Trends in unrelated-donor kidney transplantation in the developing world
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EDITORIAL COMMENTARY
Trends in unrelated-donor kidney transplantation in the developing world Rashad S. Barsoum
Received: 5 January 2008 / Revised: 22 February 2008 / Accepted: 4 April 2008 / Published online: 7 June 2008 # IPNA 2008
Abstract Living unrelated donors (LUDs) constitute an incremental source of kidneys for transplantation at a global level. Excellent outcomes are reported, superior to those of deceased-donor transplantation and comparable to related donor transplantation. LUD include six categories: spouses, distant relatives, paired-exchange, living-deceased exchange, and non-directed and directed donors. Although a financial reward may be involved in any of these categories, it is in the declared selling of organs that ethical concerns have intensified. There are three patterns of paid LUDs in the developing world: organized, erratic and commercial. The only model of organized LUDs is in Iran, where a central agency assigns and compensates the donors. Erratic LUD transplantation has been experienced, and subsequently banned, in the development of transplant programmes in most developing countries. However, the tightness and enforcement of the official ban are geographically different, providing variable room for uncontrolled trafficking. Commercial transplantation has, thus, become phenomenal in a few countries, gradually evolving into an organized business that follows market dynamics, including advertisement, brokerage, commissions, auctions and tourism. While most international organizations and activist groups condemn commercial transplantation, it is often perceived, in certain cultures and under particular socio-
R. S. Barsoum Kasr-El-Aini Medical School, Cairo University, Cairo Kidney Center, Cairo, Egypt
economic standards, as a human right that meets the demands of all stakeholders, and should be organized rather than declined just for the purpose of meeting the values of a third party. Keywords Transplant tourism . Unrelated living donors . Directed living donors . Undirected living donors . Organ trafficking
Introduction The practice of kidney transplantation has never been short of motivation, being the ultimate goal of the typical stakeholders involved in the management of end-stage renal disease (ESRD). Compared with dialysis, transplantation has gracefully offered to the patients prolonged survival and improved quality of life; to the medical profession, better knowledge and pride; to the health sponsors, a better cost-effective solution for an aching problem; and to the community, pragmatic relief from a high-impact socioeconomic burden. Yet the bottle neck that checks its potential in any transplant programme is the unavailability of enough donors. Regardless of many logistic, ethical and biological debates, the pool of unrelated donors has globally expanded at a much faster rate than that of live-related and deceased donors [1, 2] (Figs. 1 and 2).
Outcomes of living unrelated-donor transplantation R. S. Barsoum (*) Cairo Kidney Center, 3 Hussein El-Memar Street, Kasr-El-Nile,
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