The primary goal of the living kidney donor assessment is to answer the following questions:
- Is donation medically safe for this person for the rest of their life?
- Is the kidney likely to function well in the intended recipient?
- Is the decision truly voluntary, informed and not coerced or commercial?
If there is doubt in answering any of the above questions, then the donor should be declined.
The assessment typically follows a stepwise, layered screening approach to avoid excessive or invasive testing until deemed necessary.
There are four baskets of suitability that are assessed:
- Medical Suitability – assessment for normal kidney function, low lifetime risk of CKD, no diabetes, no significant hypertension, no proteinuria, low cardiovascular risk
- Anatomical suitability – this includes acceptable vasculature of the kidneys, no complicated stones, cysts or masses
- Psychosocially suitable – assessment of whether a potential donor is fully informed, not exposed to coercion, is of stable mental health and has realistic expectations.
- Legally and ethically valid – this includes verification of full and informed consent, no commercial gain for either party, donation is purely voluntary.
The four completed baskets of suitability assessment are presented to a multidisciplinary panel for approval. This panel typically comprises nephrology, transplant surgery, psychology, social work, and other allied disciplines.
This panel will provide a final status on the eligibility of the potential donor – approved, declined or deferred
If the donor is not related by blood to the recipient, then the Department of Health needs to provide final approval for transplant following the panel approval.
Some of the more common reasons for a donor being declined include:
- High blood pressure
- Obesity – BMI >35
- Pre-diabetes or diabetes
- Family history of kidney failure
- Protein in the urine
- Low GFR – GFR < 80ml/min
- Kidney stones
- Fatty liver
- Mental health concerns including substance abuse and untreated psychiatric conditions
- Coercion
In summary:
Potential living donor comes forward for suitability assessment.
Complete basic health questionnaire – meets basic entry criteria (BMI, BP, cholesterol, glucose, HIV) If yes, then
Application to recipient medical aid for funding approval
Cross-matching to determine blood and immunological compatibility. If yes, then
Medical assessment (Can occur in any order)
Anatomical assessment (Can occur in any order)
Psychological assessment (Can occur in any order)
Legal and ethical assessment (Can occur in any order)
Presentation to multidisciplinary panel
Final decision
