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  • Print publication year: 2011
  • Online publication date: September 2011

Chapter 41 - US transplant service – legal and operational framework

from Section 8 - The transplant service


For a patient with end-stage renal disease, the best option is a living donor transplant. The major concern about living donor transplantation is the risk to the donor. The donor operation is a major procedure that is associated with morbidity, mortality, and the potential for adverse long-term consequences, secondary to living with a single kidney. The surgical risks for laparoscopic and open nephrectomy are similar. The most common causes of death have been pulmonary embolism, bleeding, and infection. Living donors report a similar or better quality of life, as compared with the general population. Risk factors for less positive quality of life after donation have also been identified, including poor donor or recipient physical outcome, a negative personal donor-recipient relationship, and financial hardship. Population studies have shown that smoking, obesity, hypertension, and elevated blood glucose levels are associated with an increased risk of proteinuria and kidney disease.

Further reading

LuskinRS, GlazierAK, DelmonicoFL. Organ donation and dual advocacy. N Engl J Med 2008; 358: 1297–8.
McDiarmidSV, PruettTL, GrahamWK. The oversight of solid organ transplantation in the United States. Am J Transplant 2008; 8: 739–44.
Organ Procurement and Transplantation Network. Available at:
PretagostiniR, GabbrielliF, FiaschettiP, et al. Risk management systems for health care and safety development on transplantation: a review and a proposal. Transplant Proc 2010; 42: 1014–6.
Tuttle-NewhallJE, KrishnanSM, LevyMF, McBrideV, OrlowskiJP, SungRS. Organ donation and utilization in the United States: 1998–2007. Am J Transplant 2009; 9: 879–93.
United Network for Organ Sharing. Available at: