Assessment of Potential Living Kidney Donors: Options for Increasing Donation

Survey of Patient's Experience of Altruistic Nondirected Kidney Donation

The scarcity of organs for donation is an ongoing issue. Change in legislative framework allows for altruistic donations in the UK, but, whereas the number of donations from deceased donors has increased, there has been a slow decline in altruistic living donors. The aim of this study was to review perspectives of altruistic nondirected kidney donors (ANDKD) at our center and outcome of all enquiries to inform service improvement and increase the numbers of donors. All enquiries by potential ANDKD at our center from September 2005 to September 2017 were analyzed. Donor assessment was performed as per the UK Guidelines, prior to obtaining Human Tissue Authority approval. The outcome of donation and results of questionnaires sent to 50 ANDKD were analyzed. During the period, 51 of the 180 enquiries (28.3%) resulted in kidney donation. Questionnaire responses were: 66% donors were retired; most heard about altruistic donation through media (60%); 72% thought psychological or psychiatric assessment was necessary; 95% found the information provided prior to donation adequate; 82% rated their overall experience as good/excellent; and 90% would recommend kidney donation to others. Thirteen of 50 donated kidneys were fed into the kidney exchange program. The mean ± standard error of the mean of the duration from human tissue authority approval to donation were 60.4 ± 5.4 and 131.2 ± 11.2 days, respectively (P = 0.00001). A significant proportion of enquiries for altruistic donation would result in donation but the assessment process needs to be quicker. ANDKD is useful way of priming the National Living Donor Kidney Sharing Scheme.

The Efficiency of Evaluating Candidates for Living Kidney Donation: A Scoping Review

INTRODUCTION

The process of evaluating candidates for living kidney donation can be inefficient. A structured review of existing information on this topic can provide a necessary foundation for quality improvement.

METHODS

We conducted a scoping review to map the published literature to different themes related to an efficient donor candidate evaluation. We reviewed the websites of living donor programs to describe information provided to candidates about the nature and length of the evaluation process.

RESULTS

We reviewed of 273 published articles and 296 websites. Surveys of living donor programs show variability in donor evaluation protocols. Computed tomography (a routinely done test for all successful candidates) may be used to assess split renal volume instead of nuclear renography when the 2 kidneys differ in size. Depending on the candidate's estimated glomerular filtration rate, a nuclear medicine scan for measured glomerular filtration rate may not be needed. When reported, the time to complete the evaluation varied from 3 months to over a year. The potential for undesirable outcomes was reported in 23 studies, including missed opportunities for living donation and/or preemptive transplants. According to living donor websites, programs generally evaluate 1 candidate at a time when multiple come forward for assessment, and few programs describe completing most of the evaluation in a single in-person visit.

CONCLUSIONS

Data on the efficiency of the living donor evaluation are limited. Future efforts can better define, collect, and report indicators of an efficient living donor evaluation to promote quality improvement and better patient outcomes.

Pretransplant uric acid levels may be predictive for prognosis of renal transplant donors

BACKGROUND

The living kidney donor counseling prior to the operation may be helpful to learn how to properly care for the remaining single kidney for the rest of their lives. Worsening kidney function is associated with elevated serum uric acid (UA) levels. In this study, we compared the baseline laboratory findings of renal transplant donors with their follow-up laboratory values.

METHODS

The study consisted of 173 adult donors including 91 females and 82 males with a mean age of 46.82 ± 11.31 years. The follow-up clinical and laboratory examinations were performed on the third day at the end of the first and the sixth months of the surgery. According to donor's creatinine levels we constituted two groups: high creatinine and normal creatinine.

