Is a history of diabetes mellitus (DM) a contraindication to kidney donation?

Diabetes Mellitus as an Absolute Contraindication to Kidney Donation

Yes, known diabetes mellitus is an absolute contraindication to living kidney donation. 1

Clear Exclusion Criteria

The American Journal of Kidney Diseases guidelines explicitly state the following absolute contraindications for kidney donation related to diabetes 1:

• Known diabetes mellitus of any type
• Fasting plasma glucose (FPG) ≥126 mg/dL on two or more occasions
• Plasma glucose ≥200 mg/dL two hours after 75-g oral glucose challenge on two or more occasions

This represents a firm, non-negotiable exclusion criterion that applies universally to potential living kidney donors.

Rationale for Exclusion

The prohibition against diabetic donors is based on several critical concerns:

Risk to the Donor

• Diabetic patients face accelerated progression of their own kidney disease, and losing one kidney would further compromise their renal reserve 1
• Diabetes is already the leading cause of end-stage renal disease, accounting for nearly half of new ESRD cases 1
• Donors with diabetes have substantially higher long-term risks of cardiovascular disease, neuropathy, and other microvascular complications that would be exacerbated by donation 1

Risk to the Recipient

• Diabetic donor kidneys can transmit diabetic kidney disease to recipients, even when recipients maintain excellent glucose control 2
• Studies demonstrate that 26% of recipients receiving diabetic donor kidneys developed biopsy-proven diabetic kidney disease, with ongoing histological progression despite fair blood sugar control 2
• Pre-implantation biopsies from diabetic donors frequently show diabetic lesions worse than diabetic nephropathy class IIa 2

Borderline Glucose Abnormalities

The guidelines also address prediabetic states as relative contraindications 1:

Impaired Fasting Glucose (IFG)

• FPG between 110-125 mg/dL represents a relative contraindication 1
• Donation is not recommended for individuals with IFG in the high range (110-125 mg/dL) due to greater tendency for deterioration 1
• However, carefully screened prediabetic donors with IFG often revert to normal fasting glucose and show preserved kidney function at 10-year follow-up 3

Impaired Glucose Tolerance (IGT)

• 2-hour plasma glucose between 140-199 mg/dL after glucose challenge 1
• Donation is not recommended when IGT occurs with additional risk factors including first-degree relatives with type 2 diabetes, obesity, gestational diabetes history, or dyslipidemia 1

Critical Distinction from Kidney Recipients

It is essential to understand that these guidelines address kidney donors, not recipients:

• Diabetic patients with ESRD are excellent candidates to receive kidney transplants, with significantly improved survival compared to remaining on dialysis 1, 4
• The evidence shows 32% of kidney transplant recipients have ESRD caused by diabetes 1
• However, having diabetes absolutely disqualifies someone from donating a kidney 1

Common Pitfall to Avoid

Do not confuse the extensive literature about diabetic kidney transplant recipients (which discusses pancreas-kidney transplantation and management of diabetes after receiving a transplant) with criteria for kidney donors. The provided evidence about pancreas transplantation 1 addresses treatment options for diabetic patients receiving kidneys, not eligibility for donation.