Could minors be living kidney donors? A systematic review of guidelines, position papers and reports

Abstract

Summary The purpose of this study is to systematically review guidelines, position papers, and reports on living kidney donation by minors. We systematically searched the databases such as Medline, Embase, ISI Web of knowledge, Google scholar as well as the websites of various bioethics committees, transplant organizations and societies. Guidelines were included if they provided recommendations for or against living kidney donation by minors. Data were analyzed using qualitative content analysis. We included 39 documents in this study. Twenty seven of these endorse an absolute prohibition of living kidney donation by minors, because of concerns regarding the decision‐making capacity of minors, the impartiality of parental authorization, the best interests of the minor, and the necessity of the donation. Twelve guidelines, however, would exceptionally allow living kidney donation by minors, provided that adequate safeguards are put in place, including an assessment of the minor's autonomy and maturity, authorization by an independent body, assuring that the anticipated psychosocial benefits outweigh the medical and psychosocial risks for the donor and the restriction to situations of last resort. A more adequate medical and psychosocial follow‐up of living kidney donors may likely contribute to a more unified approach towards living kidney donation by minors.

Marginal Donors in Renal Transplantation

“…Interestingly, there are suggestions in the literature discussing the possibility of living kidney donations from minors, provided that authorization and assurance of the last resort for donor are given [71].…”

“…Renal transplantations from HIV-positive deceased donors to HIV-positive recipients were performed successfully previously but were not common because of the possibility of subsequent acceleration of the recipient's HIV to AIDS [69]. Recently, the possibility of using HIV-positive deceased donors to HIV-infected ESRD patients is supported by legal prohibition in the United States (the HIV Organ Positive Equity; HOPE act) to provide a donor pool for an increasing number of HIV-positive ESRD patients as a better alternative to a life-long dialysis [70,71]. The safety and effectiveness of the use of kidney donations from deceased HIV-positive donors in renal transplantation to HIV-positive recipients are now under investigation in the United States.…”

The Outcomes of Living Kidney Donation from Medically Complex Donors: Implications for the Donor and the Recipient

“…Most programs exclude prospective donors below eighteen years of age, the legal age of consent in the US. Donation between the age of 18 and 21 is often considered a relative contraindication [55*], although international guidelines differ with regard to absolute prohibition of kidney donation by minors in particular situations [56]. Besides issues of consent, younger potential donors presumably also have longer cumulative lifetime risk of developing conditions that predispose them to renal disease (e.g., diabetes, hypertension, obesity), and a normal initial donor evaluation may not accurately predict one's lifetime risk of ESRD [57].…”

Criteria for Living Donation from Marginal Donors: One, No One, and One Hundred Thousand

“…Some centers accept minors as potential donors, seemingly against current guidelines [24], which state that minors should only be considered as potential donors if no other options exist, mostly in case of identical twins.…”

“…General consensus is that minors (< 18 years old) should not be considered as kidney donors because of concerns regarding their decision-making capacity, the impartiality of parental authorization, and the best interests of the minor [24]. Only if no other options are available for the recipient, minors could be exceptionally considered, provided that adequate safeguards are put in place.…”