The Arcane Process of Screening Living Donors

This chapter focuses on the careful medical and psychosocial screening that is required for living donors. It analyzes the motivations of family donors, voluntariness, and the possibility of intrafamilial coercion. In the early days of transplantation, nobody was considering living donors who were unrelated to the recipient. That was partly for legal reasons, partly for emotional reasons, but mostly for medical reasons. The chapter then shifts to discuss the first kidney transplant that took place in 1950, and traces the discoveries and developments in early medical science. The key breakthrough in improving outcomes for liver, kidney, and heart transplants was the fortuitous discovery of a remarkable new immunosuppressive medication, cyclosporine, and better tissue typing. The chapter then investigates how these developments in immunosuppression and tissue matching improved the outcomes of transplantation from both related and unrelated donors.