{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T23:07:02Z","timestamp":1787699222755,"version":"build-2784847793"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2019,6,16]],"date-time":"2019-06-16T00:00:00Z","timestamp":1560643200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Living donor kidney transplantation (LDKT) is the preferred treatment for patients with end-stage renal disease and unspecified living kidney donation is morally justified. Despite the excellent outcomes of LDKT, unspecified kidney donation (UKD) is limited to a minority of European countries due to legal constraints and moral objections. Consequently, there are significant variations in practice and approach between countries and the contribution of UKD is undervalued. Where UKD is accepted as routine, an increasing number of patients in the kidney exchange programme are successfully transplanted when a \u2018chain\u2019 of transplants is triggered by a single unspecified donor. By expanding the shared living donor pool, the benefit of LDKT is extended to patients who do not have their own living donor because a recipient on the national transplant list always completes the chain. Is there a moral imperative to increase the scope of UKD and how could this be achieved?<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An examination of the literature and individual country practices was performed to identify the limitations on UKD in Europe and recommend strategies to increase transplant opportunities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Primary limitations to UKD, key players and their roles and responsibilities were identified.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Raising awareness to encourage the public to volunteer to donate is appropriate and desirable to increase UKD. Recommendations are made to provide a framework for increasing awareness and engagement in UKD. The public, healthcare professionals, policy makers and society and religious leaders have a role to play in creating an environment for change.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ckj\/sfz067","type":"journal-article","created":{"date-parts":[[2019,5,18]],"date-time":"2019-05-18T11:09:09Z","timestamp":1558177749000},"page":"159-165","source":"Crossref","is-referenced-by-count":30,"title":["Raising awareness of unspecified living kidney donation: an ELPAT* view"],"prefix":"10.1093","volume":"13","author":[{"given":"Lisa","family":"Burnapp","sequence":"first","affiliation":[{"name":"Department of Transplantation and Nephrology, Guy\u2019s & St Thomas\u2019 NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristof","family":"Van Assche","sequence":"first","affiliation":[{"name":"Faculty of Law, University of Antwerp, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Lennerling","sequence":"first","affiliation":[{"name":"Department of Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorthe","family":"Slaats","sequence":"first","affiliation":[{"name":"Department Internal Medicine, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Van Dellen","sequence":"first","affiliation":[{"name":"Department of Surgery, Manchester Royal Infirmary, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nizam","family":"Mamode","sequence":"first","affiliation":[{"name":"Department of Transplantation and Nephrology, Guy\u2019s & St Thomas\u2019 NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franco","family":"Citterio","sequence":"first","affiliation":[{"name":"Renal Transplantation Unit, Catholic University, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willij","family":"Zuidema","sequence":"first","affiliation":[{"name":"Department Internal Medicine, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willem","family":"Weimar","sequence":"first","affiliation":[{"name":"Department Internal Medicine, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank J M F","family":"Dor","sequence":"first","affiliation":[{"name":"Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,6,15]]},"reference":[{"key":"2020041009152814500_sfz067-B1"},{"key":"2020041009152814500_sfz067-B2","year":"2018"},{"key":"2020041009152814500_sfz067-B3","year":"2012"},{"key":"2020041009152814500_sfz067-B4","doi-asserted-by":"crossref","first-page":"135","DOI":"10.4103\/0971-4065.43686","article-title":"The declaration of Istanbul on organ trafficking and transplant tourism","volume":"18","year":"2008","journal-title":"Indian J Nephrol"},{"key":"2020041009152814500_sfz067-B5","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1097\/01.TP.0000136654.85459.1E","article-title":"The consensus statement of the Amsterdam