At least three people died today in the United Kingdom because they couldn’t get a kidney transplant. Several thousand more will attend dialysis units. There are increasing numbers of patients, usually young, whose doctors would like to give them “pre-emptive” kidney transplants instead of starting dialysis, which is harsh on the patient and expensive for NHS resources. A transplanted kidney will “pay for itself” within 18 months. Although kidneys obtained within minutes of cardiac death or during the process of “neurological death” are usable and a boon to the recipients, those from living kidney donors give the recipient a better and longer lease of life.

The increase in diabetes and hypertension in the community puts further pressure on the need for kidney transplantation. But the rate of donation of kidneys from deceased and living donors has never kept pace with the need, and has plateaued at about 2000 a year in the UK. At present we have a reimbursement model whereby donors’ costs are covered for several weeks by the NHS, insurers (who well know the …