Problems and outcomes of living unrelated donor transplants in the developing countries

The increasing success and broadening of the selection criteria of kidney transplantation have widened the gap between the demand and availability of donor organs worldwide. Developed countries have well-organized cadaver donor programs and living donor transplants constitute only a minority. Though living unrelated donor (LURD) transplants are prohibited, emotionally related live kidney donors (ERLKD) such as a spouse, a partner, or a highly motivated friend are being accepted in several countries. The results of ERLKD have been shown to be superior to LURD transplants. ERLKD transplants do not pose any ethical problems because of the absence of any monetary transaction. In contrast, in countries with less favorable economies, living related and unrelated donors constitute the major source of donor organs. With rare exceptions, cadaver donor programs are almost nonexistent. Here the majority of LURD transplants use paid donors. The beneficiaries include affluent patients from within the country and abroad. Instances of donors being exploited by middlemen are often reported. Life-threatening infections have been transmitted through contaminated allografts. HLA matching and pretransplant workup of recipients and donors are often deficient. LURD transplants have led not only to a decline in the living related donor (LRD) transplants but have been a major deterrent to establishment of cadaver donor programs. Overall, the results of LURD transplants are inferior to ERLKD transplants. Some transplant communities in the wealthier countries have recently started pleading for reopening the debate on unrelated commercial transplants. We strongly feel that such a tendency must be discouraged.