de Klerk Marry, Zuidema Willij C, Ijzermans Jan N M, Weimar Willem
Department of Internal Medicine-Transplantation, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Front Biosci. 2008 May 1;13:3373-80. doi: 10.2741/2932.
Structural shortage of deceased donor kidneys for transplantation has resulted in the expansion of living donation programs. A number of possibilities are now being explored, since it became clear that donors do not need to be genetically related to their recipients. Apart from classical direct donation we now conduct paired exchange, list exchange, altruistic donation and domino paired exchange programs. Other alternative programs are desensitization and transplantation across the blood type barrier. The purpose of this article is to give a general view of all optimizing living donation programs by reviewing the literature. First we describe logistic solutions, thereafter the more intensive medical treatments. We observed a wide variation in clinical experiences with living donation dependent on local jurisdiction, culture and customs. Professionals disagree on various ethical issues inherent to alternative programs. In our opinion logistic solutions like paired exchange, list exchange and altruistic donation programs are to be preferred over the more medical demanding programs e.g. desensitization and transplantation across the blood type barrier.
用于移植的已故捐赠者肾脏的结构性短缺导致了活体捐赠项目的扩张。自从明确捐赠者无需与接受者有基因关系后，目前正在探索多种可能性。除了传统的直接捐赠外，我们现在开展配对交换、列表交换、利他性捐赠和多米诺配对交换项目。其他替代项目包括脱敏治疗和跨越血型屏障的移植。本文的目的是通过回顾文献，对所有优化活体捐赠项目进行概述。首先我们描述后勤解决方案，之后是更强化的医学治疗。我们观察到，根据当地管辖权、文化和习俗的不同，活体捐赠的临床经验存在很大差异。专业人士对替代项目固有的各种伦理问题存在分歧。我们认为，配对交换、列表交换和利他性捐赠项目等后勤解决方案比要求更高的医学项目（如脱敏治疗和跨越血型屏障的移植）更可取。
