Introduction

Kidney transplantation should be strongly considered for all medically suitable patients with chronic and end-stage renal disease. A successful kidney transplant saves lives and greatly enhances quality of life.1,2 Hundreds of thousands of patients worldwide have received a kidney transplant since the mid-1950's. Currently, in the U.S., there are over 100,000 persons living with a functioning kidney transplant. This number represents only a fraction of the nearly 400,000 persons enrolled in the U.S. end-stage renal disease (ESRD) program. Figure 6.1 illustrates the number of ESRD patients on either dialysis therapy or living with a functional kidney transplant according to age. The median age of a transplant patient is 40 years and that of a patient on dialysis 64 years.

Interestingly, for ESRD patients living in Canada, United Kingdom, Australia, and Sweden the transplantation rates all exceed 50%. The international disparity in renal transplant rates is due, in large part, to the differential degree of access to dialysis therapy and transplantation in the various countries. In 1973, the U.S. Congress enacted Medicare entitlement for the treatment of end-stage renal disease to provide equal access to dialysis and transplantation for all ESRD patients in the Social Security system by decreasing the financial barrier to care. At the time, this was a major step forward in improving the quality of care of the patient with failing kidneys.

Today, access to transplantation is primarily obstructed by the donor organ shortage. Unfortunately, only a minority of patients that could benefit from a kidney transplant ever receive one. Figure 6.2 illustrates, by year, the growing size of the waiting list, the number of kidney transplants performed, and the relatively stagnant number of cadaver organ donors per year.3 In 2003, approximately 55,000 persons were awaiting kidney transplantation. In 2002, only 14,728 kidney transplants were performed — 8,493 cadaveric and 6,235 living donor transplants.

The annual number of kidney transplants has doubled over the past 18 years. Growth has been largely due to an increase in living donation. At the current pace, the number of living donor kidney transplants will soon exceed cadaveric transplants. Already the number of living donors exceeds cadaveric donors. The growing popularity of living kidney transplantation is due, in part, to the recognition that waiting for a cadaveric kidney is a slow process. Waiting times of 4-5 years are not uncommon. It is also widely appreciated that recipients of living donor

Organ Transplantation, 2nd edition, edited by Frank P. Stuart, Michael M. Abecassis and Dixon B. Kaufman. ©2003 Landes Bioscience.

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