Exploring the Complex Ethical Challenges Associated with Living Donor Kidney Transplantation

Living donor kidney transplantation is regarded as the best treatment for selected patients with end­ ‑stage renal disease, associated with improved survival and quality of life. However, it should be recognized as a distinct medical procedure during which an organ is procured from a healthy individual for the benefit of another patient. Seven decades after the first successful procedure, ethical constraints persist, even though the procedure has become routine worldwide. The perceived risks for donors are considered low and ethically acceptable; however, recent studies have identified increased long­‑term risks of end­ ‑stage renal disease for living donors compared to healthy non­ ‑donors, raised hypertensive disorders during pregnancy, and a possible increase in mortality. Additionally, in most centers, there is a growing acceptance of donors with minor abnormalities, which were previously declined, yet long­ ‑term follow­ ‑up data on these donors remains scarce. Furthermore, various risks and benefits must be evaluated, including the potential risks from refusing donations and possible lifesaving opportunities arising from conditions identified during the evaluation process. A thorough assessment of the candidate donor’s risks is essential. While current literature helps us mitigate significant risks for the candidate donor, it is important to elaborate on these risks with greater precision. Maintaining ethical practices and ensuring informed consent requires an updated registry of all living donors and candidates, along with long­ ‑term follow­ ‑up that includes ongoing data reviews.