Not surprisingly, researchers are still debating living kidney donors’ risk of end stage renal disease or kidney failure. The two most damning studies say that LKDs have an 8-11x increased risk ESRD as compared to their well-matched, two-kidneyed counterpart. Of course, the pro-living donor people tried to minimize these findings, calling it a “modest” 1% absolute lifetime risk. The fact that most people, meaning the public, has no idea what that really means, certainly helps in their information manipulation.
Steiner agrees that the prior studies’ findings are not absolute, but only because they tend to lump all living kidney donors together as a monolith. He asserts that certain classes of kidney donors assume a much *hgher* risk of end-stage renal disease than previously stated. If the risk of ESRD is due to the loss of nephrons at the time of donation (the conclusion of the aforementioned research) then LKDs under the age of 35 have a much *higher* risk than those older than 35, because they’re living more of their life without a Renal Reserve. Their already reduced nephrons will be damaged and become dysfunctional through disease, damage, toxins and age.
He also states that African-American donors and those with lower pre-donation GFRs are at a higher than previously stated risk. African-American folks have a much higher incidence of diabetes, the largest cause of kidney failure in the US, so this squares with all other data.
Too many transplant centers are still using the “one size fits all” pre-donation GFR cut-off, which severely harms LKDs who fall on the lower end of the spectrum. In 2010, a Consensus document on LKD medical evaluation called for a predonatoin GFR based on sex, age and Body Surface Area, but the members of OPTN (transplant centers and others who profit from transplant) removed it from the proposal. Steiner advocates a much higher predonation GFR cut-off, and utilizing older donors with minor medical abnormalities.
Steiner, R. (2016). Moving closer to understanding the risks of living kidney donation Clinical Transplantation, 30 (1), 10-16 DOI: 10.1111/ctr.12652