Cadaver And Living Kidney Donation

The annual number of patients that receive a kidney transplant are determined by the number of cadaveric kidneys available and the number of living kidney donors. Cadaver kidney transplants make up the majority, numbering 8,493 in 2002. The bulk of the increase in kidney transplants over the past several years is due to greater numbers of living donors. There were 6,235 living donor kidney transplants in 2002.

Numerous strides have been made to increase the total number of cadaver kidneys available by public education programs encouraging organ donation. There is also a new classification of expanded criteria organ donors, and more liberal consideration of controlled and uncontrolled non-heart-beating donors. In addition, many programs are expanding their living kidney donor experience by including distantly related donors such as spouses, cousins, aunts, uncles, close friends, and even emotionally unrelated donors. This has resulted in an increase in the proportion of all kidney transplants performed in the U.S. by living donors to almost 45%. In many transplant programs, living kidney donation accounts for nearly 75% of all the kidney transplants. There are few medical ethical issues related to accepting kidneys from living donors. The donor mortality risk is <0.01%. Life expectancy is unaffected. There is no long-term morbidity related to development of hypertension or impaired renal function (7). In fact, many patients have been benefited by the thorough medical examination during work-up by revealing unexpected medical issues.

A. Evaluation of the Living Donor

The pertinent aspects of the medical evaluation of the potential live kidney donor are outlined in Table 6.6. The psychosocial evaluation is necessary to confirm that the motive to donate the kidney is altruistic. Not all individuals willing to donate can be accepted as a donor because of ABO blood type incompatibilities with the recipient. This uncertainty requires the evaluation to proceed in stages so that expensive imaging studies are not performed in ABO incompatible donors. The work-up is performed in phases, beginning with determination of blood type, blood chemistry profile, complete blood count, coagulation studies, and urinalysis with culture. If the donor is one of multiple siblings willing to donate, then HLA typing is conducted. This is done to determine if an HLA identical or one-haplotype match can be found.

When the single best donor is identified with a negative crossmatch the work-up proceeds with a 24-hour collection of urine for detection of protein and creatinine clearance. Next, viral serologies are obtained, chest x-ray, EKG, and if indicated, a two-dimensional cardiac echocardiogram. Finally, the special imaging studies to evaluate the renal vasculature and collecting system are obtained. It is imperative that there is confirmation that the potential live donor has two kid-

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