Over the past 20 years, kidney transplantation has positioned itself as the best treatment for chronic renal failure in terms of survival, quality of life, complications and cost-benefit ratio, compared to dialysis. In Spain, more than 90% of transplants are carried out using cadaver donors but, unfortunately, the number of deceased donors is insufficient to meet the needs of the recipient waiting list. However, published studies on living-donor kidney transplants in Spanish hospitals and the results of large series in countries with significant experience with this treatment show a reduction in donor morbidity and greater survival of the graft as compared to cadaveric transplants.
In Spain, there is renewed interest in living-donor kidney transplants, as shown by the slow but progressive increase in recent years in the use of this procedure. The number of hospitals that have initiated living-donor kidney transplant programmes is growing, but the total number of transplants is low and there is still a lack of knowledge among professionals regarding various aspects of living donation. There is still a long way to go until living-donor kidney transplants are routinely offered as another alternative treatment to patients with advanced kidney failure (pre-dialysis). Training professionals and educating patients and their families will meet this objective. For this purpose, the Spanish Nephrology Society (SEN by its Spanish initials) and the Spanish National Transplant Organisation (ONT by its Spanish initials) have joined forces to promote this type of kidney replacement treatment. They have developed recommendations that offer a global approach to the living-donor kidney transplant process, from the ethical and legal basis to donor selection and care, including patient and family education, new surgical techniques and the use of immunosuppression. Increased use of living-donor kidney transplants will result in more frequent obstacles such as ABO incompatibility or positive crossmatch and therefore our system must be prepared to handle these problems. Likewise, live kidney donation must be able to guarantee the safety of the living donor at all times, which will require the best evidence for the donor’s safety in the short, medium, and long-term, and the development of new initiatives aimed at eliminating disincentives for this type of donation. The objectives are clear and institutional and professional collaborations are underway.
These recommendations were initiated by the ONT and were jointly developed with the complete support of the SEN. The expert group responsible for its development was designated by the Steering Committee of the SEN and members of the ONT based on their proven experience and knowledge of the subject matter. They selected the topics to be developed, which were then distributed among all group members. Each group member was responsible for developing their topic with the collaboration of additional experts as needed. These groups developed each proposed chapter and identified existing scientific evidence. Once topics had been developed, a face-to-face meeting was held in which each expert presented their topic to be reviewed. All documents were shared by e-mail prior to the meeting. Afterwards, each author made appropriate changes and the documents were once again circulated among group members. The final result was published on the SEN web page in September 2010, with an e-mail address for suggestions. The expert group discussed proposed changes, which then led to the current final document. Furthermore, some chapters included treatment algorithms to help clinicians understand and apply the information in the text quickly and easily.
As with the rest of the SEN documents and guides, absolute economic independence has been maintained and there are no conflicts of interest among the writers of the Recommendations. The industry has contributed financially to the publication, always through the secretariat of the SEN, in order to maintain maximum independence. All group meetings were organised by the secretariat of the SEN.
