Lisa Burnapp
Nurse Consultant in Transplantation,
Guys Hospital, London
Living donor kidney transplantation
provides patients with end-stage renal disease (ESRD) the best chance of both
long-term rehabilitation and transplant survival.1 Evidence from the
US also suggests that the opportunity for pre-emptive transplantation before
dialysis becomes inevitable enhances graft survival and reduces cardiovascular
risk.2 Living donor transplantation offers the only realistic way to
achieve this in a coherent fashion and to maximise benefit to patients. With
increasing expertise, kidneys from living donors offer an opportunity to extend
the advantages of transplantation to more complex patients, such as those with
significant co-morbidity, the highly sensitised and older patients. There has
been significant growth in living donor kidney transplantation in the UK in the
last 5 years, with one in four kidney transplants now performed from a living
donor and an acceptance that outcomes from genetically unrelated donors are
equal to more traditional, genetically related scenarios.1,3
However, there is still significant disparity in comparison with living donor
activity in Scandinavia and the US.
In order to realise similar
potential in the UK, there must be a commitment to develop sustainable,
clinical effective programmes that support an ethical expansion of
transplantation and are responsive to the requirements of patients and their
families. Such programmes must be built upon established best practice and
proven integrated models of care delivery, underpinned by contemporary national
standards and guidelines.1,4 This is a rapidly evolving field and
one in which the agenda is driven by increasing public awareness and patient
choice. The renal community must be alert and receptive to this. When the Human
Tissue Act 2004 comes into force in April 2006, the Codes of Practice within
the Act are likely to provide greater flexibility around issues pertaining to
genetically unrelated living donor transplantation, for example non-directed
(altruistic) donation and paired exchange.5,6 Mechanisms will need
to be put in place to deal with these scenarios safely and appropriately.
Living donor renal transplantation is
well established in the majority of transplant centres in the UK but it has yet
to achieve its potential. It is a challenging agenda but, if met with
enthusiasm on the part of healthcare professionals, it is realistic and
achievable and appropriately fulfils the criteria of the NSF by optimising
quality, reducing the dialysis burden and maximising effective resource
management. What we have accomplished so far is the tip of the iceberg in
comparison with what is possible for the future.
References
1. United Kingdom
Guidelines for Living Donor Kidney Transplantation. British Transplantation
Society and The Renal Association; 2nd edition 2005 (awaiting
publication).
2. Meier-Kriesche, H-U, Kaplan, B. Transplantation 2002;
74(10): 1377–1381.
3.
UK Transplant, 2004 www.uktransplant.org.uk
4.
Standards for Solid Organ Transplantation in the United
Kingdom. British Transplantation Society, 2003.
5.
Human Tissue Act 2004. www.hmso.gov.uk/acts/acts2004/20040030.htm.
Human Tissue Act 2004 information. www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialcareTopics/Tissue