Hany Riad: The risk of live kidney donation to the donor is quite small. The risk of death is in the region of one in four or five thousand. Keyhole surgery is expanding and if done properly is a very safe procedure.

On paying for loss of earnings and expenses, this is supported by the Department of Health. However, the guidance from the Department of Health seems to be, they encourage it but they never put pressure on the purchaser and health authorities to actually do it, and I have a case of a mother who is asking for £100 and the health authority is refusing to pay it.

Prof. Feest: You might watch when the NSF comes out. It is likely that there will be very clear guidance that the costs of donors should be reimbursed.

Lilian Cerosoli (nee Rutherford): I would rather die than get a kidney that was not a gift of life. For me, it's peace of mind and for the nurses I work with it's peace of mind as well. Because I look after people after a kidney patient has died, I still see the relatives because I work in the community.

Hany Riad: I very much agree. A scenario which we come across not infrequently is of an 18 year-old who comes off his motorbike and has a serious head injury. If this person had not opted out and if the mother says she did not want her son's organs removed, would you still want me to take his organs out against his mother's request? For that's what opting out means.

Prof. Feest: It's a convenient debate - it has been in the past - to get everyone arguing about opting out and opting in while they're not looking at getting money into other areas that are proven to work. I think things have changed through UK Transplant, but there are lots of other areas that are going to make much more difference than opting in or opting out. I think the politicians have got you comfortable talking about something that probably won't make much difference and isn't politically such a hot potato as other things.

Maggi Steele: An important point is that if your family know what your wishes are in the event of your death, even if it is not what they would want, the chances of them going against your wishes are remote.

Anne Keogh: I can't tell you specifically whether there is anything going on. Holidays are a major issue. All patients' families and staff would like to encourage holidays but the difficulty is the amount of capacity for haemodialysis up and down the country. What will be interesting is that the National Institute for Clinical Excellence (NICE) have now said that home haemodialysis should be encouraged much more, but again that's going to take quite a long time in freeing up spaces.

Guy Hill (North West KPA): This is something that we've looked at as a KPA because we represent Manchester where you would feel that lots of people would want to travel for longer than one night. I did approach our hospital and ask them whether they would allow us to fund a holiday/dialysis situation where we paid for the bill for that particular stay. I was told that they had never considered it because they had never been asked for it. I think it's within the NKF to try and arrange that sort of situation. And the question I ask of all of us here is, if it was offered as some sort of arrangement where you could have that sort of thing, would we actually use it?

Simon Lloyd (Tyneside KPA): Having sat on our own regional special commissioning group, there are ways of cost exchanging. I would caution against KPAs getting involved in expenditure.