Shifting paradigms in eligibility criteria for live kidney donation: a systematic review

Abstract

As the organ shortage increases, inherently the demand for donor kidneys continues to rise. Thus, live kidney donation is essential for increasing the donor pool. In order to create successful expansion, extended criteria live kidney donors should be considered. This review combines current guidelines with all available literature in this field, trying to seek and establish the optimal extended criteria. Comprehensive searches were carried out in major databases until November 2013 to search for articles regarding older age, overweight and obesity, hypertension, vascular anomalies/multiplicity, nulliparous women, and minors as donors. Of the 2079 articles found, 152 fell within the scope of the review. Five major guidelines were included and reviewed. Based on the literature search, live kidney donation in older donors (up to 70 years of age) seems to be safe as outcome is comparable to younger donors. Obese donors have comparable outcome to lean donors, in short- and mid-term follow-up. Since little literature is available proving the safety of donation of hypertensive donors, caution is advised. Vascular multiplicity poses no direct danger to the donor and women of childbearing age can be safely included as donors. Although outcome after donation in minors is shown to be comparable to adult donors, they should only be considered if no other options exist. We conclude that the analyzed factors above should not be considered as absolute contraindications for donation.

Living Donor Kidney Transplantation

“…By contrast, in this same time period, LKD has increased 2% per year for those aged $50 years. Importantly, older donors do not appear to be at any heightened risk of poor outcomes after donation (52), and LDKT outcomes from older living donors are comparable to receiving a kidney from a deceased standard criteria donor (53). Research is needed to examine the underlying mechanism for the shift in living donor age and whether it persists after implementation of the new kidney allocation system.…”

Untitled

“…For example, a systematic analysis of 22 studies found no real difference in outcomes in grafts from older donors compared with those from younger donors. 11 However, other studies have shown poorer graft outcomes, which were associated with higher levels of complications. 8 With increasing demand for organs, longer wait times, and more frequent deaths when waiting for organs, this lack of consensus promotes elderly kidney donation.…”

“…[7][8][9] During the early stages of living-donor kidney programs, advanced age was widely considered as an absolute contraindication, mainly as it was deemed to increase long-term morbidity and mortality. 10,11 Patients with advanced age also were more likely to be excluded from donation because of the presence of comorbidities. 11 To minimize both short-term and long-term complications, an extensive donor work-up is performed before donation.…”

“…10,11 Patients with advanced age also were more likely to be excluded from donation because of the presence of comorbidities. 11 To minimize both short-term and long-term complications, an extensive donor work-up is performed before donation. A low threshold is set for screening potential living donors for cardiovascular disease, and various tests, such as exercise electrocardiograms, echocardiograms, myocardial perfusion scans, and coronary angiograms, may be employed depending on the indication.…”

Living kidney donation

“…In addition, when living donation was first introduced only relatively young and healthy individuals were accepted for kidney donation. As the criteria for donation have expanded to include older donors and those with comorbidities, 44 however, the current donor population is now demographically different from the cohort for whom long term follow-up data are available. This limits the generalisability of findings from studies of early donor populations to currently accepted donors.…”