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
- Section Editor
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Medical Director and Co-Director of the Comprehensive Transplant Center, Department of Internal Medicine, Division of Nephrology
- Johns Hopkins Medical School
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.
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS). National data reports, transplants by donor type, latest data http://optn.transplant.hrsa.gov/converge/latestData/rptData.asp (Accessed on July 19, 2015).
- Matas AJ, Smith JM, Skeans MA, et al. OPTN/SRTR 2013 Annual Data Report: kidney. Am J Transplant 2015; 15 Suppl 2:1.
- OPTN (Organ Procurement and Transplantation Network)/UNOS (United Network for Organ Sharing). OPTN Policies, Policy 14: Living Donation. http://optn.transplant.hrsa.gov/ContentDocuments/OPTN_Policies.pdf (Accessed on February 07, 2014).
- Davis CL. Evaluation of the living kidney donor: current perspectives. Am J Kidney Dis 2004; 43:508.
- http://optn.transplant.hrsa.gov/ContentDocuments/Living_Kidney_Donor_Requirements_FAQ.pdf (Accessed on September 25, 2013).
- Delmonico F, Council of the Transplantation Society. A Report of the Amsterdam Forum On the Care of the Live Kidney Donor: Data and Medical Guidelines. Transplantation 2005; 79:S53.
- Port FK, Dykstra DM, Merion RM, Wolfe RA. Trends and results for organ donation and transplantation in the United States, 2004. Am J Transplant 2005; 5:843.
- Melcher ML, Blosser CD, Baxter-Lowe LA, et al. Dynamic challenges inhibiting optimal adoption of kidney paired donation: findings of a consensus conference. Am J Transplant 2013; 13:851.
- Osman Y, El-Husseini A, Sheashaa H, et al. Impact of Rh(D) blood group system on graft function and survival in live-donor kidney transplantation: a single-institution experience. Transplantation 2004; 78:1693.
- Bryan CF, Mitchell SI, Lin HM, et al. Influence of the Rh (D) blood group system on graft survival in renal transplantation. Transplantation 1998; 65:588.
- Brodthagen UA, Bud M. Rhesus immunization after Rh-incompatible kidney transplantation. Tissue Antigens 1986; 27:102.
- Quan VA, Kemp LJ, Payne A, et al. Rhesus immunization after renal transplantation. Transplantation 1996; 61:149.
- Seem DL, Lee I, Umscheid CA, Kuehnert MJ. Excerpt from PHS guideline for reducing HIV, HBV and HCV transmission through organ transplantation. Am J Transplant 2013; 13:1953.
- Pei Y, Obaji J, Dupuis A, et al. Unified criteria for ultrasonographic diagnosis of ADPKD. J Am Soc Nephrol 2009; 20:205.
- Gluecker TM, Mayr M, Schwarz J, et al. Comparison of CT angiography with MR angiography in the preoperative assessment of living kidney donors. Transplantation 2008; 86:1249.
- OPTN Guidance Document: Guidance for identifying risk factors for Mycobacterium tuberculosis (MTB) during evaluation of potential living kidney donors. http://optn.transplant.hrsa.gov/SharedContentDocuments/Risk_Factors_Exhibit_C_Guidance.pdf (Accessed on July 21, 2015).
- Levi ME, Kumar D, Green M, et al. Considerations for screening live kidney donors for endemic infections: a viewpoint on the UNOS policy. Am J Transplant 2014; 14:1003.
- OPTN Guidance Document: Recognizing seasonal and geographically endemic infections in organ donors: Considerations during living donor evaluaiton http://optn.transplant.hrsa.gov/media/1138/seasonal_disease_guidance.pdf (Accessed on July 21, 2015).
- OPTN Guidance Document: Identifying risk factors for West Nile Virus (WNV) during evaluation of potential living donors http://optn.transplant.hrsa.gov/SharedContentDocuments/West_Nile_Virus_Living_Donors.pdf (Accessed on July 21, 2015).
- Chin-Hong PV, Schwartz BS, Bern C, et al. Screening and treatment of chagas disease in organ transplant recipients in the United States: recommendations from the chagas in transplant working group. Am J Transplant 2011; 11:672.
- UNOS Transplant Pro. OPTN policies, procedures implemented to support HOPE Act. November 23, 2015. https://www.transplantpro.org/news/optn-policies-procedures-implemented-to-support-hope-act/ (Accessed on November 27, 2015).
- Abramowicz D, Cochat P, Claas FH, et al. European Renal Best Practice Guideline on kidney donor and recipient evaluation and perioperative care. Nephrol Dial Transplant 2015; 30:1790.
- AST/ASTS/NATCO/UNOS Joint Societies Work Group. Evaluation of the living kidney donor - A consensus document from the AST/ASTS/NATCO/UNOS Joint Societies Work Group (2011). http://optn.transplant.hrsa.gov/PublicComments/pubcommentPropSurveyExhibit_38.pdf (Accessed on August 18, 2015).
