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

Abstract

Living kidney donation is an important option for patients with end-stage renal disease (ESRD), and has improved life expectancy and quality for patients otherwise requiring maintenance dialysis or deceased-donor transplantation. Given the favorable outcomes of live donation and the shortage of organs to transplant, individuals with potentially unfavorable demographic and clinical characteristics are increasingly being permitted to donate kidneys. While this trend has successfully expanded the live donor pool, it has raised concerns as to which acceptance criteria are safe. This review aims to summarize the existing literature on the outcomes of transplantation from medically complex, living kidney donors, including both donor and recipient outcomes when available.

Regulatory and pro‐inflammatory cytokines in Brazilian living‐related renal transplant recipients according to creatinine plasma levels

“…The transverse design of the study also could interfere with the establishment of a causal relation between the immunological parameters and clinical findings. Although the inclusion of only living donors has been a medical suggestion, this may represent a selection bias, since surgery with living donor reflects on greater graft survival and deceased donor is associated with a higher incidence of rejection and lower survival rates for the patient . In further studies we will consider the inclusion of deceased and living donors in order to compare both groups and also the determination of cytokines and other biomarkers in urinary samples.…”

Consensus Conference on Best Practices in Live Kidney Donation: Recommendations to Optimize Education, Access, and Care

“…Additionally, comfort level with LKD risk varies across programs; therefore, we recommend that programs carefully evaluate medically complex donors (e.g., with well-controlled hypertension or mild-moderate obesity)[31], and inform donor candidates who are turned down because of these issues that eligibility criteria vary across transplant programs. [32] Whether programs are ethically obligated to inform turned-down donor candidates (and their intended recipients) that they may be acceptable donor candidates at some other programs warrants further discussion by the transplant community.…”

Successful Utilization of a Live Donor Kidney with Angiomyolipoma

“…Niemi and Mandelbrot reported comprehensively on the utilization of medically complex patients for kidney donations and concluded that the use of complex patients as donors is worthwhile for recipients [7]. There is minimal reporting on the utilization of kidneys with AML tumors.…”

“…Kidneys donated by living donors are high-quality organs that afford longer graft survival for recipients [6]. The recovery of recipients also tends to be faster with lesser chance of delayed graft function [7].…”