Living Donor Kidney Transplantation I. Introduction Kidney Transplantation – Optimal Treatment Kidney transplantation is the treatment of choice for most patients with renal insuffi ciency leading to terminal uraemia. The outcomes after transplantation include improved quality of life, reduction of cardiovascular risk factors and, as a consequence, prolongation of patient survival. Kidney Transplantation – Reduction of Costs The alternative treatment for terminal uraemia, haemodialysis, is an expensive procedure. It is estimated that the cost of haemodialysis (3 times per week) at a dialysis unit in Sweden amounts to the equivalent of 100,000 USD per year (in 2009). The overall cost of a living donor kidney transplantation is estimated at 40,000 USD. The follow-up after kidney transplantation amounts to a level of about 5-10,000 USD per year, including medication and follow-up visits. Consequently, with the investment of less than 6 months’ dialysis costs – for the transplantation – the savings for the health care provider (in Sweden) amounts to at least 90,000 USD per year thereafter. Similar calculations may be done in different countries. Transplant Centre Objectives The primary objective of the kidney transplant centre should be to offer the living donor kidney transplantation procedure to any citizen who is in need of renal replacement therapy and who has a living donor willing to give a kidney. The recipient shall be examined and determined to have no contraindications or unacceptably increased risks for transplantation. The living donor shall also be examined and determined to have no contraindications and no identifi ed risk factors for the procedure or for future health after kidney donation. The living donor shall be a family member, and give consent without coercion and without fi nancial incentive to the procedure. The objective is to perform these procedures at internationally accepted high standards. II. The Living Donor At the present time the living related donor is an important source of kidneys for transplantation. This is a novel procedure to many people and not very well known by the general public. Therefore, information and education about the existence of the transplant centre and possibility of kidney donation and transplantation are initially very important steps. Information should be given to the general public through mass media; and to dialysis patients via their nephrologists, educational symposia with dialysis nephrologists’ participation, and written Practical Protocols for Living Donor Kidney Transplantation 10 booklets about kidney donation given to the patients, especially new patients with renal insuffi ciency. Dialysis patients should themselves inform their family about kidney donation as a possibility; potential donors should be invited to the out-patient clinic to receive detailed information before they make their decision. There should be no fi nancial incentive for the donor; conversely, there should be no cost for the donor. The family member who donates his or her kidney makes a great contribution leading to a great reduction in the costs for the health care provider. The insurance company makes the greatest economical benefi t. Consequently, it is logical for the donor not to pay anything for the kidney donation procedure. This should preferably be solved by the insurance company taking full responsibility for the costs associated with the donation. Further fi nancial motivation for the family of the recipient would be that the amount spent for one year of dialysis treatment now may be spent for transplantation, leading to much reduced treatment costs in the future. The major incentive for the family of the recipient is of course the increased quality of life for the patient. It should also be emphasized that the long-term prognosis, the life expectancy, would signifi cantly improve. Concerning the operative risk for both the donor and the recipient, it is the obligation of all experts at the transplant centre to fulfi l the procedures according to international high standards with every measure taken to avoid donor mortality and ensure minimal morbidity after kidney donation. The goals for very high success rates for the kidney recipient should be 95% graft survival and 98-100% patient survival at one year. III. Structure of the Transplant Centre There are of course several solutions on the question of the structure of the transplant centre. Here we present a suggestion. The head of the transplant centre will be the Director and he or she will report directly to the President of the hospital. The Board of the transplant centre, including experts in transplant surgery, transplant nephrology and the transplant laboratories, will assist the Director. The fi rst two members of the Board will also be Vice Directors, able to replace the Director during an absence. Other important members of the board will be a cardiologist and the transplant co-ordinator. The head nurse of the transplant ward should always be present at the board meetings. Director Transplant Centre Transplant Surgery Vice Director Transplant Nephrology Vice Director Transplant Laboratories Risk assessment Cardiology Transplant Co-