Introduction: The current pattern of evaluation for living kidney donors was investigated. Methods: We designed a 37-question electronic survey to collect information about living kidney donor evaluation. Of the 181 United Network for Organ Sharing (UNOS)-approved centers, 72 responded. Survey responses were coded and downloaded into SPSS. Data was expressed as means and standard deviations or the percentage of centers with specific responses. Results: 66% of the centers used a cut-off of <80 ml/min for exclusion of living kidney donors. 24-hour urine measuring creatinine clearance (CrCl) was the most common screening method for glomerular filtration rate (GFR) assessment in potential living donors. 56% of the centers excluded donors with blood pressure (BP) >140/90, whereas 22.7 and 7.1% excluded patients with pre-hypertension with a cut-off BP of 130/85 and 120/80, respectively. 66% of the centers used 24-hour urine creatinine to assess for proteinuria. 20% of the centers accepted living kidney donors with microalbuminuria and 84% accepted patients with a history of nephrolithiasis. 24% of the centers reported use of formal cognitive testing of potential living donors. Discussion: There were significant variations in exclusion criteria based on GFR, history of kidney stones, body mass index, BP and donors with urinary abnormalities. The definitions for hematuria and proteinuria were variable. There is a need for uniformity in selection and for a living donor registry. We also recommend raising the cut-off for estimated GFR to 90 ml/min to account for 10–15% overestimation when CrCl is used.

Keywords:
Living donation, Kidney transplant, Evaluation, Practice patterns
1.
Laupacis A, Keown P, Pus N, et al: A study of the quality of life and cost-utility of renal transplantation. Kidney Int 1996;50:235–242.
2.
Evans RW, Manninen DL, Garrison LP Jr, et al: The quality of life of patients with end-stage renal disease. N Engl J Med 1985;312:553–559.
3.
Wolfe RA, Ashby VB, Milford EL, et al: Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999;341:1725–1730.
4.
Meier-Kriesche HU, Kaplan B: Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: a paired donor kidney analysis. Transplantation 2002;74:1377–1381.
5.
Mange KC, Joffe MM, Feldman HI: Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors. N Engl J Med 2001;344:726–731.
6.
Najarian JS, Chavers BM, McHugh LE, Matas AJ: 20 years or more of follow-up of living kidney donors. Lancet 1992;340:807–810.
7.
Fehrman-Ekholm I, Elinder CG, Stenbeck M, Tyden G, Groth CG: Kidney donors live longer. Transplantation 1997;64:976–978.
8.
Ramcharan T, Matas AJ: Long-term (20–37 years) follow-up of living kidney donors. Am J Transplant 2002;2:959–964.
9.
Bia MJ, Ramos EL, Danovitch GM, et al: Evaluation of living renal donors. The current practice of US transplant centers. Transplantation 1995;60:322–327.
10.
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;7:2333–2343.
11.
Ennis J, Kocherginsky M, Schumm LP, Worcester E, Coe FL, Josephson MA: Trends in kidney donation among kidney stone formers: a survey of US transplant centers. Am J Nephrol 2009;30:12–18.
12.
Lumsdaine JA, Wigmore SJ, Forsythe JL: Live kidney donor assessment in the UK and Ireland. Br J Surg 1999;86:877–881.
13.
Ter Wee PM, Tegzess AM, Donker AJ: Renal reserve filtration capacity before and after kidney donation. J Intern Med 1990;228:393–399.
14.
Rao PS, Jindal RM, Elster EA, Salifu MO: Debate: CON position. Formal assessment of donor kidney function should be mandatory. Am J Nephrol 2011;33:201–204.
15.
Reese PP, Feldman HI, McBride MA, Anderson K, Asch DA, Bloom RD: Substantial variation in the acceptance of medically complex live kidney donors across US renal transplant centers. Am J Transplant 2008;8:2062–2070.
16.
Hsu CY, McCulloch CE, Iribarren C, Darbinian J, Go AS: Body mass index and risk for end-stage renal disease. Ann Intern Med 2006;144:21–28.
17.
Gelber RP, Kurth T, Kausz AT, et al: Association between body mass index and CKD in apparently healthy men. Am J Kidney Dis 2005;46:871–880.
18.
Cuevas-Ramos D, Almeda-Valdes P, Arvizu M, et al: Association of the metabolic syndrome and long-term renal function in kidney donors. Transplant Proc 2011;43:1601–1606.
19.
Gracida C, Espinoza R, Cedillo U, Cancino J: Kidney transplantation with living donors: nine years of follow-up of 628 living donors. Transplant Proc 2003;35:946–947.
20.
Textor SC, Taler SJ, Driscoll N, et al: Blood pressure and renal function after kidney donation from hypertensive living donors. Transplantation 2004;78:276–282.
21.
Boudville N, Prasad GV, Knoll G, et al: Meta-analysis: risk for hypertension in living kidney donors. Ann Intern Med 2006;145:185–196.
22.
Young A, Storsley L, Garg AX, et al: Health outcomes for living kidney donors with isolated medical abnormalities: a systematic review. Am J Transplant 2008;8:1878–1890.
23.
Ozdemir FN, Guz G, Sezer S, Arat Z, Haberal M: Ambulatory blood pressure monitoring in potential renal transplant donors. Nephrol Dial Transplant 2000;15:1038–1040.
24.
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;10:1597–1604.
25.
Gross O, Weber M, Fries JW, Muller GA: Living donor kidney transplantation from relatives with mild urinary abnormalities in Alport syndrome: long-term risk, benefit and outcome. Nephrol Dial Transplant 2009;24:1626–1630.
26.
Giessing M, Fuller F, Tuellmann M, et al: Attitude to nephrolithiasis in the potential living kidney donor: a survey of the German kidney transplant centers and review of the literature. Clin Transplant 2008;22:476–483.
27.
Martin G, Sundaram CP, Sharfuddin A, Govani M: Asymptomatic urolithiasis in living donor transplant kidneys: initial results. Urology 2007;70:2–6.
28.
Worcester E, Parks JH, Josephson MA, Thisted RA, Coe FL: Causes and consequences of kidney loss in patients with nephrolithiasis. Kidney Int 2003;64:2204–2213.
29.
Delmonico F: A report of the Amsterdam Forum on the Care of the Live Kidney Donor: data and medical guidelines. Transplantation 2005;79:S53–S66.
© 2012 S. Karger AG, Basel
2012
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.