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Evaluation of the living kidney donor

Authors
Krista L Lentine, MD, PhD
John Vella, MD, FACP, FRCP, FASN
Section Editor
Daniel C Brennan, MD, FACP
Deputy Editor
Alice M Sheridan, MD

INTRODUCTION

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 [1]. 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 [2].

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 [3]. 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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Literature review current through: Nov 2016. | This topic last updated: Mon Mar 14 00:00:00 GMT+00:00 2016.
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