SCM13: The Medically Complex Living Donor: Should we be using?

As a transplant nephrologist myself, one session I particularly enjoyed in the NKF was “Controversies in Kidney Transplantation.” Three experienced speakers showcased their knowledge on difficult topics and captivated both the general nephrology and transplant audience. Here is a brief recap of one of the 3 talks.

The Medically Complex Living Donor: Should we be using?

Tough topic by Dr. Peter Reese. He defines a medically complex donor as someone with at least 1 clinically important risk for CKD. As examples he uses HTN, obesity, marginal GFR, and in some cases – African Americans. Some interesting aspects of his talk. He mentions that in the case of donors, “avoid undo harm” may be a better saying than “do no harm.” Another interesting concept was to consider the harm to the donor by declining them. For example a parent who would like to donate to their child. To sum up the rest – most centers allow older hypertensive caucasian to donate if blood pressure is well controlled and if they have no evidence of end organ damage, obese donors if they do not have impaired glucose tolerance or evidence of metabolic syndrome, and donors with marginal GFR (meaning close to the commonly used cutoff of 80 ml/min) if there is no evidence of intrinsic renal disease. The problem with African American donors is the lack of long term follow up; although short term follow up suggests risk for ESRD is no higher than in the general African American population. So should we be using high risk donors? It seems that in many transplant centers the use of complex donors is common. His message is that we need to be aware of subtle pressure in accepting donors, we need to simplify our explanations of “risk” to potential donors, and keep in mind the risk of not accepting a donor in addition to the risk of allowing them to donate.

Post written by Dr. Vinay Nair, eAJKD Advisory Board member.

Check out more eAJKD coverage of the NKF’s 2013 Spring Clinical Meetings!

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