Minors as recipients and donors in solid organ transplantation

Case narrative 1: a minor as solid organ donor. A 15-year-old girl with end-stage kidney disease due to Wegener’s granulomatosis has been on dialysis since her diagnosis 18 months before. Her lung disease is quiescent. The transplant team has determined that she is ready for transplant and has identified no psychological or medical issues to delay the procedure. Each parent volunteered to be a living kidney donor, but both were blood type incompatible (they were both type A and she was a type O). The patient is highly sensitized due to transfusions received early in her illness, suggesting a long wait on the deceased-donor kidney list, even with some priority accorded children awaiting a kidney. Her fraternal twin accompanied her to a clinic visit and stated, “I want to give my sister my kidney. I’m blood type O, I know what I’m getting myself into, and I understand the risks. How do we make this happen?”. Should the transplant team accept the twin’s offer and proceed with a donor evaluation? Would the situation be different if the girls were identical twins? What if the twins were 8 years old?