Is an Absolute Prohibition of Living Kidney Donation by Minors Appropriate? A Discussion of the Arguments in Favor and Against

Abstract

Kidney transplantation is the treatment of choice for many patients suffering from end-stage renal disease and is associated with a lower incidence of morbidity,a higher quality of life and favorable cost effectiveness compared to chronic renal dialysis therapy. As a consequence of organ shortage, however, the average waiting time for a deceased donor kidney has steadily increased over the last decade and currently exceeds 1.5 years for children and 3.5 years for adults in the Eurotransplant region.In order to reduce long waiting times on the deceased donor list, living donor kidney transplantation has become a well-established practice in many countries.Living donor kidney transplantation not only reduces the risk of future morbidity as a consequence of long-term dialysis, but also confers better graft and patient outcomes compared to deceased donor transplantation. A thorough donor screening process ensures optimal quality of the donor kidney and semi-elective timing of the donation allows for a minimal cold ischemia time. Indeed, increasing the duration of pre-transplant dialysis treatment has been associated with an increased risk of patient death and graft failure.Specifically, one study found that patients undergoing pre-emptive kidney transplantation, defined as kidney transplant procedures without preceding dialysis treatment, had a 37 % lower risk of death-censored graft loss compared to kidney transplant patients that received a 6–12 months dialysis treatment prior to transplantation.