Kidney donation: needs and possibilities.

The need for cadaver kidney donors far surpasses the present supply. The subject of how to increase the number of donors is extremely complex, involving not only the medical issue of determination of brain death, but also philosophical, religious, legal, political, psychological, and economic considerations and the opinions of leaders and lay groups. It now seems that the physician can rapidly and unequivocally ascertain brain death, that the law not only recognizes this but can facilitate organ retrieval, that adequate numbers of potential donors should be available, and that both the public and physicians generally favor retrieval. Our survey of patients seeking aid in the emergency room revealed that 19% had signed the donor statement on their driving license. Of the neurosurgeons and neurologists who responded to a questionnaire, 74% had requested donation and 37% had obtained permission for organ retrieval. Review of our case material revealed that 60% of individuals with head injuries alone who were hospitalized for over 3 days were suitable donors. Of the 54 kidneys retrieved during a 6-month period, 49 (90%) were transplanted. Because most potential donors come to the attention of neurosurgeons and neurologists and because it seems ethically appropriate for physicians to consider transplantation when death is certain, we suggest that an organized effort be undertaken to develop a liaison with transplantation services to facilitate the process of obtaining adequate numbers of cadaver kidneys.