1. MEDICAL ASPECTS OF LIVING KIDNEY DONATION Introduction:  Kidney Tx cannot Proceed without donor.  Appropriate identification & preparation of the donors contribute in the success of the Tx in both individual and national level. Types of Kidney Donor: 1.Living Related Donors 2.Living Unrelated 3.Deceased Donors Evaluation of the Living Kidney Donors:  There are different opinion and practice in evaluation and acceptance of living kidney donors between different programs.  Two basic question are always to be considered 1. Is the potential donor at higher risk to undergo the acute surgical procedure than what would be expected? 2. What is the degree of risk on developing medical problem in the future as a result of having single kidney?

2. Informed Consent: Elements for Consent in the Living Kidney Donor Evaluation. The potential kidney donor should understand that: 1.Undergoing evaluation is not a commitment to donate, we can stop at any time. 2.The physicians may turn you down as a donor and will inform you the reason. 3.The information obtained during the course of the evaluation is confidential. 4.You will be tested for AIDS, Hepatitis and other infection. 5.There may be risks and discomfort associated with some of the test (blood draws, I.V. contrast). 6.There are potential financial costs to the donor related to time off work, travel expenses. 7.There are potential study uses the information obtained. 8.There is alternative Rx available to the recipient other than you donate a kidney to him. The Person who will give the consent of Kidney Donation should be: 1.Competent (having a decision making capacity). 2.Willing to donate, free from coercion, (pressure). 3.Medically suitable. 4.Psychosocially suitable. 5.Fully informed about the alternative Rx available to the recipient. 6.He should understand that his participation is completely voluntary and he can withdraw at any time.

3. Recommended Evaluation for a Living Donor  Requirement: 1. Complete hx and physical exam 2. Psychologist evaluation 3. Measurement of BMI (Body Mass Index) 4. Blood Pressure Measurements 5. Fasting blood sugar and fasting cholesterol 6. 24 hr urine collection for protein 7. Urine for creatinine clearance 8. Chest x-ray 9. ECG 10.Viral Serology HIV, Hepatitis B & C, HTLV, CMV, EBV and Syphilis. 11.Renal Imaging – CT Anpiogram 12.Abdomenal Ultrasound.  Optional Evaluation: These tests are performed for further evaluations if we found abnormalities in the initial studies. 1. GTT 2. Echo cardiogram 3. 24 hr BP monitoring 4. Skin Test for TB 5. Cardiac Stress Test 6. Cystoscopy 7. Renal Biopsy

4.  Which donor to choose? - Living related donors are generally preferred over unrelated donors. - If there is more than one donor in the family it is logical to select the relative who is having best match with the recipient. match with the recipient. - If the donors have the same match grade it may be advisable to choose the older donor with the thought that the younger donor still be available for donation if the first donor fails. the thought that the younger donor still be available for donation if the first donor fails. What is the Exclusion Criteria for Living Donors  Absolute Contra Indication 1. Inadequately treated Psychiatric Disease 2. Active drug or alcohol abuse 3. Evidence of Renal Disease (low GFR, Protein Urea, Hematurea) 4. Significant abnormal renal anatomy 5. Recurrent nephrolithiasis or bilateral kidney stones 6. Collagen Vascular Disease 7. DM & HTN 8. Previous MI 9. Mod to Server Pulmonary Disease 10.Cancer or hx of Cancer 11.Active infection 12.Significant Chronic Liver Disease 13.Current pregnancy

5.  Relative Contraindication 1. ABO incompatibility 2. Age 65 3. Obesity BMI >35 4. Mild HTN 5. Border line urine abnormality 6. Hx of gestational diabetes 7. Current tobacco use

6. Conclusion   Appropriate identification and preparation of the living donors contribute in the success of the transplant in both individual and national level.