Has the time come for more flexible organ donation

To the Editor: In their excellent article regarding living unrelated donor kidney transplantation in the August 2000 issue of Kidney International, Gjertson and Cecka reported that in addition to the 1765 spouses, 986 additional cases of living unrelated donor kidney transplants were performed without reporting any information about the circumstances under which these transplantations were performed1. Apparently, the authors were unaware of the details and most likely this information was beyond the scope of their investigation. However, to non-American nephrologists, this article raises some critical questions. Are these 986 cases considered "legal" under current legislation? How many recipients, if any, paid for the kidney they received? How many, if any, of the 1765 marriage-related donors contracted "marriages of convenience" with the recipients only for the purpose of transplantation? If a foreigner and his or her unrelated, non-spouse–donor ask to come to the United States to receive a kidney transplant, would they be accepted?