title: Successful expansion of the living donor pool by alternative living donation programs.
abstract: Between January 2000 and December 2007, 786 potential recipients and 1059 potential donors attended our pretransplant unit with the request for a living-donor renal transplant procedure. The recipients brought one potential donor in 77.2% and two or more donors in 22.8% of cases. In the regular living donor program, a compatible donor was found for 467 recipients. Without considering alternative donation, 579 donors would have been refused. Alternative living donation programs led to 114 compatible combinations: kidney-exchange program (35), ABO-incompatible donation (25), anonymous donation (37) and domino-paired anonymous donation (17). Together, the 114 alternative program donations and the 467 regular living donations led to 581 living donor transplantations (24.4% increase). Eventually for 54.9% (581/1059) of our donors, a compatible combination was found. Donor-recipient incompatibility comprised 19.4% (89/458) in the final refused population, which is 8.8% of the potential donor-recipient couples. Without considering alternative donation, 30.1% (174/579) of the refused donors would have been refused on incompatibility and 6.4% (37/579) because they were anonymous. This is 20% of the potential donor population (211/1059). The implementation of alternative living donation programs led to a significant increase in the number of transplantations, while transplantations via the direct donation program steadily increased.
authors.affiliation: Department of Internal Medicine, Erasmus MC Rotterdam, The Netherlands. j.roodnat@erasmusmc.nl
authors.forename: J I
authors.initials: JI
authors.lastname: Roodnat
authors.forename: J A
authors.initials: JA
authors.lastname: Kal-van Gestel
authors.forename: W
authors.initials: W
authors.lastname: Zuidema
authors.forename: M A A
authors.initials: MA
authors.lastname: van Noord
authors.forename: J
authors.initials: J
authors.lastname: van de Wetering
authors.forename: J N M
authors.initials: JN
authors.lastname: IJzermans
authors.forename: W
authors.initials: W
authors.lastname: Weimar
mesh_terms: D000017:ABO Blood-Group System; D000328:Adult; D000533:Altruism; D001787:Blood Group Incompatibility; D046148:Donor Selection / Q000379:methods*; D005260:Female; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D009927:Tissue and Organ Procurement / Q000379:methods*
chemical_list: D000017:ABO Blood-Group System