- The United Kingdom guidelines for living donor kidney transplantation, 3rd edition, The British Transplant Society and the Renal Association, 2011. p.1.
- Spanish Society of Nephrology (SEN) and Spanish Transplant Organisation (ONT) recommendations for living-donor kidney transplantation. Nefrologia 2010; 30(Suppl 2):1.
- van Hardeveld E, Tong A, CARI. The CARI guidelines. Psychosocial care of living kidney donors. Nephrology (Carlton) 2010; 15 Suppl 1:S80.
- Mandelbrot DA, Pavlakis M, Danovitch GM, et al. The medical evaluation of living kidney donors: a survey of US transplant centers. Am J Transplant 2007; 7:2333.
- Pascual J, Abramowicz D, Cochat P, et al. European renal best practice guideline on the management and evaluation of the kidney donor and recipient. Nefrologia 2014; 34:293.
- Joint Working Party of the British Transplantation Society and the Renal Association. United Kingdom Guidelines for Living Donor Kidney Transplantation, 3rd Ed. 2011:1.
- Naik RP, Derebail VK, Grams ME, et al. Association of sickle cell trait with chronic kidney disease and albuminuria in African Americans. JAMA 2014; 312:2115.
- Hays R. Informed consent of living kidney donors: Pitfalls and best practices. Current Transplantation Reports 2015; 2:44.
- Boudville N, Isbel N, CARI. The CARI guidelines. Donors at risk: impaired glucose tolerance. Nephrology (Carlton) 2010; 15 Suppl 1:S133.
- Okamoto M, Suzuki T, Fujiki M, et al. The consequences for live kidney donors with preexisting glucose intolerance without diabetic complication: analysis at a single Japanese center. Transplantation 2010; 89:1391.
- PULLMAN TN, ALVING AS, DERN RJ, LANDOWNE M. The influence of dietary protein intake on specific renal functions in normal man. J Lab Clin Med 1954; 44:320.
- Kido R, Shibagaki Y, Iwadoh K, et al. Persistent glomerular hematuria in living kidney donors confers a risk of progressive kidney disease in donors after heminephrectomy. Am J Transplant 2010; 10:1597.
- Textor SC, Taler SJ, Driscoll N, et al. Blood pressure and renal function after kidney donation from hypertensive living donors. Transplantation 2004; 78:276.
- Lentine KL, Schnitzler MA, Xiao H, et al. Associations of recipient illness history with hypertension and diabetes after living kidney donation. Transplantation 2011; 91:1227.
- Ommen ES, Schröppel B, Kim JY, et al. Routine use of ambulatory blood pressure monitoring in potential living kidney donors. Clin J Am Soc Nephrol 2007; 2:1030.
- Grams ME, Sang Y, Levey AS, et al. Kidney-Failure Risk Projection for the Living Kidney-Donor Candidate. N Engl J Med 2016; 374:411.
- Ghafari A. Transplantation of a kidney with a renal cell carcinoma after living donation: a case report. Transplant Proc 2007; 39:1660.
- Sener A, Uberoi V, Bartlett ST, et al. Living-donor renal transplantation of grafts with incidental renal masses after ex-vivo partial nephrectomy. BJU Int 2009; 104:1655.
- Valente M, Furian L, Rigotti P. Organ donors with small renal cancer: report of 3 cases. Transplant Proc 2012; 44:1846.
- Musquera M, Pérez M, Peri L, et al. Kidneys from donors with incidental renal tumors: should they be considered acceptable option for transplantation? Transplantation 2013; 95:1129.
- Nalesnik MA, Woodle ES, Dimaio JM, et al. Donor-transmitted malignancies in organ transplantation: assessment of clinical risk. Am J Transplant 2011; 11:1140.
- Kirchner VA, Liu PT, Pruett TL. Infection and cancer screening in potential living donors: Best practices to protect the donor and recipient. Curr Transpl Rep 2015; 2:35.
- Zhang S, Yuan J, Li W, Ye Q. Organ transplantation from donors (cadaveric or living) with a history of malignancy: review of the literature. Transplant Rev (Orlando) 2014; 28:169.
- Hays RE, LaPointe Rudow D, Dew MA, et al. The independent living donor advocate: a guidance document from the American Society of Transplantation's Living Donor Community of Practice (AST LDCOP). Am J Transplant 2015; 15:518.
- http://optn.transplant.hrsa.gov/ContentDocuments/Guidance_Post_Donation_Donor_Followup.pdf (Accessed on September 26, 2013).
- Living Kidney Donor Follow-Up Conference Writing Group, Leichtman A, Abecassis M, et al. Living kidney donor follow-up: state-of-the-art and future directions, conference summary and recommendations. Am J Transplant 2011; 11:2561.
- Thiel GT, Nolte C, Tsinalis D. Prospective Swiss cohort study of living-kidney donors: study protocol. BMJ Open 2011; 1:e000202.
- 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