Living Kidney Donation: A Practical Guide

Contents
1: Introduction
References
2: Living Kidney Recipient Outcomes
Background
Donor Demographics
Surgical Approaches and Early Hospital Utilization and Outcomes
Donor Procedures
Recipient Procedures
Recipient Survival
Recipient Demographics
Recipient Comorbidities
Allograft Survival
Immunological Factors Affecting Allograft Survival
Vascular Complexity and Allograft Survival
Donor Laterality and Allograft Survival
Repeat Transplantation with Living Donor Kidneys
Relationship to Recipient
Quality of Life after Living Donor Kidney Transplantation
Access to Living Donor Kidney Transplantation
References
3: Living Donor Activity
Global Perspective
Living Donation in Developing Countries
Africa
Asia
Central and Eastern Europe
Latin America
The Middle East
Conclusion
References
4: Psychology of Living Kidney Donation
Introduction
Psychological Screening
Motivation and Decision-Making
Relationship with the Recipient
Social Support
Experience of Donation and Satisfaction with the Donation
Mental Health Outcomes
Conclusions
References
5: The Ethics of Living Donation
Introduction
Key Ethical Principles in Living Donor Transplantation
Categories of Living Donors
Ethics of Living Donation: Clinical Cases
Spotting Coercion
Practical Guidance
Misattributed Paternity
Practical Guidance
Recipient Confidentiality
Practical Guidance
Altruistic Donation and Risk
Practical Guidance
The Broken Chain
Practical Guidance
Kidney Vouchers
Practical Guidance
Soliciting for Donors on Social Media
Practical Guidance
Keeping it in the Community
Practical Guidance
The Paid Donor
Practical Guidance
Conclusion
References
6: Histocompatibility in Live Donor Kidney Transplantation
Impact on Histocompatibility of Kidney donor and Recipient on Allograft Patency
ABO- System (from Landsteiner to Now)
HLA-System (from Jean Dausset to NGS)
HLA Nomenclature from Broad and Split Levels to Allelic Specificity
Tissue Typing
Allorecognition
Epitope Concept in Humoral Alloimmunity
nonHLA Alloantigens
References
7: Barriers to Living Kidney Donation
Socio-Ecological Model
Individual Level Barriers to Living Kidney Donation
Transplant Candidates
Potential Donors
Healthcare Providers
Interpersonal Barriers to Living Kidney Donation
Recipient-Donor-Family
Recipient-Donor-Family
Healthcare Provider Judgement and Communication
Cultural Competency
Risk Threshold
Institutional, Organizational and Community Level Barriers to Living Kidney Donation
Healthcare System
Assessment Pathway
Socio-Cultural Barriers to Living Kidney Donation
Culture
Religion
Public Policy Barriers to Living Kidney Donation
Healthcare Funding and Reimbursement Policies
National Policy and Legislation
Conclusion
References
8: Medical Evaluation of Potential Living Kidney Donors
Purpose of Assessment
Short-Term
Medium-Term
Long-Term
Principles of Assessment
Suitability for General Anaesthetic/Surgery
Suitability to Be Left with a Single Kidney
Suitability of Kidney for Transplant into Recipient
Practicalities of Assessment
Process
Health Questionnaire
Investigations
Psychology
Personnel
Proportion Proceeding
Pitfalls in Assessment
Predictions
Paternalism
Conclusion
References
9: Surgical Assessment of Potential Living Kidney Donors
Introduction
Past Medical History
Investigations for Surgical Assessment
Anatomical Considerations
Surgical Considerations of Donor Outcomes
Surgical Considerations of Recipient Outcomes
Consent Process
Surgical Listing: Multidisciplinary Team (MDT) Approach
Conclusion
References
10: High-Risk Living Kidney Donors
Introduction
Human Immunodeficiency Virus (HIV)
Hepatitis B
Hepatitis C
Previous Cancer
Elevated Cardio-Metabolic Risk
Conclusion
References
11: Contraindications to Living Kidney Donation
