What are the criteria for assessing a potential kidney donor's suitability, considering both the donor and recipient are Jehovah's Witnesses (JW) and may refuse certain medical interventions?

From the Guidelines

To assess someone's suitability as a kidney donor for a Jehovah's Witness recipient, a comprehensive medical evaluation is essential, prioritizing the donor's safety and respecting the religious beliefs of both parties, as outlined in the 2020 KDOQI US commentary on the 2017 KDIGO clinical practice guideline on the evaluation and care of living kidney donors 1. The assessment begins with blood typing and tissue matching to determine compatibility between donor and recipient, including ABO blood typing and human leukocyte antigen (HLA) matching. A thorough medical history review and physical examination follow to identify any contraindications to donation, considering factors such as obesity, with individuals having a body mass index (BMI) greater than 35 kg/m2 advised to lose weight and not donate in the presence of other comorbid conditions, as suggested in the 2007 evaluation of the potential living kidney donor 1. Laboratory tests are crucial, including:

• Complete blood count
• Comprehensive metabolic panel
• Urinalysis
• Tests for infectious diseases like HIV, hepatitis, and cytomegalovirus Kidney function tests such as glomerular filtration rate (GFR), creatinine clearance, and protein-to-creatinine ratio are performed to ensure the donor has adequate kidney function, with the GFR expressed as mL/min/1.73 m2, as recommended in the 2020 KDOQI US commentary 1. Imaging studies like CT angiography or MRI evaluate kidney anatomy and vascular supply. For Jehovah's Witnesses specifically, bloodless surgical techniques must be planned, including:
• Cell salvage
• Hemodilution
• Erythropoietin therapy (typically 300 units/kg three times weekly for 2-3 weeks pre-surgery)
• Iron supplementation (oral ferrous sulfate 325mg three times daily or IV iron if needed) A psychological evaluation assesses the donor's mental health and ensures informed consent without coercion, with the transplant team discussing with both parties their understanding that blood transfusions will be declined, and developing contingency plans for blood conservation, as emphasized in the 2020 KDOQI US commentary 1. This comprehensive approach ensures both medical suitability and respect for religious beliefs while maximizing the chances of successful transplantation.

From the Research

Assessing Donor Suitability for Kidney Transplantation in Jehovah's Witnesses

To assess a donor's suitability for kidney transplantation, particularly when both the donor and recipient are Jehovah's Witnesses, several factors must be considered:

• The donor's medical history and current health status, including any pre-existing conditions that may affect the transplantation process or the recipient's health outcomes 2
• The donor's willingness to donate and their understanding of the risks and benefits associated with the procedure, as well as their commitment to respecting the recipient's refusal of blood transfusions 3
• The recipient's medical history and current health status, including their ability to withstand the transplantation procedure and any potential complications that may arise, such as severe anemia 2
• The availability of non-blood alternatives and the transplant team's experience with bloodless organ transplantation 4

Evaluating the Recipient's Suitability for Transplantation

When evaluating the recipient's suitability for transplantation, the following factors should be considered:

• The recipient's age and overall health status, including any pre-existing conditions that may affect their ability to withstand the transplantation procedure 2
• The recipient's emotional and psychological state, including their ability to cope with the stresses of transplantation and any potential complications that may arise 2
• The recipient's commitment to respecting their own refusal of blood transfusions and their understanding of the potential risks and benefits associated with the procedure 3

Considering the Ethical Implications

The ethical implications of transplanting a kidney into a Jehovah's Witness recipient must also be considered:

• The principle of respect for autonomy supports the recipient's right to refuse blood transfusions, and the transplant team must respect this decision 4
• The potential impact on other patients who may be waiting for a transplant and are willing to accept blood transfusions must be considered, and the transplant team must weigh the potential benefits and risks of transplanting a kidney into a Jehovah's Witness recipient 4
• The availability of data on outcomes of transplant with and without transfusion must be considered, and the transplant team must be aware of the latest research and guidelines on bloodless organ transplantation 4