Special Feature Creating a Medical, Ethical, and Legal Framework for

T he ever-increasing waiting times for deceased-donorkidneys have focused attention on living donation as auseful way to increase the supply of organs for trans-plant candidates (1). Many renal transplant centers now rou-tinely accept donors with risk factors for developing future kidney disease, a group of patients that we term “complex living donors ” (2,3). A lack of consensus about what constitutes an important risk factor and insufficient data about long-term outcomes for complex living donors have generated heated debate among transplant professionals over the ethics of allow-ing donation to proceed (4–6). A medical, ethical, and legal framework for protecting com-plex living donors therefore is important given the diverse, sometimes conflicting pressures that transplant centers are un-der to accept living donors. The devastating cardiovascular mortality of chronic kidney disease (CKD) has contributed to the sense that long waiting times for deceased donor kidney