptable to donors by transplant programs has slowly increased over the past two to three decades, but it will likely always be the responsibility of transplant teams to restrain excessive risk taking by donors.
