Policy: Kidney Living Donor: Medical Selection Criteria Guidelines for Living Kidney
Donors
Statement: 1. Activation date: 5/20/14
2. Affected Department: Kidney and Pancreas Transplant Program
3. Vision Strategy: Patient Care
4. Policy Statement: The Emory Transplant Center will comply with all applicable
federal, state and local laws, regulations and policies regarding the management of
prescribing medications and refills.
5. Basis: These guidelines are necessary for the protection of patients, physicians and
staff
6. Administrative Responsibility: Section heads, physicians, practitioners, and staff
are responsible for compliance with this policy.
Scope/Procedure:
Guidelines:
1. Age – donors must be at least 18 years of age, if they are less than 18 years old they
are considered not a candidate for donation.
2. Renal function – We will follow the National Kidney Foundation guidelines. Case by
case assessment may be utilized.
3. Body Mass Index
a. ≤ 38 for evaluation
b. ≤ 35 for surgery
4. Anatomic factors
a. Size differential will be evaluated by CTA, MRI, or Mag3 scanning. If the donor is left
with a residual functioning renal mass of <45 % of the original renal mass the team will
determine suitability.
b. Non-malignant neoplasms - patients with small benign neoplasms (with histological
confirmation) may be considered providing the affected kidney is removed for
transplantation. The neoplasm may or may not be excised ex vivo at the discretion of
the recipient surgeon.
c. Multiple arteries – acceptable at the discretion of the donor and recipient surgeons.
5. Past medical history
a. HTN – patients with well-controlled HTN (demonstrated by a normal 24 hr. BP
monitor that does not show HTN) by low to moderate doses of a medication may be
considered if they meet the following criteria:
i. Not African American
ii. Donating to a someone with whom they have a close relationship, (eg. spouse or
long-time close friend)
iii. No LVH by echocardiogram
b. History of pre-eclampsia – may be a candidate at the discretion of the living donor
team. Key factors include:
i. Should meet all other criteria and be at least 1 year after pre-eclamptic episode.
c. Glucose metabolism – demonstration of a normal HgbA1c will be required for the
following groups of patients:
i. African Americans, Hispanics, Native Americans
iii. First degree relative with diabetes
iv. Pregnancy-induced diabetes
d. Renal calculi – donors with a single episode/single stone may donate if they have a
normal metabolic evaluation (Litholink®). Patients found at the time of evaluation to
have a single stone by imaging may donate with normal metabolic evaluation. Multiple
stone formers may be considered if they have an identifiable defect by metabolic
evaluation that is subsequently proven corrected on therapy.
e. Sickle cell trait (AS by elcetrophoresis) – not a contraindication
f. Family history of PCKD
i. > 30 years of age okay if no cysts by imaging (counsel about potential risk of
transmission to children).
ii. < 30 years of age
1. Need an MRI to evaluate for cysts. If no cysts can be a donor.
g. History of malignancies –squamous and basal cell skin cancers are not a
contraindication to donation, all others will be evaluated on a case by case basis
6. Laboratory abnormalities a. Proteinuria
i. <180 mg on 24 hr urine acceptable
ii. 181-250 mg – need albumin to Cr ration on a spot urine. Okay to proceed if value <
0.03
iii. >250 mg – not acceptable
b. Persistent microscopic hematuria – order urine cytology with microscopy
i. Cystoscopy
ii. Renal biopsy if cystoscopy normal
c. NASH – acceptable if liver biopsy reveals no fibrosis, LFTs normalize with therapy,
and cleared by hepatology.
e. Anemia/leukopenia/thrombocytopenia – consider evaluation by a hematologist
7. Psychological/social factors
a. Ability to independently consent without coercion – as determined by Independent
Living Donor Advocate (ILDA) who evaluates each donor candidate and makes
recommendations to team utilizing the Donor Advocate Psychosocial Tool
b. Freedom from alcohol/drug dependence – demonstrated abstinence and/or
completion of a treatment program
c. Smoking – not a contraindication but cessation strongly recommended
8. Infectious disease transmission
a. HIV – HIV is an absolute contraindication
b. Hepatitis B
1. HBsAg+ - absolute contraindication
2. HBcAb+ - okay if PCR is negative for Hep B and if recipient is HBsAb+
c. Hepatitis C – absolute contraindication
d. Histoplasmosis – okay if disease manifested by calcified granulomas
e. Sarcoidosis – not a candidate if disease is active requiring treatment
f. Tuberculosis – okay if completely treated. New + PPD requires ID consult and
treatment
g. West Nile Virus – demonstrated negative for viremia by PCR during the peak season
(April 1st – October 31st).
Approved by:
Kenneth Newell, MD, PhD
Head of the Emory Renal Living Donor Program
Approval Dates: 2/8/06, 9/20/06
Revision Date: 3/23/2011, 4/6/2011
Regulatory
References:
Lit search??