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