Updates in guidelines and policy for selection, care and aftercare of the living kidney donor.

PURPOSE OF REVIEW: Living donor kidney transplantation is a cornerstone of modern transplant systems, offering patients with end-stage kidney disease improved survival, reduced waiting times, and, in many settings, the most effective pathway to transplantation. Despite these benefits, the development and expansion of living donation programs have occurred unevenly across jurisdictions, reflecting variability in donor protections, oversight structures, and long-term monitoring of living donor outcomes.

RECENT FINDINGS: The 2023 Santander Summit convened international stakeholders to establish a global framework for the safe and sustainable expansion of living donation under the principles of sufficiency, transparency, and oversight, emphasizing that living donation should complement deceased donation systems and that expansion must occur within frameworks that support informed decision-making, removal of financial disincentives without introducing incentives, and long-term accountability for living donor well-being. This review examines developments in policy and clinical practice that emerged since the Summit, focusing on evolving approaches to living donor selection and risk assessment, donor care during evaluation and donation, long-term follow-up and registry development, and advances in ethical and regulatory oversight.

SUMMARY: This review illustrates how recent evidence and policy initiatives operationalize the Summit's principles and support a transition toward a more transparent, evidence-based, and donor-centered model of care.