Patients with kidney failure have substantially higher morbidity and mortality than the general population and need high-cost treatments. [1][2][3][4][5][6] Patients currently on dialysis have extremely poor survival when compared with the general population (unadjusted survival rate at 5 yr is < 45% and 10 yr is < 15%). 4 In these patients, living donor kidney transplantation (LDKT) is the best therapeutic option, especially when done pre-emptively (i.e., before requirement for renal replacement therapy). 3,[7][8][9][10][11][12][13] Living donor kidney transplantation can provide early access to a transplant; the graft has a superior survival when compared with a graft from a deceased donor; and patients live longer and report a better quality of life. 1,2,4,14 Despite these well-known advantages to LDKT, the living donor rate in Canada has stayed the same since 2010 (about 15 donors per 1 000 000 population) and varies substantially across provinces (ranging from 6 to 23 donors per 1 000 000 population). 3,4,15,16 British Columbia is recognized to be a highperforming health system in this regard as their living donor rate has been consistently 20 donors or more per 1 000 000 population. 4,16,17 In addition, 50%-60% of all kidney transplantations performed annually in the province are from living donors. This is much higher than in Quebec or Ontario, for example, where this fraction is less than 15% and 30%-40%, respectively. 4 Even when analyzing national initiatives such as the Kidney Paired Donation Program managed by Canadian Blood Services, BC is a leader in contributing to this effort. British Columbia has the highest number of registered recipients per 1 000 000 population, total transplantations performed via the registry, total transplants to registered recipients and altruistic donors who come forward to participate in this program.
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