Living donor kidney transplantation: an update on evaluation and medical implications of donation

As the number of potential transplant recipient candidates increases with a relatively fixed number of organ donors, waitlists for kidney donation continue to grow. The disparity has forced physicians to reconsider prospective living organ candidates who are advanced in age with some degree of illness burden as a viable option for donation. The 2004 Amsterdam Forum was established to create consensus guidelines for donor evaluation. The primary goal of the evaluation of the prospective living donor is to risk stratify disease burden to ensure the safety of the donor. This article underscores some of the most contentious aspects of living donor evaluation such as metabolic derangements, donor age, donor gender and kidney function among others. Outcomes of the allograft and recipient are reviewed in the context of these medical conditions. The evaluation of the prospective living donor requires that he/she has agreed to proceed with donation after obtaining informed consent which can only be acquired by understanding all the short and long term complications and risks associated with kidney donation. This review will discuss the immediate surgical complications and long-term implications. There may be additional risk for female donors who are at childbearing age and plan to start a family. However, living kidney donation is the best treatment option available for patients with end stage renal disease and it is a safe procedure for the donor after careful medical consideration in each particular case is given.