Living Donor Transplant Program Growth, Innovation and Sustainability

Despite the ongoing need to increase kidney transplantation and the rise in deceased donor transplantation rates, the number of living donor kidney transplants (LDKT) performed had been largely stagnant over the past decade. However, recent innovations have contributed to a modest expansion in access to living donation. In part, this increase is related to kidney paired donation (KPD) programs, which allow the exchange of incompatible living kidneys across geographic regions among different transplant centers to overcome barriers of blood group and antibody incompatibility. In addition, increasing comfort with laparoscopic living kidney donation has led to acceptance of donors with higher surgical and medical risks, reduced the morbidity, and expanded acceptance of donation surgery. In order to truly realize the potential of LDKT, transplant programs need to incorporate initiatives that highlight the value of living donation, reduce racial disparities, and eliminate financial barriers facing low- and middle-income donors. Centers also need to adopt strategies that increase donation rates including utilization of donor champions, culturally competent websites, online donor screening tools that allow easier access for working adults, and appropriate use of social media. In summary, the growth in living donation reflects the systematic organization of transplant center practice to reduce barriers and expand access for potential donors.