A trading scheme among patients with access to live kidney donors is needed to more readily match recipients and organs because differing blood types are blocking transplants. A trial programme at Johns Hopkins University School of Medicine that used a trading strategy among patients with access to live kidney donors resulted in successful transplants in 21 out of 22 cases over a three-year period. Existing transplant programmes match deceased donors with patients on the waiting list for kidneys. A similar system now needs to be in place for living donors, according to researchers from the Johns Hopkins University in Baltimore, USA. Between 2,000 and 3,500 U.S. patients suffering from renal failure have willing live donors, but more than one-third are blocked from receiving the organs by incompatible blood types or a condition where the recipient is especially sensitive to foreign tissue and must be matched carefully. The researchers estimated a trading system, which could successfully pair off half the patients with access to live donors. There are several good reasons for creating such a living donor kidney registry, but ethical dilemmas could arise. For example, what if one kidney fails early but the other functions well. Kidney transplantation remains a success story, but its promise and future continue to be threatened by the ongoing lack of suitable organ donors. While new methods to overcome this problem are welcome, the transplant community must face up to the new ethical issues that surround every advance.
JAMA,
October 2005