A Brief History of Living Kidney Donation

Living kidney donation began in 1954 with the donation by Ronald Herrick to his identical twin, Richard. The procedure was performed by Dr. Joseph E. Murray at Peter Bent Brigham Hospital in Boston, MA. Being identical twins was an advantage because there was no risk of rejection--the tissue types were identical. The procedure was a success, and Richard lived a healthy life until his death eight years later of causes unrelated to the donation. At this writing, Ronald Herrick is still living.

Living kidney donation is now commonplace. In fact, kidney transplantation is no longer considered experimental and is routinely covered by medical insurance programs.

In 1995, a new surgical procedure using laparoscopic techniques to procure the kidney from the donor was pioneered. This less invasive procedure, called "laparoscopic nephrectomy," has replaced "open nephrectomy" as the most common surgical procedure because of more positive outcomes for the donor.

An emerging ethical issue is the growth in the number of donations where this is no biological or emotional tie between the donor and recipient. The number of these donations has been increasing since 2000, facilitated by the development of more powerful anti-rejection drugs, which has reduced the importance of tissue matching and, therefore, the need for close biological ties. It has also been aided by the use of web sites that connect potential donors with potential recipients even though the individuals are essentially strangers. On one side of the issue, such donors increase the number of transplants at a time when they are desperately needed. 

Some argue these donors also receive personal benefit and increased self-esteem from donating. On the other side of the issue, some ethicists and medical professionals are suspicious of people who meet over the Internet, assuming the probability of illegal compensation or coercion is higher. Ethicists are also concerned that solicitation of an unrelated person to donate bypasses the safeguards built into the current organ allocation system. In response to these concerns, some transplant centers do not allow unrelated living donor transplants unless there is a biological or emotional relationship between the donor and recipient. People who are willing to donate anonymously or who met recipients on the Internet have been prevented from donating at these transplant centers. 

An experimental development in living donation is the use of the donor's bone marrow to minimize or even eliminate the need for anti-rejection drugs by the recipient. The technique, called chimerism, has the donor first donating bone marrow, which is used to change the recipient's immune system. The donor then donates a kidney. Anti-rejection drugs are used initially, but eventually the recipient does not need to take those drugs. This process was tried on five patients. 

The transplant teams provided an update in January 2008, five years after the procedure, reporting that one patient rejected the kidney, and the other four patients have kept the donated kidney without the use of anti-rejection drugs. Oddly, the authors of the report did not share any information whatsoever on the fate of the five donors who provided the bone marrow and kidneys essential to the procedure. This process is still considered experimental and is not available. 

http://www.livingdonorsonline.org