1. Living Donor Transplants

2. “What lies behind us and what lies before us are small matters compared to what lies within us.” Ralph Waldo Emerson

3. Benefits of Living Donation
Shorter waiting time (usually 1-2 months); permits preemptive transplantation to avoid dialysis
Higher quality kidney (healthy donor, short ischemia time), which results in higher success rates and improved graft longevity
Scheduled event, can plan accordingly, can be performed during normal work day by rested team and fully prepared donor and recipient
Psychological benefits to donor and recipient
A living donor kidney transplant allows the deceased donor kidney that would be needed for this recipient to be given to another individual in need of a transplant, so in essence two people are removed from the kidney waiting list

5. International Living Donor Rates
Effect is that LD rates tend to be higher in informed consent/opt-in countries rather than in opt-in countries -- effect present for kidneys but not livers
Perhaps an effect for more recruitment of living donors in countries where there is not as high of a PPM of deceased donors.

6. National Trends
Deceased donors recovered increased by 9.8%, and deceased donor organs transplanted increased by 10.7% from 2015
increases in ECD, DCD, SCD donors
DCD donors now comprise 17% of deceased donors overall (ranges from 10%-25% by region)
0.4% decrease in living donation from
In 2016, living donors represented 37% of all donors and 31% of all kidney transplants

7. The 60:40 Rule About 60% of kidney donors are deceased and 40% living
About 60% of kidney waiting list is active and 40% inactive
About 60% of patients on the waiting list will ever receive a kidney transplant and 40% will not
About 60% of deceased donor kidneys are SCD, 40% are ECD/DCD/marginal donors
10 year graft survival for SCD kidneys is 60%, 40% for ECD kidneys
Estimated that about 60% of discarded kidneys are usable, 40% are not

8. Survival Benefit of Transplantation
JAMA Surgery, 1/28/2015
Retrospective analysis of UNOS data during a 25-year period (9/1/87 – 12/31/2012)
669,000 kidney wait-list patients studied
Median survival: 5.4 years for kidney wait-list, 12.4 years for transplanted patients
1.37 million life-years saved by kidney transplant; mean of 4.4 life- years saved per recipient
Only 47% of patients ever received a kidney

9. Waiting List Additions 2007-2016 U.S.

10. Shortage of Donor Kidneys
>35,000 new patients added to kidney waiting list each year (96 additions per day, one every 15 min)
Only 19,310 kidney transplants were performed in 2016 (53 per day, one every 27 min)
>4000 deaths on kidney waiting list each year (11 per day, one every 133 min)
Annual mortality on waiting list is 6-7% (10% if diabetic)
Almost half (46%) of kidney transplant candidates ≥60 years of age placed on waiting list will die before receiving a deceased donor kidney transplant

11. Shortage of Donor Kidneys
Only 25% of active wait-list candidates are transplanted in a given year; chance of receiving a deceased donor kidney transplant within one year of listing is <10%
<20% of kidney waiting list transplanted each year (median waiting time of 5 years)
Median waiting times and kidney discard rates have doubled in the new millennium
Loss of quality and quantity of life by those on the waiting list remains a staggering and sobering reality

12. Waiting List Registrations 2007-2016 Region 11

13. Deceased and Living Donors 2007-2016 U.S.

14. Deceased and Living Donors 2007-2016 U.S.
Living donation appears to be more prevalent in some regions than others. 40% or more of all donors are living donors in Region 1, 7, 9, and 10. While in Regions 3 and 11, less than 30% of donors are living donors.

15. Evaluating Living Donor Potential: A New Metric
AJT, in press, Matar et al
Retrospective analysis of SRTR data from 7/1/14 to 6/30/15
235 active kidney transplant centers (35 peds centers excluded), 8 centers did not perform LDKT during study period, leaving 192 adult centers
16,815 total kidney transplants, 5393 (32.1%) from living donors
35,513 new waitlist registrations; proportion receiving LDKT was 15.2%
% LDKT as proportion of total KTs at each center, median 27.9%
% LKDT as proportion of new waitlist registrations, median 12.3%

16. Evaluating Living Donor Potential: A New Metric
Expected LDKT rate by gender: 15.3% male, 15.0% female
Expected LKDT rate by race: 22.9% Caucasian, 6.3% black, 12.8% Hispanic, 12.2% Asian, 10.7% other
Expected LKDT rate by age: (24.0%), (16.2%), (12.7%), 65+ (12.2%)
Traditional model based on proportion of LDKT compared to total annual transplant volume (LD + DDKT)
New model based on proportion of LKDT compared to total annual number of new waitlist registrants

17. Deceased and Living Donors 2007-2016 Region 11

18. Pediatric Living Donor Kidney Transplants 2007-2016 Region 11 and Nation

19. Region 11 Living Donors, 2014-2016 2014 2015 2016 LD kidney: 293
LD liver: 13
LD liver: 12
LD liver: 18

20. Discussion
Barriers to increasing living donation nationally and within the region
Ideas for maximizing living donation
Best practices
Use of living donor ESRD risk projection calculator
Recent literature focuses on negative aspects of living donation
Social networking
Education, education, education