The Medical Evaluation of Living Kidney Donors: A Survey of US Transplant Centers

Abstract

There are no conflicts of interest to report.The use of living donors for kidney transplantation in the United States is common, and long-term studies have demonstrated the safety of donation by young, healthy individuals. However, transplant programs have little data to guide them in deciding which donors are unacceptable, and which characteristics are associated with kidney disease or poor psychosocial outcomes after donation. To document current practices in evaluating potential donors, we surveyed all US kidney transplant programs. Compared to a survey 12 years ago, medical criteria for donation are more inclusive in several areas. All responding programs now accept living unrelated donors. Most programs no longer have an upper age limit to be eligible. Programs are now more likely to accept donors with treated hypertension, or a history of kidney stones, provided that certain additional criteria are met. In contrast, medical criteria for donation are more restrictive in other areas, such as younger donor age and low creatinine clearance. Overall, significant variability remains among transplant programs in the criteria used to evaluate donors. These findings highlight the need for more data on long-term outcomes in various types of donors with potential morbidities related to donation.

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

“…A quarter of programs exclude patients with a history of renal stones, while another quarter accept these patients without requiring a metabolic workup. 3 Our study results should be generalizable because our acceptance criteria are similar to many other programs.…”

“…A 2007 survey of transplant centres demonstrated that older, more obese, hypertensive and non-related patients are more likely to be accepted as donors compared to the previous decade. [3][4][5] Long-term health outcomes for extended-criteria donors are less clear. 4 In an attempt to make the donor screening process consistent, several consensus statements outlining the medical and psychosocial evaluation exist.…”

“…3,4,7 The use of computed tomographic angiography (CTA) to assess the quality of donor kidneys and the renal vasculature is part of the donor workup. 3,5,8 There are inherent risks associated with the medical and radiological evaluation itself, including incidental pathological findings and the emotional impact of being turned down for donation. 7 One review of 1600 potential donors demonstrated that 49% were excluded for medical and ethical reasons.…”

Monitoring of Renal Allograft Function with Different Equations: What are the Differences?

“…In some countries, as shown in the Norwegian registry, 16% of living donors are older than 60 years, and 7.7% are over the age of 65, whereas in Canada 6% of donors are older than 60 years [18,19]. The American RDS shows no upper age limits regarding acceptance of donors [20]. The results obtained in the recent analysis of United Network for Organ Sharing (UNOS) database from 1994 to 2012 that made comparison of living donors >60 years, living donors <60 years, showed equal graft survival and overall survival in older donors compared to SCD (standard criteria donor), better than ECD (expanded criteria donor), but worse than grafts obtained from younger living donors [21][22][23].…”

La transplantation rénale à partir de donneurs vivants

“…Historiquement, les pionniers de la transplan-plus largement à des donneurs qualifiés de « marginaux », c'est-à-dire déjà hypertendus, voire ayant une protéinurie minime. Nous manquons de données à long terme concernant ces cas et l'établissement de registres de suivi des donneurs semble indispensable, tant pour répondre à ces interrogations que pour proposer aux donneurs le suivi médical approprié dont ils pourraient avoir besoin [11]. Il ne s'agit en aucun cas de considérer les donneurs comme des malades mais de leur proposer une stratégie de dépistage et de prévention.…”