L E T T E R TO THE E D I T O R

Dear Sir,

I was delighted to read in the August 1989 issue the account by O'Meara et al of the first 16 years of living- related renal transplantation in Ireland.

It is good to see that fewer and fewer living donors are being used as the numbers of cadaver grafts rise.

The authors rightly say that minima/morbidity and mortality for the donor is essential when using living donors. The phrase "negligible mortality" is used. The only donor mortality that is negligible is a zero mortality and this is something that no-one can guarantee. In this connection I think it should have been recorded in the article that in (what was then) the Jervis Street series, one donor was lost. In that case it was a lady in her late thirties, mother of several children, who gave a kidney to one of her children. I performed the donor nephrectomy and can still remember the absolute horror when the lady died of pulmonary embolus two days later. It is true that such deaths are rare but I am aware of others in other countries.

Usually one cannot eliminate live donors altogether - for example, in Islamic countries a cadaver transplantation is virtually out of the question. I would slrongly support the authors in their implied hope that the numbers of cadaveric transplants in this country can be increased to the point where it will very rarely, if ever, be necessary to use a living donor.

Yours sincerely.

Anthony Walsh, ~CSl, FACS,

Consultant Urologist.

OB/GYN AMHERST, NOVA SCOTIA, CANADA

Incumbent going to U.S.A. Urgent Replacement Required. Catchment area 45,000. 400 deliveries/year. 110 bed hospital. Medical Staff consists of 9 specialists, 13 family physicians.

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