Forum on the Care of the Live Kidney Donor","volume":"78","year":"2004","journal-title":"Transplantation"},{"key":"2020041009152814500_sfz067-B6","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1053\/j.ajkd.2007.11.027","article-title":"A randomized trial of a home-based educational approach to increase live donor kidney transplantation: effects in blacks and whites","volume":"51","author":"Rodrigue","year":"2008","journal-title":"Am J Kidney Dis"},{"key":"2020041009152814500_sfz067-B7","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1097\/TP.0000000000000165","article-title":"Making house calls increases living donor inquiries and evaluations for blacks on the kidney transplant waiting list","volume":"98","author":"Rodrigue","year":"2014","journal-title":"Transplantation"},{"key":"2020041009152814500_sfz067-B8","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.pec.2012.08.004","article-title":"Living donor kidney transplantation among ethnic minorities in the Netherlands: a model for breaking the hurdles","volume":"90","author":"Ismail","year":"2013","journal-title":"Patient Educ Couns"},{"key":"2020041009152814500_sfz067-B9","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1093\/ndt\/gfv322","article-title":"Early home-based group education to support informed decision-making among patients with end-stage renal disease: a multi-centre randomized controlled trial","volume":"31","author":"Massey","year":"2016","journal-title":"Nephrol Dial Transplant"},{"key":"2020041009152814500_sfz067-B10","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1034\/j.1600-6143.2003.00019.x","article-title":"The living anonymous kidney donor: lunatic or saint?","volume":"3","author":"Henderson","year":"2003","journal-title":"Am J Transplant"},{"key":"2020041009152814500_sfz067-B11","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1111\/j.1432-2277.2011.01333.x","article-title":"Can we turn down autonomous wishes to donate anonymously?","volume":"24","author":"Hilhorst","year":"2011","journal-title":"Transpl Int"},{"key":"2020041009152814500_sfz067-B12","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1097\/TP.0000000000000340","article-title":"Motivations, outcomes and characteristics of unspecified (non-directed altruistic) kidney donors in the United Kingdom","volume":"98","author":"Maple","year":"2014","journal-title":"Transplantation"},{"key":"2020041009152814500_sfz067-B13","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1097\/TP.0b013e3182129236","article-title":"New classification of ELPAT for living organ donation","volume":"91","author":"Dor","year":"2011","journal-title":"Transplantation"},{"key":"2020041009152814500_sfz067-B14","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1111\/j.1399-0012.2007.00785.x","article-title":"Nondirected living kidney donation: experiences in a Swedish Transplant Centre","volume":"22","author":"Lennerling","year":"2008","journal-title":"Clin Transplant"},{"key":"2020041009152814500_sfz067-B15","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1093\/ndt\/gfn669","article-title":"Is altruistic-directed living unrelated organ donation a legal fiction?","volume":"24","author":"Epstein","year":"2009","journal-title":"Nephrol Dial Transplant"},{"key":"2020041009152814500_sfz067-B16","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1097\/TP.0b013e31829282eb","article-title":"Unspecified kidney donation\u2013a review of principles, practice and potential","volume":"95","author":"Sharif","year":"2013","journal-title":"Transplantation"},{"key":"2020041009152814500_sfz067-B17","first-page":"287","article-title":"Eight years of outcomes of the Dutch Living Donor Kidney Exchange Programme","author":"de Klerk","year":"2011","journal-title":"Clin Transpl"},{"key":"2020041009152814500_sfz067-B18","year":"2017"},{"key":"2020041009152814500_sfz067-B19","year":"2014"},{"key":"2020041009152814500_sfz067-B20","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1111\/bjhp.12048","article-title":"Understanding donation experiences of unspecified (altruistic) kidney donors","volume":"19","author":"Clarke","year":"2014","journal-title":"Br J Health Psychol"},{"key":"2020041009152814500_sfz067-B21","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1097\/TP.0b013e318247a7b7","article-title":"Summary of the British Transplantation Society\/Renal Association U.K. guidelines for living donor kidney transplantation","volume":"93","author":"Andrews","year":"2012","journal-title":"Transplantation"},{"key":"2020041009152814500_sfz067-B22","year":"2009"},{"key":"2020041009152814500_sfz067-B23","year":"2018"},{"key":"2020041009152814500_sfz067-B24","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s11019-006-9002-x","article-title":"Should