Wait List

Dear Dr. Agar,

If a pt has a living donor, must (s)he be put on a wait list for a kidney transplant?

Thank you, Dale Freundlich

Re Wait List

It is the practice, at least in Australia, to place any suitable transplant candidate on the deceased donor (DD) transplant waiting list - and that includes those where there is a potential, likely or even certain living donor - and this is so, from the dialysis start date. However, I cannot speak for the practices in other countries.

Where the potential recipient has still not commenced dialysis but a donor has been identified and worked-up for a ‘pre-emptive’ transplant - a graft planned to be undertaken prior to dialysis start - this is clearly not the case … but once a patient commences dialysis and thus has access to a listing on the DD waiting list, we list all potential recipients.

It can happen - and has happened - that while a live donor is being worked up, a perfect match DD emerges. The live donor option may ‘fall through’ during work-up or for one of many potential reasons, not progress. Unlisted, the then potential recipient of that live donor kidney would be waiting-time and list-place disadvantaged if he/she had remained unlisted on the assumption that a live donor graft would proceed, only then after (sometimes) months of work-up of an expected live donor, the LD transplant fell at a final assessment hurdle.

Most would probably agree that a perfect match DD would be preferable to the ‘risking’ of a living donor - for things can still go wrong with living donor grafts … or even living donors. Unfortunately, transplantation and the procurement of live donor kidneys is still not without risk.

I don’t want to deviate too far from the purposes of this site (haemodialysis issues … and especially home haemodialysis isues) but these are the broad tenets that govern our practices in Australia. They may differ, country to country, so what I have answered may not be entirely in line with the practices elsewhere - eg: the US - so, I stand to be corrected if I things are different there.

I hope that gives a brief answer to your question.

Thank yoou for the information. Dale Freundlich