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

Abstract

Context: The increasing need for kidney grafts has led to a progressive expansion in the selection criteria for deceased and living donors (LDs). While concerns regarding the use of organs from suboptimal deceased donors relate to the quality of the graft, donation from “marginal” LDs may pose potential harm to the donor. Subject of Review: Living kidney donation is a safe procedure, but is associated with a small risk of end-stage kidney disease in the long- term. When elderly subjects and those with comorbidities are considered, long-term post-donation data are missing, making decisions regarding donation from these populations challenging. Further, vague guidelines have led to a wide heterogeneity in the criteria for living donation from marginal donors across centers and individuals. A recent survey by Lafranca et al. [PLoS One 2017;12:e0181846] collected information from 331 members (mainly physicians) of the European Society of Transplantation regarding several expanded LD criteria. Median refusal rate for potential expanded criteria (ECD) LDs is 15% and the authors found significant differences across regions in Europe in the acceptance of donors with ECD. Some transplant specialists did also deviate from their own transplant center policy, mainly to consider donors with high body mass index. Second Opinion: The survey by Lafranca et al. [PLoS One 2017;12:e0181846] documents extreme variability in the criteria for marginal LD selection. Many centers are deviating from the few agreed upon guideline criteria and are considering individuals with hypertension and minors for kidney donation. Intriguingly, one-fourth of the surgeons even deviate occasionally from center policy, especially when the issue is donor obesity. By and large, these data indicate that transplant community has a generally open approach toward extension of criteria for living donation, but long-term follow-up studies are needed to draw solid conclusions and guidelines.

Practice Patterns in the Acceptance of Medically Complex Living Kidney Donors with Obesity, Hypertension, Family History of Kidney Disease, or Donor-Recipient Age Discrepancy

“…The survey was based on a thorough literature review of studies on LKDs with complex medical problems, 1 2 13 14 15 16 group discussion with expert transplant specialists (from nephrology and surgical fields), clinical experiences of dealing with these difficult cases, trends of transplant societies, and controversies arising in conferences. Our survey consisted of 31 questions.…”

“…12 Thus, experts' perspectives on the utility and acceptance of MCLKDs may vary. 13,14 This study aimed to assess the practice patterns of the acceptance of MCLKDs with obesity, abnormal glucose profile, hypertension, FH of kidney disease of unknown etiology and donor-recipient age discrepancy, and to explore the areas of practice where guidelines are most needed.…”

Practice Patterns for the Acceptance of Medically Complex Living Kidney Donors with Hematuria, Sickle Cell Trait, Smoking, Illegal Drug Use, or Urological Issues: A Multinational Survey

“…The survey was formulated based on a thorough literature review, 1 2 12 13 14 group discussions, and controversies highlighted in conferences.…”

“…10,11 For these reasons, centers and experts may differ in their perspectives on the suitability and acceptance of MCLKDs. 12,13 This study aimed to assess the variability of practice patterns in the acceptance of MCLKDs.…”

“…10 11 For these reasons, centers and experts may differ in their perspectives on the suitability and acceptance of MCLKDs. 12 13 …”