Burnapp Lisa, Van Assche Kristof, Lennerling Annette, Slaats Dorthe, Van Dellen David, Mamode Nizam, Citterio Franco, Zuidema Willij, Weimar Willem, Dor Frank J M F
Department of Transplantation and Nephrology, Guy's & St Thomas' NHS Foundation Trust, London, UK.
Faculty of Law, University of Antwerp, Antwerp, Belgium.
Clin Kidney J. 2019 Jun 15;13(2):159-165. doi: 10.1093/ckj/sfz067. eCollection 2020 Apr.
Living donor kidney transplantation (LDKT) is the preferred treatment for patients with end-stage renal disease and unspecified living kidney donation is morally justified. Despite the excellent outcomes of LDKT, unspecified kidney donation (UKD) is limited to a minority of European countries due to legal constraints and moral objections. Consequently, there are significant variations in practice and approach between countries and the contribution of UKD is undervalued. Where UKD is accepted as routine, an increasing number of patients in the kidney exchange programme are successfully transplanted when a 'chain' of transplants is triggered by a single unspecified donor. By expanding the shared living donor pool, the benefit of LDKT is extended to patients who do not have their own living donor because a recipient on the national transplant list always completes the chain. Is there a moral imperative to increase the scope of UKD and how could this be achieved?
An examination of the literature and individual country practices was performed to identify the limitations on UKD in Europe and recommend strategies to increase transplant opportunities.
Primary limitations to UKD, key players and their roles and responsibilities were identified.
Raising awareness to encourage the public to volunteer to donate is appropriate and desirable to increase UKD. Recommendations are made to provide a framework for increasing awareness and engagement in UKD. The public, healthcare professionals, policy makers and society and religious leaders have a role to play in creating an environment for change.
活体供肾移植（LDKT）是终末期肾病患者的首选治疗方法，非指定活体肾捐赠在道德上是合理的。尽管LDKT取得了优异的成果，但由于法律限制和道德反对，非指定肾捐赠（UKD）仅限于少数欧洲国家。因此，各国在实践和方法上存在显著差异，UKD的贡献被低估。在UKD被视为常规做法的地方，当单个非指定捐赠者引发一系列移植时，越来越多参与肾交换计划的患者成功接受了移植。通过扩大共享活体供体库，LDKT的益处扩展到了那些没有自己活体供体的患者，因为国家移植名单上的受者总能完成这个链条。是否存在扩大UKD范围的道德必要性，以及如何实现这一点呢？
对文献和各国实践进行审查，以确定欧洲UKD的限制因素，并推荐增加移植机会的策略。
确定了UKD的主要限制因素、关键参与者及其角色和责任。
提高认识以鼓励公众自愿捐赠对于增加UKD是合适且可取的。提出了一些建议，以提供一个提高对UKD的认识和参与度的框架。公众、医疗保健专业人员、政策制定者以及社会和宗教领袖都可以在营造变革环境方面发挥作用。
