Attitudes among surgeons towards live-donor nephrectomy:  a European update.
BACKGROUND
The increasing number of living kidney donors in the last decade has led to the development of novel surgical techniques for live-donor nephrectomy. The aim of the present study was to evaluate the current status of the surgical approach in Europe.


METHODS
A survey was sent to 119 transplant centers in 12 European countries. Questions included the number of donors, the technique used, and the acceptance of donors with comorbidities.


RESULTS
Ninety-six centers (81%) replied. The number of living donors per center ranged from 0 to 124. Thirty-one institutions (32%) harvested kidneys using open techniques only. Six centers (6%) applied both endoscopic and open techniques; 59 centers (61%) performed endoscopic donor nephrectomy only. Lack of evidence that endoscopic techniques provide superior results was the main reason for still performing open donor nephrectomy. In seven centers, a lumbotomy is still performed. Seventy-two centers (75%) accept donors with a body mass index of more than 30 kg/m, the median upper limit in these centers was 35 kg/m (range, 31-40). Donors with an American Society of Anesthesiologists classification higher than 1 were accepted in 55% of the centers.


CONCLUSIONS
Live kidney donation in general and minimally invasive donor nephrectomy in particular are more commonly applied in Northern and Western Europe. However, a classic lumbotomy is still performed in a minority of centers. Because minimally invasive techniques have been proven superior, more attention should be given to educational programs in this field to let many kidney donors benefit.
Division of Transplant Surgery, Department of Surgery, Erasmus Medical Center, Erasmus University Rotterdam, the Netherlands.
Karel W J
KW
Klop
Leonienke F C
LF
Dols
Niels F M
NF
Kok
Willem
W
Weimar
Jan N M
JN
Ijzermans
D001294:Attitude to Health; D015992:Body Mass Index; D015897:Comorbidity; D004724:Endoscopy / Q000379:methods; D005060:Europe; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000379:methods; D019520:Living Donors; D009392:Nephrectomy / Q000379:methods*; D013514:Surgical Procedures, Operative; D011795:Surveys and Questionnaires; D013997:Time Factors; D020858:Tissue and Organ Harvesting