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The evaluation of the living donor is a complex process, including medical, psychosocial, and ethical/legal considerations. Although society guidelines exist, there is considerable center-specific variation in the approval of a living donor.1–3 The following chapter includes essential components of a living donor evaluation and commonly cited exclusion criteria.

Donor evaluation can be divided into the following categories:

  • (1) Assessments to protect the health and safety of the donor

    • (A) Medical assessment

      • (i) Age

        • Advanced age (defined as age above 65), may be associated with decreased recipient graft and patient survival; both recipient and donor should be fully informed with regard to potential long-term disadvantages

        • Potential donors less than 18 years are generally excluded due to uncertain future long-term consequences of donation and possible maturity level of the potential donor

      • (ii) Diabetes mellitus

        • Initiate screening with hemoglobin A1C (HbA1c) and/or fasting blood glucose (FBG)

        • A 2-hour oral glucose tolerance test (2h-OGTT) should be performed in donors with:

          • Glucose intolerance by HbA1c

          • History of gestational diabetes

          • Family history of diabetes mellitus

        • Diabetic donors should be excluded (HbA1c ≥6.5%, fasting glucose ≥126 mg/dL [7.0 mmol/L], 2h-OGTT ≥200 mg/dL [11.1 mmol/L]) due to long-term risk of chronic kidney disease.

        • Prediabetic donors (HbA1c of 5.7–6.4%, fasting glucose of 100 mg/dL [5.6 mmol/l] to 125 mg/dL [6.9 mmol/L]) or a 2h-OGTT value of 140 mg/dL [7.8 mmol/L] to 199 mg/dL [11.0 mmol/L]) can be considered acceptable candidates; however, they must be counseled appropriately on weight loss, dietary modifications, and exercise.

      • (iii) Hypertension

        • Obtain two blood pressure readings on separate occasions

        • 24-hour ambulatory blood pressure monitoring can confirm any abnormal blood pressure reading or concern for white coat hypertension.

        • Prehypertensives (blood pressure ranging from 120–139 mm Hg systolic and/or 80–89 mm Hg diastolic) should be easily identified and counseled. There is uncertainty on whether to exclude them as potential donors, as they are at increased risk of developing hypertension and cardiovascular disease.

        • Candidates with hypertension that can be controlled to systolic <140, diastolic <90 using one antihypertension agent without evidence of organ damage may be acceptable for donation. Such candidates should be screened for:

          • Microalbuminuria

          • Left ventricular hypertrophy or other cardiac disease

        • A donor with a history of hypertension on two or more medications should generally be excluded

        • Caution with accepting donors with prehypertension or hypertension who are African American or Hispanic

      • (iv) Prehypertensives or hypertensives must be counseled that blood pressure typically increases after kidney donation.

      • (v) Pregnancy

        • Pregnant patients are excluded.

        • All female potential donors of childbearing age who are contemplating future pregnancies should be counseled on the potential risks of donating, including increased risk for:

          • Gestational hypertension

          • Preeclampsia

          • Prematurity

        • A high level of surveillance and monitoring is suggested for all pregnant women post donation.

    • (B) Renal assessment

      • (i) Glomerular filtration rate (GFR)

        • Obtain a 24-hour urine for creatinine clearance on all donors; ensure accurate collection.

        • Further evaluation with radionuclide methods can be performed.

        • The majority of transplant centers’ ...

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