This book provides a complete guide to the evaluation, care, and follow-up of living kidney donors. Living donor kidney transplantation is established as the best treatment option for kidney failure. However, despite the tremendous benefits of living donation to recipients and society, the outcomes and optimal care of donors themselves have received relatively less attention. Fortunately, things are changing - including recent landmark developments in living donor risk assessment, policy and guidance.
This volume offers authoritative, evidence-based guidance on the full range of clinical scenarios encountered in the evaluation and care of living kidney donors. The approach to key elements of risk assessment, ethical considerations and informed consent is accompanied by recommendations for patient-centered care before, during, and after donation. Advocacy initiatives and policies to remove disincentives to donation and advance a defensible system of practice are also discussed.
General and transplant nephrologists, as well as related allied health professionals, can look to this book as a comprehensive resource addressing contemporary clinical topics in the practice of living kidney donation.
Krista L. Lentine, MD, PhDProfessor of MedicineMid-America Transplant/Jane A. Beckman Endowed Chair in TransplantationDivision of Nephrology / Center for Abdominal TransplantationSaint Louis University School of MedicineSt. Louis, MO, USA
Beatrice P. Concepcion, MDAssistant Professor of MedicineDepartment of MedicineDivision of Nephrology and HypertensionVanderbilt University Medical CenterNashville, TN, USA
Edgar V. Lerma, MD Clinical Professor of MedicineDepartment of MedicineSection of NephrologyDepartment of MedicineUniversity of Illinois at Chicago College of Medicine/ Associates in Nephrology, S.C.Chicago, IL, USA
IntroductionOrgan shortageBenefits to recipients of LKDTEthical foundation of donor autonomy within boundaries of 'acceptable risk'Brief mention of Peter Reese work on 'harms' that may results from declining a donor candidateLandscape of living donation - Epidemiology, trends
Informed Consent and Framework for CareCore principles and processes of informed consentOverview of the Living Donor Care Team - Roles & Responsibilities
Medical EvaluationGFR, Albuminuria, HematuriaRenal anatomy, NephrolithiasisBlood pressureMetabolicCancerInfectionsGenetics - ADPKD, ApoL1, and other less common Peri-operative screening
Compatibility, Paired Donation, and Incompatible Living Donor Transplants
Risk Assessment New risk calculators for donor ESRD (Grams 'predonation', Massie 'postdonation')New tools for recipient outcomes based on LD characteristicsPregnancy-related risks and counseling
Surgical Approaches Comparative data on outcomes, recovery, pain, cosmesis as per the surgical trials.
Policy & EthicsCore Ethical Tenets & Unacceptable practices. 'Incentives'/paying donors (can be brief - Declaration of Istanbul, note as illegal and most countries, etc)Donor Candidate identification (including emerging approaches like Social Media)Non-directed donorsInternational donorsDisparities in access to LKDT and strategies to lessMitigating barriers/disincentives to living donation - including Financial, Educational/SES/health literacy-related, etc)