Donor Selection Criteria
Each transplant program is required to have criteria for the selection of both recipients and donors, and patients are required to be provided with this information. The following are the criteria for the selection of living donors.
1. Age: Our program will not consider donation from individuals under the age of 18 or any person mentally incapable of making an informed decision. Non-directed donors must be age 25 or older.
2. Smoking: There are many known health risks from smoking. Surrounding a surgical procedure, smoking can cause potentially life-threatening respiratory complications during or immediately after anesthesia. Smoking may also increase the risk of developing blood clots in the leg veins which can break loose, travel to the lungs and potentially cause death. Smoking causes increased mucus production and a decreased ability to clear the lungs which can lead to pneumonia. Smoking also causes heart and vascular disease. Smoking causes decreased wound healing. Candidates will not be considered for donation unless they have been tobacco free (including chewing tobacco) for at least 3 months prior to donation and they are expected to remain tobacco free after surgery. Smoking is strongly discouraged after donation to protect long term health.
3. Drug Use: Potential donors must not use any illicit drugs. This includes periodic use of any drug such as marijuana in any form (including orally). Potential donors who use chronic pain medication experience a higher incidence of post-operative pain after donation. These individuals may be requested to see a surgeon and/or psychiatrist prior to being considered for donation. The transplant team may request random drug screening if there is concern regarding drug use. Failure to comply with requests for drug screening would be considered cause for declining donation.
4. Health Problems: Donors must be healthy individuals. If a donor has a past history of suffering from the following problems, or if these are discovered during the medical evaluation, a donor may be declined. The RN will discuss the donor’s health history in detail before the evaluation begins and the doctor will review it again at the first clinic visit.
- High blood pressure treated with medication (there may be rare selected situations when the team may consider a donor on n more than two blood pressure medicine).
- Diabetes. In some cases, young donors may be declined for a very strong family history of diabetes even if the donor does not currently suffer from diabetes, due to the risk of developing it later in life.
- Gestational diabetes (diabetes during pregnancy). Donors are considered on a case by case basis.
- Systemic lupus erythematosus
- Polycystic kidney disease
- Substance abuse
- Psychiatric illness. If a donor has a history of mental health problems including a remote history of anxiety or other common disorders, the team may request a psychiatric evaluation. Donors with current mental health concerns may not be candidates for living kidney donation.
- Heart / heart valve disease or peripheral vascular disease (disease of blood vessels in the legs)
- Lung disease with impaired oxygenation or ventilation.
- Recent cancer or a history of cancer that was not completely treated
- Low kidney function shown by creatinine clearance testing
- Protein in the urine > 300 mg per 24 hours (a test of kidney function)
- Active hepatitis B or C infection or HIV infection.
- Use of medicines that are known to cause kidney damage
- History of blood clots
5. Obesity: Obesity is an independent risk factor for kidney disease. Candidates with a body mass index of over 35 will generally not be considered for donation unless an individual is very muscular. Candidates with BMI of less than 35 may be asked to lose weight depending on weight distribution.
6. Psychosocial Issues: The social worker will evaluate many psychosocial aspects of living donation with the potential donor. Donors may be declined if they have inadequate support for recovery, questionable donor-recipient relationship or motivation for donation, a history of poor coping or psychiatric illness, a history of not taking good care of their health, or other similar concerns.
7. Insurance coverage and primary care doctor: It is so important for donors to have good ongoing medical care to monitor the function of the remaining kidney that the United Network for Organ Sharing has recommended that all donors be required to have health insurance and a primary care doctor. Our program supports this position.