Living kidney donor transplantation--new dimensions.

The ethical view points concerning living kidney donation are changing in Europe. Objections against emotionally related donation are fading away, whilst ethical arguments around brain death and "true death" are put first in some regions. Emotionally related donation is highly motivated and gives excellent results, despite rather bad HLA matches, but yet remains neglected as large source of kidneys in many centres and countries. Avoiding dialysis by pre-emptive transplantation with living donors is the best treatment of end-stage renal disease in order to maintain quality of life and socioeconomic benefit. The technique of laparoscopic donor nephrectomy will probably spread quickly. The future of crossover transplantation is unclear as yet, but will probably not be stopped by law since it is ethically and biologically well justified. And, finally, all centres in regions where live donor kidney transplantation is rapidly expanding should prospectively follow up the health of their donors and interact as soon as necessary. An example of such an institution is the Swiss living kidney donor registry which has been following up 181 donors since April 1993.