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.

Tissue typing

Covering tissue typing, this chapter describes key elements for tissue matching, a key element for successful transplantation. Methods for detecting pre-formed circulating antibodies, serological tests, and genotyping are all described. Techniques including RFLP, PCR, sequence-specific primer are explained, along with a look forward to next-generation sequencing.

Human leucocyte antigen-associated anti-glomerular basement membrane disease in siblings

We report a case of anti-glomerular basement membrane (GBM) disease in association with human leucocyte antigen (HLA) DRB1 15:01. A 71-year-old woman presented with oligoanuric acute kidney injury accompanied by high titre anti-GBM antibodies. Renal biopsy revealed a severe crescentic glomerulonephritis. Her brother had presented 6 years earlier with oligoanuric acute kidney injury. He was dual positive for MPO ANCA and anti-GBM antibodies. Renal biopsy was not performed. Both had an absence of pulmonary involvement. Tissue typing confirmed both were heterozygous for HLA DRB1 15:01 and DRB1 04:03.