Evaluation of kidney donor

1. Evaluation of kidney DonorEvaluation of kidney Donor
Dr. Osama El-shahatDr. Osama El-shahat
Consultant nephrologistConsultant nephrologist
Head of nephrology departmentHead of nephrology department
New Mansoura general hospital (international)New Mansoura general hospital (international)
ISN educational ambassadorISN educational ambassador

2. ∗Better out come
∗Shorter waiting time
∗Elective planning and optimization of the
recipient health status
∗Realistic chance for pre-emptive kidney
transplantation
Rational for living donationRational for living donation

3. Types of DonorsTypes of Donors

4.  Genetically Related
 Emotionally Related
 Altruistic Donors
 Organ Exchangers
 Vendors
Types of Live DonorsTypes of Live Donors

5. Organ ExchangersOrgan Exchangers
Nephrology Self-Assessment Program - Vol 10, No 6, November 2011

6. Iranian ModelIranian Model
Clin J Am Soc Nephrol 1: 1136–1145, 2006

7. ContraindicationsContraindications
Clin J Am Soc Nephrol February, 2012

9. EvaluationEvaluation

10. ∗ Education, counseling and consenting
∗ Psychological evaluation
∗ Medical screening process
∗ Identification of transmissible infections
∗ Evaluation of renal anatomy
Donor evaluation processDonor evaluation process

11. ∗ Complications
∗ Blood grouping and HLA
∗ Medical evaluation steps
∗ Stress of the right to withdraw at any time
∗ Follow up
∗ Informed consent
∗ ILDA
Education, counseling andEducation, counseling and
consentingconsenting
Erratum in: Am J Transplant. 2015 May;15(5):1447

13. Recipient Donor
A A or O
B B or O
AB All
O O
Transplantation 2004;78: 1693–1696)
Living DonorLiving Donor
ABO/Rh MatchingABO/Rh Matching

14. GuidelinesGuidelines

15. American Journal of Transplantation April 2015; 15: 914–922

16. ∗ Psychiatrist, psychologist or social worker
∗ For :
∗ Psychological evaluation and identification of active
mental health problems
∗ Social assessment including high risk behavior
∗ Assessment of consenting ability
PsychologicalPsychological evaluationevaluation

17. ∗History of physical examination
∗Laboratory testing
∗Identification of transmissible infection
∗Evaluating renal anatomy and function
MedicalMedical screeningscreening processprocess

18. 2014
MedicalMedical screeningscreening processprocess

19. 2014

20. Live Kidney Donor:Live Kidney Donor:
EvaluationEvaluation ChecklistChecklist
2015

21. 2014

22. 2014

23. 2014

24. 2014

25. 2014

26. 2015
Live Kidney Donor:Live Kidney Donor:
EvaluationEvaluation ChecklistChecklist

27. ImmunologicalImmunological workwork upup
•MHCMHC class I moleculesmolecules
•HLA A, B, C
•found on all nucleated cells
•MHCMHC class II moleculesmolecules
•HLA DP, DQ, DR
•Expressed on antigen presenting cells (and inducible)
•NomenclatureNomenclature
• according to the techniques “ serological or DNA
sequencing “

28. Donor RadiologicalDonor Radiological
assessmentassessment

29. USUS Chest x rayChest x ray

30. IVUIVU
∗ Kidney film 3 min.Kidney film 3 min.
∗ A KUB radiograph is obtained to assess temporalA KUB radiograph is obtained to assess temporal
symmetry and opacification.symmetry and opacification.

31. SpiralSpiral CTCT CTACTA

32. RenogramRenogram

33. Relative (split) functionRelative (split) function
ROI’sROI’s

35. Special SituationsSpecial Situations

36. An asymptomatic potential donor with history of a single
stone may be suitable for kidney donation if:
1. No hypercalciuria, hyperuricemia or metabolic acidosis.
2. No cystinuria or hyperoxaluria.
3. No urinary tract infection.
4. No multiple stones or nephrocalcinosis are evident on CT scan
LiveLive DonorDonor:
UrinaryUrinary StonesStones

37. Clin Transplant 2014: 28: 419–422
SmokingSmoking

39. 30
 Hereditary nephritis: 25/30
 Isolated C3 deposited disease: 3/30
 IgA nephropathy: 1/30
 IgM nephropathy: 1/30
Hematuria:Hematuria:
MansouraMansoura ExperienceExperience

40. HCVHCV
Nat. Rev. Nephrol. 11, 172–182 (March 2015); published online 3 February 2015;

41. ∗ Between 1993 and 2013Between 1993 and 2013  23 HCVab+/PCR- donors23 HCVab+/PCR- donors
∗ 6 recipients were +ve6 recipients were +ve
∗ 17 recipients were -ve17 recipients were -ve
∗ Mainly childrenMainly children
∗ Age of recipients ranges from 10 to 43 years (only 3Age of recipients ranges from 10 to 43 years (only 3
recipients above 30)recipients above 30)
∗ All donors were parents except 5 “ 2 brothers, 2 unclesAll donors were parents except 5 “ 2 brothers, 2 uncles
and one unrelated”and one unrelated”
Safety of usingSafety of using HCV ab +ve PCR –veHCV ab +ve PCR –ve
kidney donorskidney donors toto HCVHCV –ve–ve recipientsrecipients

42. Safety of usingSafety of using HCV ab +ve PCR –veHCV ab +ve PCR –ve
kidney donorskidney donors toto HCVHCV –ve–ve recipientsrecipients

43. MDTMDT
TransplantTransplant
NephrologistNephrologist
TransplantTransplant
SurgeonSurgeon
PathologyPathology
LabLab
RadiologistRadiologist
ImmunologyImmunology
LabLab
System