Evaluating potential live-renal donors: Causes for rejection, deferral and planned procedure type, a single-centre experience

Abstract

Background: Renal transplantation is the preferred therapy to extend life expectancy and quality of life for patients with chronic kidney disease. There are many barriers in the process of live kidney donation that prevent the timely progression from organ requirement to transplantation, including the progression of the live donor through a medical evaluation. We assess how easily patients complete the donor workup, how often the medical evaluation identifies significant incidental findings, and which surgical procedure is planned for organ retrieval. Methods: We reviewed our donor database and the minutes from our multidisciplinary rounds from 2002 to 2008 to assess how medical, radiological and psychological findings were used to decide on the candidacy of potential donors. Results: Half (50.2%) of patients did not pass the initial health screen. Of the 467 patients who progressed beyond the health screen to the computed tomographic angiogram evaluation, 48 (10.3%) were excluded as donors and 419 (89.7%) were accepted. Of those accepted, 136 (32.5%) were conditional on further medical workup. Of the patients accepted (n=419), 375 (89.5%) were planned for laparoscopic left-sided approach. Conclusions: The vast majority of patients who passed the initial health screen for kidney donation will be accepted as donors, but about one-third will require further workup. It is rare to identify life-threatening disease on screening computerized tomographic angiograph for kidney donor workup.

Fortuitous benefits of living kidney donation: Diagnosis of serious medical conditions during the living donor evaluation

“…The discovery of incidentally discovered malignancy in the evaluated donor population has been previously described. The reported rate of incidental diagnosis of malignancy during donor evaluation is 0.2%‐0.8%, and our study corroborates these data with a rate of incidental malignancy diagnosis of 0.5% …”

“…The reported rate of incidental diagnosis of malignancy during donor evaluation is 0.2%-0.8%, and our study corroborates these data with a rate of incidental malignancy diagnosis of 0.5%. 6,7 We found kidney stones that precluded donation in five patients (1.5% of excluded potential donors; 0.6% of overall donors). The risk of clinical stone recurrence in donors and recipients is low, and thus, small stones are not an exclusion for living kidney donation.…”

The Irish living kidney donor program – why potential donors do not proceed to live kidney donation?

“…Following the further assessment stage, a third (93/269) of potential donors were declined, with a medical contraindication accounting for the majority of donors declined. Other studies have demonstrated up to a 50% dropout following initial medical assessment . Similar to other studies, medical contraindications, including hypertension and multiple medical comorbidities (30% of donors declined), were the commonest reasons for patients not to proceed to live donation donor .…”

Donor Contraindications to Living Kidney Donation: A Single-Center Experience

“…The other most frequent reasons were renal impairment, diabetes, and urologic problems in the donors [2,3]. Denial rates and reasons reported from Canada on the other hand was 50.2% in the first step in their stepwise evaluation and a further 10.3% in the second step [4].…”