title: Outcomes of commercial renal transplantation: a Canadian experience.
abstract: BACKGROUND
  Financial compensation in exchange for live kidney donation is prohibited in Canada. However, patients in Canada with end-stage renal disease and without a suitable biologically or emotionally related live donor face substantial waiting times on lists for deceased donor kidneys, and so may therefore choose to acquire organs from a live donor in a procedure performed outside Canada as part of a commercial transaction.
  
  
  METHODS
  We describe the clinical outcomes in such patients transplanted between 1998 and 2005, managed after their surgery at a single Canadian transplant center.
  
  
  RESULTS
  Patient and graft survival at three years were significantly worse in this group compared to recipients of live biologically related (P<0.0001) and emotionally related transplants (P<0.01) performed in Canada during this period. A number of different surgical and infectious complications were seen, requiring frequent and often lengthy hospitalization.
  
  
  CONCLUSIONS
  Patients considering this method of acquiring live-donated kidneys should be counseled of the inherent risks and possible adverse outcomes including diminished dialysis-free survival.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Toronto, Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: G V Ramesh
authors.initials: GV
authors.lastname: Prasad
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Shukla
authors.forename: Michael
authors.initials: M
authors.lastname: Huang
authors.forename: R John
authors.initials: RJ
authors.lastname: D'A Honey
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Zaltzman
mesh_terms: D000328:Adult; D002170:Canada; D033001:Directed Tissue Donation; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000191:economics* / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D016896:Treatment Outcome