Nephrol Dial Transplant (2004) 19: IV41-IV44
Nephrol Dial Transplant Vol. 19 Suppl 4 © ERA–EDTA 2004; all rights reserved
Evaluation of the living kidney donor
Division of Nephrology, Leopold Franzens University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
Correspondence and offprint requests to: G. Mayer, Division of Nephrology, Leopold Franzens University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. Email: gert.mayer{at}uibk.ac.at
Abstract
Living donor renal transplantation is the preferred treatment for end-stage renal failure as the risk–benefit ratio for the recipient usually very much favours this approach. However, the benefit for the donor is much harder to define and probably very small if pure medical criteria are considered. Nonetheless ‘non-medical’ issues (mostly socio-psychological) may outweigh the small medical risk. The medical pre-transplant evaluation of the potential donor must identify absolute contraindications and abnormalities, which would increase the peri-operative risk. Difficulties may arise, if during the process, minor abnormalities are detected that marginally increase the acute or especially the long-term risk or whose implications are not well defined. In this situation two options are available. If the transplant team assumes that donation per se is of no benefit for the donor, transplantation should not be performed. If, however, the supposed ‘non-medical’ benefit is large enough, this approach will be against the principle of ‘doing no harm’ because the individual is denied the possibility to help somebody and might suffer from the consequences. In these complicated cases the final decision should be with the potential donor after an intense discussion with everybody involved in the transplantation process. Such an approach, however, necessitates a post-donation follow-up programme to be offered.
Keywords: donor evaluation; exclusion criteria; living donor; post-operative risk; renal transplantation