Pre-transplant protocol
Before a living related donor can be considered, he/she must undergo a rigorous evaluation to ensure that donating a kidney will not be a threat to the donor’s health. While it is preferable to transplant a kidney from a younger person (e.g., sibling who has reached the age of majority, a parent), kidneys have been taken from healthy older donors with only modest reduction in graft survival. One advantage of being able to schedule the transplant is that it permits the initiation of immunosuppressive medications prior to the transplant. Children need to achieve a weight of about 15 pounds before most centers will proceed. To do otherwise increases the risk of surgical mishap in suturing the child’s vessels to those of the much larger donor kidney. There is also an increased risk of losing the graft to vessel thrombosis.
Previously, kidneys from cadaveric donors (CAD) were considerably inferior to those from living related donors. With today’s potent anti-rejection medications, however, graft survival is approaching that of LRD kidneys with a one-year graft survival rate of 95 percent with LRD vs. 90 percent with CAD. Although efforts are made to be sure that the cadaveric kidney is healthy and ABO compatible, there have been rare reports of cancer transmission from donor kidney to recipient. Also, about a half of potential donors have inactive Cytomegalovirus (CMV) that can become active in immunocompromized recipients. Since CMV infection can be treated, the question of whether or not to accept such a kidney depends on the urgency of transplanting a patient.