MEDICAL ASPECTS OF LIVING MEDICAL ASPECTS OF LIVING KIDNEY DONATIONKIDNEY DONATION

Introduction:Introduction:

Kidney Tx cannot Proceed without donor.Kidney Tx cannot Proceed without donor. Appropriate identification & preparation of the donors contribute in the success of the Tx in both Appropriate identification & preparation of the donors contribute in the success of the Tx in both

individual and national level.individual and national level.

Types of Kidney Donor:Types of Kidney Donor:

1. Living Related Donors2. Living Unrelated3. Deceased Donors

Evaluation of the Living Kidney Donors:Evaluation of the Living Kidney Donors:

There are different opinion and practice in evaluation and acceptance of living kidney donors

between different programs. Two basic question are always to be considered

1. Is the potential donor at higher risk to undergo the acute surgical procedure than what would be expected?2. What is the degree of risk on developing medical problem in the future as a result of having single kidney?

Informed Consent:Informed Consent:

Elements for Consent in the Living Kidney Donor Evaluation.Elements for Consent in the Living Kidney Donor Evaluation.

The potential kidney donor should understand that:The potential kidney donor should understand that:

1.1. Undergoing evaluation is not a commitment to donate, we can stop at any time. Undergoing evaluation is not a commitment to donate, we can stop at any time. 2.2. The physicians may turn you down as a donor and will inform you the reason.The physicians may turn you down as a donor and will inform you the reason.3.3. The information obtained during the course of the evaluation is confidential.The information obtained during the course of the evaluation is confidential.4.4. You will be tested for AIDS, Hepatitis and other infection.You will be tested for AIDS, Hepatitis and other infection.5.5. There may be risks and discomfort associated with some of the test (blood draws, I.V. contrast).There may be risks and discomfort associated with some of the test (blood draws, I.V. contrast).6.6. There are potential financial costs to the donor related to time off work, travel expenses.There are potential financial costs to the donor related to time off work, travel expenses.7.7. There are potential study uses the information obtained.There are potential study uses the information obtained.8.8. There is alternative Rx available to the recipient other than you donate a kidney to him.There is alternative Rx available to the recipient other than you donate a kidney to him.

The Person who will give the consent of Kidney Donation should be:The Person who will give the consent of Kidney Donation should be:

1.1. Competent (having a decision making capacity).Competent (having a decision making capacity).2.2. Willing to donate, free from coercion, (pressure).Willing to donate, free from coercion, (pressure).3.3. Medically suitable.Medically suitable.4.4. Psychosocially suitable.Psychosocially suitable.5.5. Fully informed about the alternative Rx available to the recipient.Fully informed about the alternative Rx available to the recipient.6.6. He should understand that his participation is completely voluntary and he can withdraw at any He should understand that his participation is completely voluntary and he can withdraw at any

time.time.

Recommended Evaluation for a Living DonorRecommended Evaluation for a Living Donor

Requirement:Requirement:

1. Complete hx and physical exam1. Complete hx and physical exam2. Psychologist evaluation2. Psychologist evaluation3. Measurement of BMI (Body Mass Index)3. Measurement of BMI (Body Mass Index)4. Blood Pressure Measurements4. Blood Pressure Measurements5. Fasting blood sugar and fasting cholesterol5. Fasting blood sugar and fasting cholesterol6. 24 hr urine collection for protein6. 24 hr urine collection for protein7. Urine for creatinine clearance7. Urine for creatinine clearance8. Chest x-ray8. Chest x-ray9. ECG9. ECG10.Viral Serology HIV, Hepatitis B & C, HTLV, CMV, EBV and Syphilis.10.Viral Serology HIV, Hepatitis B & C, HTLV, CMV, EBV and Syphilis.11.Renal Imaging – CT Anpiogram11.Renal Imaging – CT Anpiogram12.Abdomenal Ultrasound.12.Abdomenal Ultrasound.

Optional Evaluation:Optional Evaluation:

These tests are performed for further evaluations if we found abnormalities in the initial studies.These tests are performed for further evaluations if we found abnormalities in the initial studies.

1. GTT1. GTT2. Echo cardiogram2. Echo cardiogram3. 24 hr BP monitoring3. 24 hr BP monitoring4. Skin Test for TB4. Skin Test for TB5. Cardiac Stress Test5. Cardiac Stress Test6. Cystoscopy6. Cystoscopy7. Renal Biopsy7. Renal Biopsy

Which donor to choose?Which donor to choose?

- Living related donors are generally preferred over unrelated donors.- Living related donors are generally preferred over unrelated donors.- If there is more than one donor in the family it is logical to select the relative who is having best - If there is more than one donor in the family it is logical to select the relative who is having best match with the recipient.match with the recipient.- If the donors have the same match grade it may be advisable to choose the older donor with - If the donors have the same match grade it may be advisable to choose the older donor with the thought that the younger donor still be available for donation if the first donor fails.the thought that the younger donor still be available for donation if the first donor fails.

What is the Exclusion Criteria for Living DonorsWhat is the Exclusion Criteria for Living Donors

Absolute Contra IndicationAbsolute Contra Indication

1. Inadequately treated Psychiatric Disease1. Inadequately treated Psychiatric Disease2. Active drug or alcohol abuse2. Active drug or alcohol abuse3. Evidence of Renal Disease (low GFR, Protein Urea, Hematurea)3. Evidence of Renal Disease (low GFR, Protein Urea, Hematurea)4. Significant abnormal renal anatomy4. Significant abnormal renal anatomy5. Recurrent nephrolithiasis or bilateral kidney stones5. Recurrent nephrolithiasis or bilateral kidney stones6. Collagen Vascular Disease6. Collagen Vascular Disease7. DM & HTN7. DM & HTN8. Previous MI8. Previous MI9. Mod to Server Pulmonary Disease9. Mod to Server Pulmonary Disease10.Cancer or hx of Cancer10.Cancer or hx of Cancer11.Active infection11.Active infection12.Significant Chronic Liver Disease12.Significant Chronic Liver Disease13.Current pregnancy13.Current pregnancy

Relative ContraindicationRelative Contraindication

1. ABO incompatibility1. ABO incompatibility2. Age < 18 >652. Age < 18 >653. Obesity BMI >353. Obesity BMI >354. Mild HTN4. Mild HTN5. Border line urine abnormality5. Border line urine abnormality6. Hx of gestational diabetes6. Hx of gestational diabetes7. Current tobacco use 7. Current tobacco use

Conclusion

Appropriate identification and preparation of the living donors contribute in the success of the transplant in both individual and national level.