Care of the live kidney donor: consensus on the ultimate gift.

The Editors of Transplantation are pleased to present to their readers this supplement which records the consensus of an International Forum on the care of the Live Kidney Donor held in Amsterdam, The Netherlands from April 1-4, 2004. The objective of the meeting was to develop an international consensus on the standard of care and a position statement of The Transplantation Society defining and affirming the responsibility of the transplantation community for the live kidney donor. The result was a real international consensus, with over 100 transplant experts from more than 40 countries around the world participating. This Forum was also in part a result of the involvement of The Transplantation Society with the World Health Organization (WHO) and functioned as a continuum of the Madrid WHO conference on organ donation and transplantation held in October 2003. What is presented is a detailed analysis of all relevant aspects of selection and management of live kidney donors. This document should serve as a useful benchmark for living donor programs all over the world. The Forum analyzed the sentinel events associated with live kidney donation; the data emphasized the extremely low operative mortality rates and the long-term safety of this procedure with, noting the absence of accelerated loss of renal function and lack of appearance of hypertension in normal donors post nephrectomy. Forum participants affirmed the necessity for live donors to receive complete medical and psychosocial evaluation prior to donation (1); they elaborated in detail the acceptance limits of donor hypertension, obesity, dyslipidemia, renal function, urine protein and blood, stone disease, and historical malignancy that still permit live kidney donation. A great detail of discussion focused on prevention of transmissible infectious diseases through live kidney transplantation. Specific recommendations for screening of various viral, bacterial, and parasitic diseases are presented. Likewise preand postoperative donor issues such as determination of cardiovascular risk in the live donor, the salutary effects of smoking cessation and alcohol abstinence, and the screening for pulmonary risk and thromboembolism are detailed. Readers will find the discussion of risk estimation for donor candidates with isolated medical abnormalities (hypertension, low grade proteinuria, microscopic hematuria, etc.) useful and somewhat reassuring in justifying decisions to include such people as potential living donors in specific instances. Readers of this supplement will also find interesting and provocative the discussion on how a number of aspects of live kidney donation vary around the world. Thus some of the extremely rigid blood and tissue donation restrictions currently enforced in certain countries should probably not be applied to organ donation where the risk/benefit ratio is so different. Also, restrictions on live unrelated kidney donation (presently prohibited in various countries because of the absence of HLA matches) are certainly not justified. Likewise, live donor exchanges specifically banned in certain countries as valued considerations should be allowed. The high rate of female live kidney donation was acknowledged and the potential role of coercion/discrimination in many countries was discussed and the need to deal with this issue in a culturally sensitive manner emphasized. The high rate of minors donating to adults was also identified and a consensus proposal that minors less than 18 years of age should not be used as living kidney donors was agreed to. The Editors of Transplantation hope that this supplement will be used where appropriate as a benchmark for standard of care in selection and management of live kidney donors. We welcome your thoughts and reactions to the ideas and recommendation contained therein.