title: [Living kidney donation].
abstract: OBJECTIVE
  To review ethical, legal and technical aspects of living kidney donor surgery.
  
  
  METHODS
  An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords: Donor nephrectomy; Kidney paired donation; Kidney transplantation; Laparoscopic nephrectomy; Living donor; Organs trafficking; Robotic assisted nephrectomy; Vaginal extraction. French legal documents have been reviewed using the government portal (http://www.legifrance.gouv.fr). Articles were selected according to methods, language of publication and relevance. A total of 6421 articles were identified; after careful selection, 161 publications were considered of interest and were eligible for our review.
  
  
  RESULTS
  The ethical debate focuses on organ shortage, financial incentive, organ trafficking and the recent data suggesting a small but significant increase risk for late renal disease in donor population. Legal decisions aim to increase the number of kidneys available for donation, such as kidney-paired donation that faces several obstacles in France. Laparoscopic approach became widely used, while robotic-assisted donor nephrectomy failed to demonstrate improved outcome as compared with other minimal invasive techniques.
  
  
  CONCLUSIONS
  Minimally invasive living donor nephrectomy aims to limit side effects in the donor without increasing the morbidity in this specific population of healthy persons; long term surveillance to prevent the onset of renal disease in mandatory.
authors.affiliation: Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, 75008 Paris, France. Electronic address: marc-olivier.timsit@aphp.fr.
authors.forename: M-O
authors.initials: MO
authors.lastname: Timsit
authors.affiliation: Service d'urologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France; Université de Franche-Comté, 25000 Besançon, France; Inserm UMR 1098, 25000 Besançon, France.
authors.forename: F
authors.initials: F
authors.lastname: Kleinclauss
authors.affiliation: Unité fonctionnelle d'éthique médicale, hôpital Necker, AP-HP, 75015 Paris, France; EA 4569, laboratoire d'éthique médicale et de médecine légale, université Paris Descartes, 75006 Paris, France.
authors.forename: M F
authors.initials: MF
authors.lastname: Mamzer Bruneel
authors.affiliation: Service d'urologie et transplantation rénale, CHU de Montpellier, 34090 Montpellier, France; Université de Montpellier, 34090 Montpellier, France.
authors.forename: R
authors.initials: R
authors.lastname: Thuret
mesh_terms: D006801:Humans; D016030:Kidney Transplantation / Q000941:ethics; D010535:Laparoscopy; D019520:Living Donors / Q000941:ethics; D009392:Nephrectomy / Q000379:methods; D012307:Risk Factors; D065287:Robotic Surgical Procedures; D020858:Tissue and Organ Harvesting / Q000941:ethics / Q000379:methods / Q000592:standards
keywords: Don croisé; Donneur vivant; Donor nephrectomy; Extraction vaginale; Kidney paired donation; Kidney transplantation; Laparoscopic nephrectomy; Living donor; Néphrectomie donneur; Organs trafficking; Trafic d’organes; Transplantation rénale