Figure 1231

Use of living donors. A suitable living donor is better than a cadaveric donor because graft survival is better and preemptive transplantation is possible. The best donor usually is a family member. Psychosocial and biological factors must be taken into account when choosing among two or more living prospective donors. Every effort must be made to ensure that the donation is truly voluntary. Caregivers should tell prospective donors that if they do not wish to donate, then friends and relatives will be told "the donor was not medically suitable." (From Kasiske and coworkers [2]; with permission.)

Preliminary evaluation of a living prospective donor. The prospective donor must be made aware of the possible costs associated with donation, including travel to and from the transplantation center and time away from work. The prospective donor must undergo a psychological evaluation to ensure the donation is voluntary. A preliminary medical evaluation should assess the risks of transmitting infectious diseases with the kidney, eg, infection with human immunodeficiency virus (HIV) and cytomegalovirus (CMV). (From Kasiske and coworkers [2]; with permission.)

Assessing risks. Older age may place the living prospective donor at greater surgical risk and may be associated with reduced graft survival for the recipient. The prospective donor must be informed of both the short-term surgical risks (very low in the absence of cardiovascular disease and other risk factors) and the long-term consequences of having only one kidney. With regard to long-term risks, it should be considered whether there is a familial disease that the living donor may be at risk to acquire and whether having only one kidney would alter the natural history of renal disease progression. These questions are often most pertinent for relatives of patients with diabetes. (From Kasiske and coworkers [2]; with permission.)

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