Living-donor follow-up attitudes and practices in U.S. kidney and liver donor programs.

BACKGROUND: Although U.S. transplantation programs must submit living-donor follow-up data through 2 years after donation, the submissions have high rates of incomplete or missing data. It is important to understand barriers programs face in collecting follow-up information. METHODS: Two hundred thirty-one programs performing living kidney donor (LKD) and/or living liver donor (LLD) transplantation were contacted to complete a survey about program attitudes concerning donor follow-up, follow-up practices, and barriers to success. RESULTS: Respondents representing 147 programs (111 with only LKD and 36 with both LKD and LLD) participated. Sixty-eight percent of LKD and 83% of LLD respondents said that achieving follow-up was a high priority. The majority agreed that donors should be followed at least 2 years (61% LKD programs and 73% LLD programs), and sizeable percentages (31% LKD and 37% LLD) endorsed 5 years of follow-up. However, approximately 40% of programs lost contact with more than 75% of their donors by 2 years after donation. Follow-up barriers included donors not wanting to return to the program (87%), out-of-date contact information (73%), and lack of program (54%) or donor (49%) reimbursement for follow-up costs. Whereas 92% of LKD and 96% of LLD programs inform potential donors about follow-up requirements, fewer (67% LKD and 78% LLD) develop plans with donors to achieve follow-up. CONCLUSIONS: Most respondents agree that donor follow-up is important, but they report difficulty achieving it. Improvements may occur if programs work with donors to develop plans to achieve follow-up, programmatic standards are set for completeness in follow-up data reporting, and sufficient staff resources are available to ensure ongoing post-donation contact.

The elderly as recipients of living donor kidneys, how old is too old?

PURPOSE OF REVIEW: Transplantation of the elderly often invokes strong and sometimes passionate arguments both in support and in opposition. Age alone has not been an absolute contraindication to a life-sustaining organ transplant for several decades. A comprehensive evaluation of the risks associated with surgery and suppression of the immune system in this often comorbid population becomes the focus. Risk for the recipient, however, must continually be evaluated and frequently updated in the context of that for the donor. RECENT FINDINGS: Following careful and critical evaluation, elderly patients appreciate the increase in life expectancy and improvements in quality of life as demonstrated in their younger counterparts. The outcome of recipients receiving kidneys from living donors has demonstrated superior graft and patient survival compared to deceased donors. Careful monitoring of medication levels for prevention of rejection while avoiding over immunosuppression and infection is critical to ensure such benefit. SUMMARY: Transplantation of the elderly via living donation is not only justified but in the appropriately chosen patient, with informed consent of both donor and recipient, is ethically sound. The expectations of both parties must be clearly stated and donor safety must remain the top priority. Living donors must be fully cognizant of the potential risk both in patient and graft survival prior to making such a life-changing decision to donate.