[Assessment and selection of kidney living donors]. / Estudio y selección del donante vivo de riñón.

Donor protection should always be taken account during the selection and assessment of a living donor. On these terms, the evaluation of a potential donor must include these issues: 1) The donor act is altruistic, consciousness and out of coercion; 2) Life expectancy and quality of life of the recipient will improve after the living donor kidney transplantation; 3) The donor has normal renal function and the potential risk of developing nephropathy in the long term follow up is scarce (familiar nephropathies and other processes that may increase the potential risk for renal disease in the future, like severe hypertension, diabetes, etc must be ruled out). The glomerular filtrate should meet criteria for the normal function corresponding to age furthermore the absence of proteinuria and urine smear is normal; 4) The screening in the donor should contemplate those clinical situations or diseases non related to the kidney function but might elevate the surgical and/or anesthesia risk besides disease transmission to the recipient (as neoplasia or infections); 5) The surgical act is possible without technical difficulties and always performed after a negative result of the crossmatch between donor and recipient. The living donor evaluation process will follow a different schedule based on each particular case and the center facilities. Any case, the mentioned process is divided in two parts: The first one contains an initial screening (using non invasive and low cost tests) that allows discarding contraindications for donation (in both donor and recipient). In a second phase the assessment of the donor varies with donor characteristics. However, a test for renal function is mandatory besides imaging techniques (like angioTC), screening for transmissible diseases and a detailed evaluation for psychosocial aspects preferably made by professional. Moreover Spanish policy on living donation requires a report with information about the consent for donation developed by an independent board (ethics committee) besides the consent for donation given at the civil registry.

Estudio y selección del donante vivo de riñón / Assessing and selecting a living kidney donor

En la selección y el estudio del donante de riñón, el principio predominante para el médico debe ser la protección del donante. El estudio de una donación de riñón de vivo debe demostrar diversos aspectos: 1) La donación es libre, consciente y desinteresada. 2) El receptor no presenta contraindicaciones y su pronóstico vital y de rehabilitación mejorará de forma relevante con el trasplante renal de donante vivo. 3) El donante tiene riñones normales y el riesgo de desarrollar nefropatía a largo plazo es reducido. El filtrado glomerular debe estar por encima de un nivel mínimo en función de la edad y no deben existir proteinuria o alteraciones del sedimento. Deben descartarse nefropatías heredofamiliares y procesos o alteraciones que incrementen el riesgo de nefropatía a largo plazo (enfermedades sistémicas, hipertensión arterial severa, diabetes, etc.). 4) El donante no debe presentar otras enfermedades o alteraciones que puedan incrementar el riesgo quirúrgico o anestésico o transmitirse al receptor (cáncer, infecciones). 5) El trasplante es posible técnicamente con un riesgo aceptable: anatomía apropiada en donante y receptor, compatibilidad ABO y prueba cruzada negativa (excepto si se van a aplicar técnicas preparatorias especiales). El estudio del donante se organizará en función del caso particular y de las facilidades disponibles en el centro. En cualquier caso debe comenzar por una fase de cribado con estudios poco invasivos y costosos, que descarte contraindicaciones elementales por parte de donante y de receptor. En una segunda fase se amplían las exploraciones en función de las características del donante, si bien en todo caso deben incluir la comprobación de la función renal, estudio de imagen mediante angiotomografía axial computarizada, cribado de infecciones trasmisibles y de cáncer y un examen más detallado de los aspectos psicosociales, a ser posible por parte de personal especializado. La normativa española exige la emisión de un informe por parte del Comité Hospitalario de Ética y la declaración de voluntad del donante ante el juez del Registro Civil (AU)

Donor protection should always be taken account during the selection and assessment of a living donor. On these terms, the evaluation of a potential donor must include these issues: 1) The donor act is altruistic, consciousness and out of coercion; 2) Life expectancy and quality of life of the recipient will improve after the living donor kidney transplantation; 3) The donor has normal renal function and the potential risk of developing nephropathy in the long term follow up is scarce (familiar nephropathies and other processes that may increase the potential risk for renal disease in the future, like severe hypertension, diabetes, etc must be ruled out). The glomerular filtrate should meet criteria for the normal function corresponding to age furthermore the absence of proteinuria and urine smear is normal. 4) The screening in the donor should contemplate those clinical situations or diseases non related to the kidney function but might elevate the surgical and/or anesthesia risk besides disease transmission to the recipient (as neoplasia or infections). 5) The surgical act is possible without technical difficulties and always performed after a negative result of the crossmatch between donor and recipient. The living donor evaluation process will follow a different schedule based on each particular case and the center facilities. Any case, the mentioned process is divided in two parts: The first one contains an initial screening (using non invasive and low cost tests) that allows discarding contraindications for donation (in both donor and recipient). In a second phase the assessment of the donor varies with donor characteristics. However, a test for renal function is mandatory besides imaging techniques (like angioTC), screening for transmissible diseases and a detailed evaluation for psychosocial aspects preferably made by professional. Moreover Spanish policy on living donation requires a report with information about the consent for donation developed by an independent board (ethics committee) besides the consent for donation given at the civil registry (AU)