Evaluation of the living kidney donor candidate
- 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 use of organs from living donors is one strategy to address the need for transplants. However, rates of living kidney donation declined 15 percent from 2004 to 2012 . 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".)
While most donors experience good outcomes and have good quality of life after donation, kidney donation is associated with short- and longer-term risks [2,3]. Risks of donation include surgical, medical, psychosocial, and financial complications. (See "Risk of living kidney donation".)
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 organ donors and modified in 2017 to include new risk information in required elements of informed consent. These policies define the minimum requirements for the evaluation and selection of living kidney donors in the US and are available online.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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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 living kidney donation beyond OPTN requirements
- Increased risk of diabetes
- Kidney function
- History of nephrolithiasis
- Increased body mass index (BMI)
- Independent Living Donor Advocate
- FOLLOW-UP AFTER KIDNEY DONATION
- SUMMARY AND RECOMMENDATIONS