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. 2022 Jul-Sep;44(3):423-427.
doi: 10.1590/2175-8239-JBN-2021-0230.

Paired kidney donation: are we going beyond reasonable limits in living-donor transplantation?

[Article in English, Portuguese]
José Medina-Pestana  1   2 , Mario Abbud-Filho  3 , Valter Duro Garcia  4 , Renato Demarchi Foresto  1 , Lúcio R Requião-Moura  1   2
Affiliations

Paired kidney donation: are we going beyond reasonable limits in living-donor transplantation?

[Article in English, Portuguese]
José Medina-Pestana et al. J Bras Nefrol. 2022 Jul-Sep.

Abstract
in English, Portuguese

The growing demand for transplant kidneys requires strategies to increase organ supply and avoid long waiting periods on the list. The increase in the number of transplants from living donors involves the growth in the use of unrelated donors and paired kidney donation. Most of these transplants are performed in the USA, where they already represent, respectively, 34% and 16% of total transplants from living donors. In Latin America, and especially in Brazil, there is no collective enthusiasm for these modalities, either at the request of transplanters or that of the community, with the region's priority being to increase transplants from deceased donors, which growth can be up to three-fold. Concerning transplants from matched donors, the possible conflicting results between donors can generate public challenges and they risk compromise the concepts of equal opportunities for transplant candidates, with the possibility of generating resistance to organ donation, especially in regions with socioeconomic limitations and disparities in access to qualified health care and education. This donation model involves challenging ethical and logistical issues, which are subject to questionings, starting with an act of exchange between two pairs until reaching embarrassing proposals, which can compromise the altruistic character of organ donation, and thus not be universally incorporated.

A demanda crescente por rins para transplante requer estratégias para aumentar a oferta de órgãos e evitar longos períodos de espera em lista. O aumento no número de transplantes com doador vivo envolve o crescimento da utilização de doadores não aparentados e a doação renal pareada. A maior parte desses transplantes são realizados nos EUA, onde já representam, respectivamente, 34% e 16% do total de transplantes com doador vivo. Na América Latina, e especialmente no Brasil, não existe entusiasmo coletivo por essas modalidades, quer por demanda dos transplantadores ou da comunidade, sendo prioridade da região incrementar o transplante com doador falecido, cujo crescimento pode ser de até três vezes. Na modalidade de transplantes com doadores pareados, os possíveis resultados conflitantes entre doadores podem gerar questionamentos públicos e riscos que comprometem os conceitos de equidade de oportunidades para os candidatos a transplante, com possibilidade de gerar resistência à doação de órgãos, especialmente em regiões com limitações socioeconômicas e disparidades de acesso aos atendimentos de saúde e educação qualificados. Esse modelo de doação envolve questões éticas e logísticas desafiadoras, que estão sujeitas a questionamentos, começando por um ato de troca entre dois pares até alcançar propostas constrangedoras, o que pode comprometer o caráter altruístico da doação de órgãos, e assim não ser universalmente incorporado.

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Conflict of interest statement

Conflict of Interest

The authors declare that they have no conflicts of interest associated with the publication of this manuscript.

Figures

Figure 1
Figure 1. Modalities assimilated in paired donation between 2 pairs in 1991 to the last two concepts involving the global chain of paired donation in 2015 and the paired trans-organ exchange in 2019.
Figure 2
Figure 2. Evolution curves in the number of kidney transplants from living donors performed in the USA between 2010 and 2019, according to the relationship between pairs.
Figure 3
Figure 3. Evolution curves in the number of kidney transplants from living or deceased donors in Latin America, from 2010 to 2019.
Figure 4
Figure 4. Evolution curves of the number of kidney transplants from living and deceased donors in Brazil, according to the type of donor and the relationship between the pairs.
See this image and copyright information in PMC

Comment in

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