What is the typical workup for a living kidney donor?

Comprehensive Workup for Living Kidney Donors

The typical workup for a living kidney donor requires a thorough medical, psychosocial, and laboratory evaluation to ensure donor safety and minimize risks to both donor and recipient, including mandatory ABO compatibility testing, HLA typing, cross-matching, and assessment of kidney function through GFR measurement. 1

Initial Screening

• Blood compatibility assessment:

  • ABO blood typing
  • HLA typing
  • Cross-matching with potential recipient 2, 1

• Kidney function evaluation:

  • 24-hour urine collection for creatinine clearance (preferred over estimated formulas) 2
  • GFR measurement (expressed as mL/min/1.73 m²) 1

• Urinalysis:

  • Proteinuria assessment (confirm with 24-hour collection)
  • Microscopic hematuria evaluation (rule out contamination, infection, stones)
  • Microscopic pyuria assessment 2

Medical Evaluation

• Cardiovascular assessment:

  • Blood pressure measurements (at least 2 office readings <140/90 mmHg)
  • Cardiac stress testing indicated for:
    • Men ≥45 years or women ≥55 years
    • History of smoking
    • Family history of premature coronary artery disease
    • History of dyslipidemia
    • History of hypertension
    • Abnormal ECG 2, 1

• Metabolic evaluation:

  • Fasting plasma glucose
  • Oral glucose tolerance test
  • Absolute contraindications:
    • Known diabetes mellitus
    • Fasting plasma glucose ≥126 mg/dL on 2+ occasions
    • Plasma glucose ≥200 mg/dL 2 hours after oral glucose challenge on 2+ occasions 2, 1

• Pulmonary evaluation:

  • Not routinely indicated unless history/exam suggests lung disease
  • Contraindication: FEV1 or FVC <70% of predicted or FEV1:FVC ratio <65% 2

• Imaging studies:

  • CT angiogram or MRI/MRA to evaluate renal anatomy
    • CT is faster and can detect calcifications
    • CT better defines renal vein anatomy than MRA
    • CT has radiation exposure 2

Psychosocial Evaluation

• Should be conducted early in the evaluation process by an independent donor team 2, 1

• Recommended two-session approach:

  • First session: Initial assessment by social worker or nurse specialist
  • Second session: In-depth evaluation by psychologist or psychiatrist for areas of concern 2

• Key components:

  • History and current status (education, living situation, cultural background, etc.)
  • Cognitive capacity assessment
  • Psychological status (psychiatric disorders, coping skills)
  • Relationship with recipient
  • Motivation for donation
  • Knowledge and understanding of risks
  • Social support system
  • Financial stability 2, 1

• Mandatory "cooling off" period of at least 2 weeks after evaluation 2

Potential Pitfalls to Avoid

1. Failing to ensure true voluntariness - Donors may feel pressured by family or recipient expectations 2, 3

2. Inadequate risk assessment - Donors need clear information about short and long-term risks 1

3. Overlooking psychological impacts - Up to 31% of donors may develop psychiatric disorders within 12 months post-donation 4

4. Insufficient donor education - Donors need to understand recovery time and potential complications 3

5. Medical rejection factors - Nearly 41% of potential donors may be declined, with medical reasons (48%) and immunological incompatibility (20%) being the most common causes 5

Post-Evaluation Discussion

• Discuss possible outcomes with donor:

  • Psychological benefits after successful transplantation
  • Potential for resentment or depression after unsuccessful transplantation
  • Possibility of covert depression in altruistic donors 2

• Ensure donor understands:

  • Recovery timeline
  • Potential short and long-term health impacts
  • Financial implications
  • Support resources available 2, 1

The comprehensive evaluation process serves to protect both donor and recipient while ensuring the donation is truly voluntary and medically appropriate. Following this structured approach helps minimize risks and optimize outcomes for all parties involved.