Evaluation of the living kidney donor
- Krista L Lentine, MD, PhD
Krista L Lentine, MD, PhD
- Professor of Medicine
- Saint Louis University School of Medicine
- John Vella, MD, FACP, FRCP, FASN
John Vella, MD, FACP, FRCP, FASN
- Associate Professor of Medicine
- Tufts University School of Medicine
The number of patients awaiting kidney transplantation has steadily increased over time. The gap between allograft supply and demand continues to widen despite initiatives to expand the use of nonstandard deceased-donor allografts.
The increased use of organs from living donors is one strategy that addresses the need for transplants. However, rates of live kidney donation have declined 17 percent from 2004 to 2014 . This trend is predominantly due to a decline in living, related donation. Although unrelated kidney donations have increased since 2007, the increase is not sufficient to compensate for the decline in living, related donation .
Recipients of allografts from living donors enjoy significant graft and patient survival advantages over those who receive deceased-donor grafts. In addition, living-donor transplants may be performed with minimal delay and controlled scheduling, which permits pre-emptive transplantation (transplantation prior to dialysis) or transplantation early in a recipient’s course of renal failure. (See "Risk factors for graft failure in kidney transplantation" and "Dialysis issues prior to and after renal transplantation".)
However, donor nephrectomy exposes the donor to risks associated with surgery and potentially long-term risks afterward.
In February 2013, the Organ Procurement and Transplantation Network (OPTN) implemented policy requirements for all living kidney donor recovery hospitals in the United States in order to promote consistency in the informed consent, medical and psychosocial evaluation, and follow-up of living donors . In 2014, these requirements were incorporated within global polices for living donors. These policies define the minimum general and kidney-specific requirements for suitability as a kidney donor. These requirements are generally expanded upon in individual transplant centers, resulting in center-specific protocols that are based on local experience and targeted to individual donor candidates on a case-by-case basis.
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- DONOR EVALUATION
- Blood typing and crossmatch
- Medical evaluation
- - History and physical examination
- - Laboratory and imaging tests
- Psychosocial evaluation
- Contraindications defined by Organ Procurement and Transplant Network
- - Possible contraindications to live kidney donation beyond OPTN requirements
- Increased risk of diabetes
- Renal function
- History of nephrolithiasis
- Independent Living Donor Advocate
- FOLLOW-UP AFTER KIDNEY DONATION
- SUMMARY AND RECOMMENDATIONS