Living Donors

Kidney Function Restoration Program

Kidney Disease Treatment Diet

Get Instant Access

About 27% of the kidney transplants in the United States are performed using living-related and unrelated donors.1 Experience with the living-related lung transplant has been growing, and in selected centers, living-related pancreatic and intestinal transplants have been performed. Since 1990 living-related pediatric liver transplants have been performed worldwide, and in Japan the experience obtained with the pediatric population has been extended to the living-related adult liver transplantation.

The living donor represents the closest example of the "ideal donor." Screening and work-up are the most complete and can be conducted without the time limiting factor dictated by the impending cardiac arrest of the brain-dead cadaveric donor. The donor operation is performed in a truly elective way and the ischemia time is minimized. Age, function of the organ to be donated, absence of serious pathology, absence of transmissible infectious diseases and absence of cancer are among the requirements that the living donor must fulfill. Moreover, anatomical variations that could preclude the donor operation or the use of the organ must be found in advance of surgery. For living-related and unrelated transplants the legal age is the lowest accepted age while the upper age limit is not set and depends mostly on the general health conditions of the donor and function of the specific organ. Most transplant surgeons feel comfortable with donors up to the age of 65. The compatibility of the donor and the recipient is assessed by ABO blood group and HLA typing.

The living donor must have a comprehensive history and physical evaluation, normal hematological, hepatic and renal function tests, normal electrocardiogram and chest radiogram and negative serology for hepatitis B and C and for immunodeficiency virus. The presence of any pathology that could put his/her life at risk or could increase the chances of poor organ functioning, in both the donor and the recipient, for example diabetes or hypertension, will rule him/her out for donation. Positive serology for hepatitis B and C and HIV are also contraindications for donation. The presence of malignancy in past medical history is not necessarily considered an absolute contraindication. Living donors with more than 10 years history of malignancy and who are proven free of disease may be accepted as candidates.

Kidney

In living-related and unrelated kidney transplantation the renal function is assessed by glomerular filtration rate which is the most precise method to assess renal function in relation to the age of the person.2 Table 4.1 shows the corrected and uncorrected glomerular filtration rates. An angiogram which defines the anatomy of the vasculature is obtained. Vascular anomalies permitting, the left kidney is chosen over the right because of its longer renal vein which makes the transplant procedure technically easier. If one of the donor kidneys has some imperfection, i.e., related to anatomy or dimension, that kidney is taken for donation, leaving the perfect kidney with the donor.

Liver

For living-related liver transplantation the donor and the recipient must be blood group ABO compatible and HLA typing does not play a crucial role. The organ specific assessment is done by computed tomography that demonstrates the absence of any liver mass and also defines adequate liver volume. An angiogram is also performed to assess the anatomy of the vessels and to guide the surgeon during the dissection. The portion of the liver removed corresponds to segments 2 and 3.3

Other Organs

While the above general guidelines can be applied to any potential living-related organ donor, special tests and criteria are necessary for pancreatic, small bowel and lung transplants, due to their still limited use or experimental status.

Table 4.1. Corrected and uncorrected glomerular filtration rates

Table 4.1. Corrected and uncorrected glomerular filtration rates

Male (n)

Female (n)

Male (n)

Female (n)

< 20

126 ± 19 (10)

115 ± 12 (9)

103 ± 6 (2)

109 ± 12 (7)

21-30

121 ± 18 (50)

111 ± 18 (43)

102 ± 15 (25)

114 ± 17 (17)

31-40

122 ± 21 (65)

105 ± 18 (74)

97 ± 15 (39)

102 ± 14 (42)

41-50

117 ± 18 (32)

98 ± 22 (46)

95 ± 13 (17)

95 ± 21 (35)

51-60

96 ± 14 (14)

83 ± 21 (27)

84 ± 13 (12)

79 ± 15 (18)

> 60

100 ± 15 (6)

80 ± 12 (9)

78 ± 12 (5)

79 ± 8 (7)

Reprinted with permission from: Gonwa TA, Atkins C, Zhang YA et al. Transplantation 1993; 55(5):983-985.

Reprinted with permission from: Gonwa TA, Atkins C, Zhang YA et al. Transplantation 1993; 55(5):983-985.

Was this article helpful?

0 0

Post a comment