At what price kidneys from complex donors while patients die on the waiting list: a word of caution

More and more often living donors worldwide are used for kidney transplantation. The results are excellent, much better than from the deceased donors, disregarding the genetic disparity. Not surprisingly, living donation has not influenced the existing gap, and waiting lists are increasing. Live kidney donation technically has become a standardized, safe procedure. Many papers, including that from the Minneapolis Center quote follow-up results documenting that unilateral nephrectomy is safe. The Amsterdam Forum established criteria for living kidney donors. Most unfortunately, however, the continuous need for kidneys has led in the recent three years to the use of the so-called "complex" or "marginal" living donors, that is donors with metabolic syndrome. The argument for a continuous increase in living kidney donation, often used by transplant physicians, is quoted in the title of the abstract. This argument should never be used, especially by transplant physicians, who must consider the interests of both the recipient and the donor. Our own data presented at the last Congress of the Transplantation Society showed that moderate hypertension occurs in some patients. The risk of cardiovascular complications is definitely higher among donors with the metabolic syndrome, those with prediabetes, obesity, or mild hypertension. Most unfortunately there are no long-term follow-up data concerning such donors. They may require preemptive prophylaxis with step-wise interventional reno-protection and cardio-protection programs, which so far have not been implemented. For this reason, a Living Donor Registry is needed. It would allow objective assessment of the long-term risks of uninephrectomy among donors with metabolic syndrome. Such a registry is in operation in our country. Considering the use of kidney donors with the metabolic syndrome, one should remember a popular saying: "Be good, and if you cannot be good--be careful."