What Disease Conditions could be Considered for Potential Therapeutic Kidney Donations?

The OPTN/UNOS Living Donor Committee, UNOS Policy Department, coined the term “therapeutic organ donor” to describe an individual who has an organ removed as a component of their treatment for a medical problem, and their removed organ is suitable for transplantation into a transplant candidate. The committee suggested that potential therapeutic donors may have conditions, such as renal cell carcinoma (with the tumor removed after recovery and before transplantation), ureteral trauma (a transected ureter), or maple syrup urine disease. Many chronic kidney disease (CKD) patients on a transplant waiting list are eagerly anticipating this new OPTN policy proposal. In this manuscript, we would like to concentrate on the kidney as a therapeutic organ and propose a list of renal conditions associated with “therapeutic donatable kidneys” which include “donatable kidneys that are nephrectomized due to urologic diseases”.

The shortage of donor kidneys is a serious problem in Japan, and this trend has become worse partly because altruistic donations and paired kidney exchange programs are not currently accepted in Japan, while ABO-incompatible living kidney transplantation has increased to 30%. In addition, restored kidney transplantation by “therapeutic kidney donation” was banned by the Japanese government in 2007, with the exception of transplantations conducted as part of clinical trials. 

This donor shortage crisis prompts dialysis-intolerant patients to seek transplantation and donor kidneys in foreign countries, leading to an increase in transplant tourism. To reverse this situation, the Tokushukai group launched two clinical trials of therapeutic kidney donation (TKD) in 2009, which are still ongoing, to transplant restored kidney allografts in patients without appropriate donors among their family members or who have used all of the possible living donors in their family.