DO US TRANSPLANT CENTERS ENCOURAGE EMOTIONALLY RELATED KIDNEY DONATION

Stimulated by a severe organ shortage and an improving ability to succ essfully transplant poorly matched donor-recipient pairs, many transpl ant centers are now willing to accept emotionally related (but genetic ally unrelated) people (e.g., spouses) as kidney donors, To see whethe r this practice is encouraged, a survey was mailed to all 209 adult re nal transplant centers in the United States. Of the 154 (74%) respondi ng centers, 90% said they accept emotionally related donors and 60% sa id they actually encourage this practice, Nearly 40% prefer spouses to cadavers, while only 21% prefer friends to cadavers. To further explo re the degree to which emotionally related donation is encouraged, a s econd questionnaire was sent to a sample of centers (n=51) that suppor t this practice; 94% responded. While only 44% said they encourage the use of friends, nearly all of these preselected centers said they enc ourage spouses to donate, On the other hand, judging from their stated approach to this issue, only about half of these supportive centers s eem to actively encourage emotionally related donation, These data sug gest that, overall, at most only about one third of U.S. transplant ce nters actively encourage spousal donation and at most about one quarte r encourage the use of friends. Consistent with these results, emotion ally related donors contribute only a small fraction of all kidneys tr ansplanted in this country. If the large potential. contribution of em otionally related donors is ever to be realized, transplant centers mu st go beyond simply accepting such individuals and begin to actively e ncourage their participation. Medical and ethical considerations stron gly support this proposal.