Living Kidney Donor Criteria Based on Blood Pressure, Body Mass Index, and Glucose: Age-Stratified Decision-Making in the Absence of Hard Data

Abstract

Kidney transplantation is the preferred choice for many patients with end-stage renal disease. Long waiting times for deceased donor kidneys and declining health on dialysis remain major barriers. It is within this paradigm that optimal timing of kidney transplantation requires the availability of a living donor. Historically, potential donors were most often young and in excellent health by standards of the time. Accepted values of blood pressure and glucose have become more restrictive in recent decades. Living kidney donation has appeared generally safe but nonetheless carries some surgical and potential long-term risks. Demographic changes with aging and higher obesity rates have challenged transplant centers to reevaluate donor acceptance criteria to consider potential donors with isolated medical abnormalities. We adopted a set of age-based protocols to consider donor risk by incorporating relevant data from studies of the general population. These criteria may potentially allow an older donor to take on some additional risk in the context of both a more established medical history and fewer additional life-years during which that risk might manifest. Herein, we describe our rationale and approach.