Renal Transplant

• Ten-year graft survival is greater with a living than a deceased donor
• The best donor is a sibling with no HLA mismatches (siblings have a 1 in 4 chance of a full match based on HLA inheritance patterns). However, the Organ Procurement and Transplant Network (OPTN) considers age <18 an absolute contraindication for organ donation.
• Advances in immunosuppressive therapy have expanded the number of possible suitable kidney donors.
• DM, HTN with end-organ damage (eg, LVH) are often considered contraindications

Common contraindications to kidney donation

• Age <18 years
• Lack of mental ability to make an informed decision
• HIV infection
• Active or partially treated cancer, history of malignancy in lung, breast, gastrointestinal, renal, hematological, or melanoma
• Acute infection
• High suspicion of donor coercion
• High suspicion of illegal financial exchange from recipient to donor
• Active suicidality or active major psychiatric illness
• Acute or chronic kidney injury or preexisting urological/renal condition
• Active substance abuse
• Pregnancy

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The complications of donor nephrectomy