Age
Obesity
Hypertension
Inadequate Pre-Donation Kidney Function
Risk for Future Kidney Disease
Diabetes Mellitus
Likelihood of Inheritable Kidney Disease
Albuminuria
Haematuria
Two Apolipoprotein L1 Risk Alleles
Nephrolithiasis
Chronic Illness
Anatomical Anomalies Including Multi-Vascularity
Active or Transmittable Infection
Active, Recent or Incompletely Treated Cancer
Uncontrolled Psychiatric or Psychosocial Conditions Including Active Substance or Alcohol Misuse
Current Pregnancy
Conclusion
References
12: Live Donor Nephrectomy: Current Techniques and Safety Profiles
Introduction to Live Donor Kidney Transplantation
Principles of Live Kidney Donation
Evolution in Practice
Types of Live Donor Nephrectomy
Open Surgical Techniques
Open Live Donor Nephrectomy (ODN)
Classical Lumbotomy
Anterior Subcostal Extraperitoneal Donor Nephrectomy
Open Transperitoneal Donor Nephrectomy
Minimally Invasive Techniques
Mini-open Live Donor Nephrectomy (MODN)
Outline of Operative Technique
Laparoscopic Transperitoneal Live Donor Nephrectomy (LTDN)
Outline of Operative Technique
Hand Assisted Laparoscopic Donor Nephrectomy (HALDN)
Outline of Operative Technique
Retroperitoneoscopic Donor Nephrectomy (RDN)
Outline of Operative Technique
Hand Assisted Retroperitoneoscopic Donor Nephrectomy (HARDN)
Outline of Operative Technique
Laparoendoscopic Single Site Surgery (LESS)
Outline of Operative Technique
Robot Assisted Laparoscopic Donor Nephrectomy (RADN)
Outline of Operative Technique
Natural Orifice Transluminal Endoscopic Surgery (NOTES)
Outline of Operative Technique
Geographical Variations in Techniques
Safety Profiles
General Principles
Split Function in Determining Choice of Kidney
Vascular Multiplicity
Previous Abdominal Surgery
Vascular Management of the Renal Hilum
Body Mass Index (BMI)
ODN
Safety Aspects of ODN
Safety Profiles of Minimally Invasive Techniques
ODN vs. LDN
Left Versus Right Kidney in LDN
Hand-Assisted Versus Non-hand-assisted Live Donor Nephrectomy
LESS and NOTES
LESS
NOTES
Transperitoneal vs. Retroperitoneal Live Donor Nephrectomy
Right Versus Left Using the Retroperitoneal Approach
Robotic Surgery
Training Challenges (Table 12.2)
Principles of Training (Fig. 12.12)
Planning for Intraoperative Emergencies
Recovery
Cosmesis
Enhanced Recovery After Surgery (ERAS)
Conclusion
References
13: Anaesthetic Considerations and Post-operative Care of Living Kidney Donors
Pre-operative Considerations
Fasting
Intra-operative Considerations
Considerations in Robotic Surgery
Anaesthetic Technique
Stress Response
Antibiotic Prophylaxis
Positioning Considerations
Fluid Therapy
Post-operative Considerations
Analgesia
Thromboprophylaxis
General Post-operative Ward Management
Conclusion
References
14: Post-donation Haemodynamic Consequences
Introduction
Mortality and Cardiovascular Events
Hypertension
Pre-eclampsia and Gestational Hypertension
Arterial Stiffness
Cardiac Structure and Function
Conclusion
References
15: Long-Term Outcomes for Living Donors
Introduction
Mortality and Cardiovascular Disease
End-Stage Kidney Disease
Hypertension
Proteinuria
Preeclampsia
Other Outcomes
Practical Consequences of Long-Term Risks for the Evaluation of Donors
Consequences for Donor Selection
Future Research
Conclusion
References
16: Strategies to Increase Living Kidney Donation
Introduction
Increase the Number of Potential Donors
Increase the Number of Screened Donors
Provide Education About LDKT
Address the Transplant Candidate Psychosocial Barrier
Provide Culturally Competent Education
Increase the Number of Evaluated Donors
Increase the Number of Approved Donors
Increase the Number of Living Kidney Donors
Improve Post-Donation Follow-Up, Care, and Data Collection
Conclusion/Summary
References
17: Conclusion
Index