The case for using living non-related donors to alleviate the world wide shortage of cadaver kidneys for transplantation.

There continues to be a shortage of kidneys for transplantation even in countries with developed cadaver donor programmes. It is becoming clearer that cadaver donation will probably never satisfy the demand for kidneys, and living donor transplants are bound to play an important role in transplantation, more so in developing countries. Living non-related donation played a significant role in the early days of clinical renal transplantation, but fell into disrepute partly because of the activities of a few individuals and a few transplant centers that profited from commerce in human organs. However, it has always been recognised that living non-related donor (LNRD) renal transplantation per se was ethically acceptable. With the improvement in the results of renal transplantation, the persistent shortage has led to a reassessment of LNRD transplantation. Evidence indicates that both the public and the profession are in favour of this source of donation, although many transplant units are still reluctant to use it. However, more and more units, in both the developed and the developing world, are now performing such transplants. Where this is done ethically, the results appear to be excellent. We strongly believe that spouses, distant relatives and genetically non-related individuals who have an enduring relationship should be permitted to donate.