Evaluating Risk in Kidney Living Donors

Kidney donation is a safe procedure for carefully screened donors. The growing shortage of organs and improved survival rates among recipients of living donor transplants have broadened the criteria for acceptable living donors, including older individuals and those with pre-existing health conditions. Consequently, ensuring both the short- and long-term safety of living donors is of paramount importance. The primary objectives are to prevent the need for kidney replacement therapy, major cardiovascular events, or premature death. Lifelong monitoring of living donors is essential to facilitate early treatment for preventable illnesses. To this end, annual follow-up is generally recommended, which should minimally include an assessment of blood pressure, body mass index, kidney function, albuminuria, lifestyle factors, and general wellbeing. However, the management of these risk factors and treatment targets in this population remain inadequately defined. Recommendations for genetic counseling in cases of living-related donation also remain inconsistent. The aim of this mini-review is to address the challenges in evaluating the evidence on the long-term consequences of kidney donation, particularly concerning the risk of developing end-stage kidney disease, cardiovascular mortality, gestational complications, and hypertension. This article aligns with the ESOT call for action to promote living kidney donation and EKITA’s mission.