Living or deceased donor kidney transplantation in children

Purpose of review Kidney transplantation is the preferred treatment modality for children with end-stage renal disease. In this review, we discuss the factors affecting the selection of the appropriate donor to ensure the best possible short and long-term outcomes. Recent findings Outcomes of pediatric renal transplantation from living donors are superior to those obtained from deceased donors. Despite this, the rate of living donor kidney transplantation has declined over the last decade. Living donation is considered to be safe but long-term outcomes, especially for parents who are often young donors, are not well understood. Living donation can also cause a financial impact to the donor and family. Barriers to living donation must be sought and defeated. Deceased donor organs are now the primary source of kidneys. How the risk of extended time on dialysis must be weighed against the improved outcomes that may accrue from better matching is controversial. Increasing the donor pool may be accomplished by reassessing sources that are currently avoided, such as donation after cardiac death and infant kidneys transplanted en bloc. Summary The pediatric nephrologist must balance waiting for the highest quality kidney against the need for the shortest possible waiting time.