healthcare professional encourage living kidney donation?","volume":"10","author":"Hilhorst","year":"2007","journal-title":"Med Health Care Philos"},{"key":"2020041009152814500_sfz067-B25","author":"Gare"},{"key":"2020041009152814500_sfz067-B26","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1097\/TP.0b013e31829b754c","article-title":"Modifiable factors in access to living-donor kidney transplantation among diverse populations","volume":"96","author":"Ismail","year":"2013","journal-title":"Transplantation"},{"key":"2020041009152814500_sfz067-B27","doi-asserted-by":"crossref","first-page":"995","DOI":"10.2215\/CJN.08880812","article-title":"Modifiable patient characteristic and racial disparities in evaluation completion and living donor transplant","volume":"8","author":"Waterman","year":"2013","journal-title":"Clin J Am Soc Nephrol"},{"key":"2020041009152814500_sfz067-B28","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1097\/TP.0000000000000027","article-title":"Health literacy of living kidney donors and kidney transplant recipients","volume":"98","author":"Dageforde","year":"2014","journal-title":"Transplantation"},{"key":"2020041009152814500_sfz067-B29","year":"2018"},{"key":"2020041009152814500_sfz067-B30"},{"key":"2020041009152814500_sfz067-B31","year":"2004"},{"key":"2020041009152814500_sfz067-B32","year":"2008"},{"key":"2020041009152814500_sfz067-B33","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1111\/tri.12698","article-title":"Long-term outcome of living kidney donation \u2013 position paper","volume":"29","year":"2016","journal-title":"Transplant Int"},{"key":"2020041009152814500_sfz067-B34","doi-asserted-by":"crossref","first-page":"2912","DOI":"10.1111\/ajt.12411","article-title":"Living donor assessment: challenges, uncertainties and controversies among transplant nephrologists and surgeons","volume":"13","author":"Tong","year":"2013","journal-title":"Am J Transplant"},{"key":"2020041009152814500_sfz067-B35","doi-asserted-by":"crossref","first-page":"2210","DOI":"10.1097\/TP.0000000000000669","article-title":"Dealing with public solicitation of organs from living donors- an ELPAT view","volume":"99","author":"Frunza","year":"2015","journal-title":"Transplantation"},{"key":"2020041009152814500_sfz067-B36","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1111\/j.1600-6143.2010.03115.x","article-title":"Encouraging psychosocial outcomes after altruistic donation to a stranger","volume":"10","author":"Massey","year":"2010","journal-title":"Am J Transplant"},{"key":"2020041009152814500_sfz067-B37","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1097\/TP.0b013e31820dd2bd","article-title":"Altruistic kidney donation to a stranger: psychosocial and functional outcomes at two US transplant centers","volume":"91","author":"Rodrigue","year":"2011","journal-title":"Transplantation"},{"key":"2020041009152814500_sfz067-B38","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1136\/medethics-2014-102230","article-title":"Directed altruistic donation: what is wrong with the beauty contest?","volume":"41911","author":"Moorlock","year":"2015","journal-title":"J Med Ethics"},{"key":"2020041009152814500_sfz067-B39","year":"2014"},{"key":"2020041009152814500_sfz067-B40","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.1097\/TP.0000000000001128","article-title":"Summary of the British Transplantation Society UK Guidelines for living donor liver transplantation","volume":"100","author":"Manas","year":"2016","journal-title":"Transplantation"},{"key":"2020041009152814500_sfz067-B41","year":"2004"},{"key":"2020041009152814500_sfz067-B42","year":"2006"}],"container-title":["Clinical Kidney Journal"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ckj\/article-pdf\/13\/2\/159\/33028085\/sfz067.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ckj\/article-pdf\/13\/2\/159\/33028085\/sfz067.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,18]],"date-time":"2024-07-18T06:44:52Z","timestamp":1721285092000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ckj\/article\/13\/2\/159\/5519368"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,15]]},"references-count":42,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,6,15]]},"published-print":{"date-parts":[[2020,4,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ckj\/sfz067","relation":{},"ISSN":["2048-8505","2048-8513"],"issn-type":[{"value":"2048-8505","type":"print"},{"value":"2048-8513","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,4]]},"published":{"date-parts":[[2019,6,15]]}}}