Can a kidney donor with hypertension be considered for donation?

From the Guidelines

Hypertensive individuals can be considered for kidney donation if their blood pressure is well-controlled, typically with systolic blood pressure less than 140 mm Hg and diastolic blood pressure less than 90 mm Hg, using one or two antihypertensive agents, and they have no evidence of target organ damage. The decision to approve a hypertensive donor candidate should be individualized, taking into account their demographic and health profile in relation to the transplant program's acceptable risk threshold 1.

When evaluating a potential donor with hypertension, it is essential to consider the context of their demographics, clinical characteristics, and risks attributable to donation, rather than relying solely on blood pressure readings 1. The use of ambulatory blood pressure monitoring (ABPM) or repeated standardized blood pressure measurements can help clarify the presence or absence of hypertension in cases where the diagnosis is uncertain 1.

Key factors to consider in the evaluation process include:

• The donor's ability to control their blood pressure with one or two antihypertensive medications
• The absence of evidence of target organ damage
• The donor's kidney function and overall health profile
• The potential risks and benefits of donation for both the donor and the recipient

The transplant team should carefully weigh these factors and prioritize the donor's safety above all else. By doing so, they can make an informed decision about whether a hypertensive individual can safely donate a kidney.

From the Research

Hypertensive Kidney Donors

• Hypertensive kidney donors can be considered for donation, as long as their blood pressure is well-controlled (2, 3)
• Studies have shown that hypertensive donors do well in follow-up, with no increase in the incidence of kidney disease or worsening of the control of hypertension (2, 4)
• The selection of hypertensive donors should be based on individual assessment, taking into account factors such as age, body mass index, and the presence of end-organ damage (2, 5)

Outcomes of Hypertensive Kidney Donors

• Hypertensive donors have similar renal outcomes and mortality rates compared to non-hypertensive donors (3, 6)
• The risk of cardiovascular disease and end-stage kidney disease is also similar between hypertensive and non-hypertensive donors (3, 6)
• However, hypertensive donors may be more likely to develop cardiovascular disease and diabetes, especially when using the current definition of hypertension (3)

Considerations for Hypertensive Kidney Donors

• Donors with well-controlled hypertension (blood pressure <140/90 mmHg) and no evidence of end-organ damage can be considered for donation (2, 5)
• The use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may be associated with a lower risk of kidney disease and cardiovascular disease in hypertensive donors (6)
• Accepting hypertensive donors can lead to a slight increase in transplantation rates, but efforts to improve living donor awareness and overcome immunologic barriers may have a greater impact (5)