RESULTS

Patients within the high creatinine group had significantly higher mean serum UA levels when compared with the normal creatinine group. In multivariate analysis, among the other effective variables, UA level alone was found to be the most effective parameter predicting the post-transplant creatinine levels (p = 0.004, odds ratio: 12.4, 95% CI: 2.3-68.3) at sixth month post-transplantation. In the ROC analysis for the effects of UA, the following cutoff values were found: >6 mg/dL in men (sensitivity 81.3%, specificity 76.9%, positive predictive value 89.7%, negative predictive value 62.5%, accuracy 80%) and ≥5 mg/dL in women (sensitivity 72.2, specificity 74.4%, positive predictive value 89.7%, negative predictive value 62.5%, accuracy: 73.7%).

CONCLUSION

Pretransplant serum UA levels can give important clues regarding the renal functions of the donors during the postoperative period.

Renal transplantation from elderly living donors

Acceptance of elderly living kidney donors remains controversial due to the higher incidence of comorbidity and greater risk of postoperative complications. This is a review of publications in the English language between 2000 and 2013 about renal transplantation from elderly living donors to determine trends and effects of donation, and the outcomes of such transplantation. The last decade witnessed a 50% increase in living kidney donor transplants, with a disproportionate increase in donors >60 years. There is no accelerated loss of kidney function following donation, and the incidence of established renal failure (ERF) and hypertension among donors is similar to that of the general population. The overall incidence of ERF in living donors is about 0.134 per 1000 years. Elderly donors require rigorous assessment and should have a predicted glomerular filtration rate of at least 37.5 mL/min/1.73 m(2) at the age of 80. Though elderly donors had lower glomerular filtration rate before donation, proportionate decline after donation was similar in both young and elderly groups. The risks of delayed graft function, acute rejection, and graft failure in transplants from living donors >65 years are significantly higher than transplants from younger donors. A multicentred, long-term, and prospective database addressing the outcomes of kidneys from elderly living donors is recommended.

Donor perspectives in living kidney transplantation

OBJECTIVE

The aim of this study was to determine the overall experience of living kidney donors.

METHODS

All 80 kidney donors at a teaching hospital between 2003 and 2008 were sent a postal questionnaire to determine the level of satisfaction with the kidney donation process, including post‐operative pain and return to fitness after surgery.

RESULTS

A total of 56 donors returned the questionnaires. The average loss of earnings in 29 donors was £995.17 6 £297.03. A total of 52 donors (93%) rated their overall experience as excellent or good, 55 donors (98%) had no regrets about donation, and 26 donors (46%) would have considered altruistic donation if they were unable to donate to their intended recipient. Qualitative analysis of responses showed a positive attitude to organ donation, with a willingness to encourage others, a request for chat facilities on the unit's website, and a more regular follow‐up.

DISCUSSION

Living kidney donors were generally satisfied with the organ donation process and likely to recommend it to others. The issue of compensation for loss of earnings must be addressed in order to encourage other potential donors. Perhaps other potential donors withdrawing from the assessment process due to inability to donate to their intended recipient should be counseled about altruistic non‐directed donation.

Unusual Complications Following Living Donor Nephrectomy

BACKGROUND

The aim of this study was to highlight unusual complications following living‐donor nephrectomy within a single center.

METHODS

Between January 2003 and February 2008, 58 donor nephrectomies (52 open and 6 laparoscopic hand‐assisted) were performed. All donors were followed up at 6 weeks and then discharged to regular yearly visits with their designated nephrologists. All complications were entered prospectively into a database used for this analysis.

RESULTS

Forty‐four (76%) had a left donor nephrectomy, whereas 14 (24%) had a right nephrectomy. There were 22 men and 34 women with a median age of 48 years (range 27–70 years). Average length of hospital stay of the donors was 5 days (median 4 days). Fifty donors (86%) had no complications; the complications seen in the remaining 8 (14%) were hemorrhage in 4 donors, testicular pain treated by orchidectomy in 1 donor, neuropathic pain in 1 donor, and lymphoma in 1 transplanted kidney.

CONCLUSIONS

In addition to rigorous and careful assessment of potential donors, every effort must be made to reduce the risk of postoperative complications by adopting a careful surgical technique, ensuring a high level of vigilance, and early detection of complications—bearing in mind some of the unusual complications detailed in this report.