Living donor practices in the United States

Area of Science:

• Nephrology
• Transplantation Surgery
• Public Health Policy

Background:

• Living kidney donation is a frequent procedure in the United States.
• Significant variability exists in transplant center protocols and donor exclusion criteria.
• Lack of clinical trial data necessitates understanding current practices to guide future protocols and research.

Purpose of the Study:

• To review current knowledge on living donor practices in the United States.
• To identify trends in donor selection and follow-up protocols.
• To highlight challenges in maintaining long-term donor follow-up.

Main Methods:

• Review of existing literature and surveys on living donor practices.
• Analysis of trends in donor exclusion criteria over the past 25 years.
• Examination of mandated donor follow-up requirements and reported barriers.

Main Results:

• Opposition to living unrelated kidney donation has significantly decreased.
• Donor age criteria have relaxed for older candidates but tightened for younger ones.
• Most living kidney donors are lost to follow-up within one year, despite a two-year mandate.

Conclusions:

• Living donor selection criteria are dynamic and vary across centers.
• Barriers to donor follow-up, including inconvenience and costs, require addressing.
• Further research and standardized protocols are needed to optimize living donor care and outcomes.