ABSTRACT
Perioperative morbidity and mortality are rarely the prohibitive issues in the generally healthy potential living kidney donor population. However, in order to obtain truly informed consent from potential kidney donors, it is important to understand and explain the potential long-term effects that can accompany a reduction in renal mass (1,2). This chapter will focus on the preoperative assessment of kidney function and the predictors of long-term health consequences of kidney donation, both in terms of renal and overall patient health. It will discuss the medical evaluation of donors and will focus on what is currently known regarding the risks of both End-Stage Renal Disease (ESRD) and overall morbidity associated with common medical problems identified during the medical evaluation of potential kidney donors. It will review the available data regarding the effects of nephrectomy in the setting of comorbidity or illness that may modify the risk of renal failure, specifically discussing issues of aging, lower estimated glomerular filtration rate (GFR), proteinuria, hematuria, stone disease, hypertension, glucose intolerance, and obesity. Finally, it will offer suggestions regarding the long-term follow-up care of the kidney donor. In situations for which long-term data are lacking, we have tried to avoid setting arbitrary cut offs to define acceptability for donor nephrectomy, because multiple individual factors need to be weighed when determining the overall advisability of kidney donation. The ultimate goal of the medical evaluation is to arrive at a decision made jointly in a spirit of cooperation by the transplant center and a well-informed donor candidate.
