Table 1.
Organ Procurement and Transplantation Network/United Network of Organ Sharing requirements for living kidney donor medical evaluations (11)
| Requirement | Specific Evaluations and Assessments |
|---|---|
| A general living donor history | 1. A personal history of significant medical conditions which include but are not limited to the following: |
| • Hypertension | |
| • Diabetes | |
| • Lung disease | |
| • Heart disease | |
| • Gastrointestinal disease | |
| • Autoimmune disease | |
| • Neurologic disease | |
| • Genitourinary disease | |
| • Hematologic disorders | |
| • Bleeding or clotting disorders | |
| • History of cancer | |
| 2. History of infections | |
| 3. Kidney-specific personal history including the following: | |
| • Genetic renal diseases | |
| • Kidney disease, proteinuria, hematuria | |
| • Kidney injury | |
| • Diabetes including gestational diabetes | |
| • Nephrolithiasis | |
| • Recurrent urinary tract infections | |
| 4. Active and past medications with special consideration for known nephrotoxic medications | |
| 5. Allergies | |
| 6. Evaluation for coronary artery disease | |
| General family history | Living donor’s family history of coronary heart disease and cancer |
| Kidney-specific family history | Living donor’s family history of the following: |
| • Kidney disease | |
| • Diabetes | |
| • Hypertension | |
| • Kidney cancer | |
| Social history | Living donor’s history of the following: |
| • Occupation, employment status, health insurance status, living arrangements, social support | |
| • Smoking, alcohol and drug use and abuse | |
| • Criteria to assess increased risk for disease transmission as defined by the US Public Health Service Guidelines | |
| • Psychiatric illness, depression, suicide attempts | |
| Physical examination | Physical examination of the living donor including the following: |
| • Height | |
| • Weight | |
| • BMI | |
| • Examination of all major organ systems | |
| • BP taken on at least two different occasions or 24-hour or overnight BP monitoring | |
| General laboratory and imaging tests | 1.Complete blood count with platelet count |
| 2. Blood type and screen | |
| 3. Prothrombin time or international normalized ratio | |
| 4. Partial thromboplastin time | |
| 5. Metabolic testing (to include electrolytes, BUN, creatinine, transaminase levels, albumin, calcium, phosphorus, alkaline phosphatase, bilirubin) | |
| 6. HCG quantitative pregnancy test for premenopausal women without surgical sterilization | |
| 7. Chest x-ray | |
| 8. Electrocardiogram | |
| Other metabolic testing | 1. Fasting blood glucose |
| 2. Fasting lipid profile (cholesterol, triglycerides, HDL cholesterol, LDL cholesterol) | |
| 3. Glucose tolerance test or glycosylated hemoglobin in first degree relatives of patients with diabetes and in high-risk individuals | |
| Kidney-specific tests | 1. Urinalysis or urine microscopy |
| 2. Urine culture if clinically indicated | |
| 3. Measurement of urinary protein and albumin excretion | |
| 4. Measurement of GFR by isotopic methods or a creatinine clearance calculated from a 24-hour urine collection | |
| 5. Hospitals must develop and comply with a protocol for polycystic kidney disease or other inherited renal disease as indicated by family history | |
| 6. Patients with a history of nephrolithiasis or nephrolithiasis (>3 mm) identified on radiographic imaging must have a 24-hour urine stone panel measuring the following: | |
| • Calcium | |
| • Oxalate | |
| • Uric acid | |
| • Citric acid | |
| • Creatinine | |
| • Sodium | |
| Anatomic assessment | 1. Assessment to determine the following: |
| • Whether the kidneys are of equal size | |
| • If the kidneys have masses, cysts, stones | |
| • If the kidneys have other anatomic defects | |
| • Which kidney is more anatomically suited for transplant | |
| 2. The choice of test for radiologic imaging may be determined on the basis of the local radiologic expertise and surgical preference and may include CT angiogram or MR angiogram | |
| Transmissible disease screening | 1. Infectious disease testing must include all of the following: |
| • Cytomegalovirus antibody | |
| • Epstein–Barr virus antibody | |
| • HIV 1,2 antibody testing | |
| • Hepatitis B surface antigen | |
| • Hepatitis B core antibody | |
| • Hepatitis B surface antibody | |
| • Hepatitis C virus antibody testing | |
| • Rapid plasma reagin test for syphilis | |
| 2. Living donor recovery hospitals must determine if the potential donor is at increased risk for TB and if so testing must include screening for latent TB using either intradermal PPD or interferon-γ release assay | |
| Endemic transmissible diseases | For the following infectious diseases, recovery hospitals must determine if the potential donor is from an endemic area, and if so they must test for the following |
| • Strongyloides | |
| • Trypanosoma cruzi | |
| • West Nile virus | |
| Cancer screening | Recovery hospitals must develop and comply with protocols consistent with the American Cancer Society to screen for the following: |
| • Cervical cancer | |
| • Breast cancer | |
| • Prostate cancer | |
| • Colon cancer | |
| • Skin cancer | |
| • Lung cancer |
BMI, body mass index; HCG, human chorionic gonadotropin; CT, computed tomography; MR, magnetic resonance; TB, tuberculosis; PPD, Purified Protein Derivative.