Opinion Review
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Feb 18, 2023; 13(2): 28-35
Published online Feb 18, 2023. doi: 10.5500/wjt.v13.i2.28
Changing landscape in living kidney donation in Greece
Nikolaos Karydis, Ioannis Maroulis
Nikolaos Karydis, Department of General Surgery and Transplantation, University of Patras, Patras 26504, Greece
Ioannis Maroulis, Department of General Surgery, University of Patras, Patras 26504, Greece
Author contributions: Karydis N drafted the original manuscript and its revision; Maroulis I contributed to the final editing of the original and revised manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest with the contents of this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nikolaos Karydis, FEBS, FRCS, MD, PhD, Assistant Professor, Department of General Surgery and Transplantation, University of Patras, University Campus 26504 Rio Achaia, Patras 26504, Greece. npkaridis@gmail.com
Received: September 3, 2022
Peer-review started: September 3, 2022
First decision: October 31, 2022
Revised: January 5, 2023
Accepted: January 8, 2023
Article in press: February 8, 2023
Published online: February 18, 2023

Patients with end-stage renal disease in Greece are facing long waiting times to receive a kidney transplant from a deceased donor. Living kidney donation offers a valuable alternative that provides optimal outcomes and significantly expands the donor pool but still remains relatively underutilised. Developments around the world in the field of kidney transplantation mandate a change in current practice to include additional options for living donation through paired exchange, antibody-incompatible transplantation and other strategies, following careful consideration of the cultural and ethical factors involved in these complex clinical decisions. An increase in living donation rates may be achieved in several ways, including targeted campaigning to overcome potential barriers. Educating clinicians on transplantation will prove as equally important as informing patients and prospective donors but requires training and resources. Adoption of established practices and implementation of new strategies must be tailored to the needs of the Greek donor and recipient population. Local beliefs about donation, perception of associated risk and other social characteristics must be considered in the design of future strategies. Facilitating living donation in a safe environment with appropriate donor and recipient education will form the solid foundation of a new era of kidney transplantation in Greece.

Keywords: Living kidney donation, Paired exchange, Incompatible transplantation, Unrelated donors, Greece

Core Tip: Living kidney donation is the driving force behind every successful kidney transplant programme worldwide. In Greece, in particular, it accounts for nearly half of performed transplants annually. Its role is of paramount importance since deceased donor kidney transplant waiting times are currently unacceptably long. Paired exchange and other options will form the basis to expand the donor pool and facilitate future developments in the field.