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

The increasing success and broadening of the selection criteria of kidney t ransplantation have widened the gap between the demand and availability of donor organs worldwide. Developed countries have well-organized cadaver don or programs and living donor transplants constitute only a minority. Though living unrelated donor (LURD) transplants are prohibited, emotionally rela ted live kidney donors (ERLKD) such as a spouse, a partner, or a highly mot ivated friend are being accepted in several countries. The results of ERLKD have been shown to be superior to LURD transplants. ERLKD transplants do n ot pose any ethical problems because of the absence of any monetary transac tion. In contrast, in countries with less favorable economies, living relat ed and unrelated donors constitute the major source of donor organs. With r are exceptions, cadaver donor programs are almost nonexistent. Here the maj ority of LURD transplants use paid donors. The beneficiaries include afflue nt patients from within the country and abroad. Instances of donors being e xploited by middlemen are often reported. Life-threatening infections have been transmitted through contaminated allografts. HLA matching and pretrans plant workup of recipients and donors are often deficient. LURD transplants have led not only to a decline in the living related donor (LRD) transplan ts but have been a major deterrent to establishment of cadaver donor progra ms. Overall, the results of LURD transplants are inferior to ERLKD transpla nts. Some transplant communities in the wealthier countries have recently s tarted pleading for reopening the debate on unrelated commercial transplant s. We strongly feel that such a tendency must be discouraged.