Toward Global Equity in Living Kidney Donation: Expanding Kinship Criteria Through a DEI-Informed Framework

In Taiwan, more than 8,500 individuals remain on the national organ transplant waiting list, the majority of whom require kidney transplantation. However, for patients with hereditary kidney disorders or polycystic kidney disease, biological relatives are often medically unsuitable donors. The current restriction that permits only blood relatives aged 20 or older to serve as living kidney donors creates inequities and limits transplant access. Expanding eligibility to include in-laws and socially bonded individuals could enhance donor diversity, promote equitable access to transplantation, and uphold the constitutional right to health. In late 2024, members of the Legislative Yuan urged the Ministry of Health and Welfare to review and revise these kinship restrictions. This study aimed to explore key considerations for policy reform through a diversity, equity, and inclusion (DEI) lens and to propose evidence-based recommendations for a more inclusive transplant framework.

Between March and April 2025, two multidisciplinary expert meetings were convened, involving 14 participants: transplant surgeons and nurses, nephrologists, gender equality specialists, legal scholars, human rights advocates, and medical ethicists. Discussions examined the legislative history of Article 8 of the Human Organ Transplant Act and compared living donor eligibility policies across the United States, United Kingdom, Germany, and Japan. The analysis incorporated 2023 data from the International Registry on Organ Donation and Transplantation (IRODaT) and assessed current national transplant practices, ethical review procedures, and cultural perceptions influencing donor eligibility in Taiwan.

Experts identified a key inconsistency in Taiwan’s policy framework. Living liver donation is already permitted from in-laws aged 18 or older under ethical committee oversight, whereas living kidney donation remains restricted to blood relatives. In contrast, many countries have adopted inclusive definitions of kinship—recognizing emotional, marital, or social bonds—supported by standardized ethical and psychological evaluations to safeguard voluntariness and donor welfare. Evidence from these models demonstrates that expanding donor eligibility improves access and equity without compromising safety. The expert panel recommended harmonizing Taiwan’s kidney donation criteria with those of liver donation by: (1) permitting kidney donation from in-laws within five degrees of kinship; (2) lowering the minimum donor age from 20 to 18 years; and (3) strengthening psychological and ethical screening processes. They further emphasized enhancing public awareness of the “donor priority mechanism,” which ensures that living donors receive preferential access to transplantation if they later develop organ failure.

Revising Taiwan’s living kidney donor eligibility criteria would advance diversity and inclusion in transplantation, reduce disparities in access for women and genetically high-risk families, and alleviate the national dialysis burden. By aligning legal and ethical standards across organ types, Taiwan can foster a fairer, safer, and more sustainable transplant ecosystem that reflects DEI principles and global best practices.