**1. Introduction**

Living kidney donation has successfully improved the lives of many patients worldwide for over half a century. Do we still have the same need for living donors in 2018? The answer is obviously yes and for many reasons. The first is organ shortage with a widening gap between renal supply and demand in all countries that increases every year despite the use of marginal deceased donors. Waiting lists are growing everywhere. The site of the US Government Information on Organ Donation and Transplantation, organdonor.gov, shows recently a transplant waiting list of more than 114,000 patients of whom 83% are potential kidney recipients [1]. The second reason is the significant graft survival advantage and the reduction of the waiting time between end-stage renal disease and graft implantation. The results of renal transplantation from living donors are better compared to those from cadaveric kidneys with a graft half-life of 18 versus

### **Figure 1.**

*Worldwide kidney transplant from living donors in 2017. International Registry in Organ Donation and Transplantation.*

12 years, respectively [2]. Kidney transplantation from a living donor, when possible, is the best treatment for most patients with end-stage renal disease. This is related to multiple factors such as less time from dialysis to transplantation, shorter cold ischemia time, and better quality of the graft. The third reason stands for pediatric recipients where a prompt transplantation from a living donor, mostly a parent, can help for a better growth, quick return to school, and a good psychological stability; it is considered today as the gold standard therapy for children with end-stage renal disease. The fourth argument is that living donation provides a good opportunity to perform a preemptive transplantation avoiding the need of going through dialysis. A fifth reason is that we are still too far to overcome organ shortage by using xenografts from transgenic animals, or engineered organs from stem cells.

Currently, 40% of kidney grafts in the United States are from living donors [1]. In Europe, the level is highly variable between countries, standing for approximately 10% in France and up to 60% in Norway and Sweden [2, 3]. Approximately, one in three kidney transplants performed in the UK are from living donors [4], and according to the Global Observatory on Donation and Transplantation (GODT), 84,347 kidney transplants were done worldwide in 2015, of which 41.8% were from living donors [5].

In some countries, namely Middle Eastern and Eastern, kidney transplantation is relying only or mostly on living donors [6, 7]. Worldwide kidney transplant from living donors in 2017, based on the International Registry in Organ Donation and Transplantation, is shown in **Figure 1** [8].

Women traditionally outrank men in their enthusiasm to donate one of their kidneys. Although most recipients are male, women represented 63% of all living donations in 2016 [9].

In regard to these facts, living donors have exceptional courage and nobility; they go through a major surgery, accepting all surgical and medical risks and of no medical and physical benefit for them. It is our vocation and duty to provide them a safe and good practice according to legal and ethical bylaws and to protect their health in the long term.
