Gentil Govantes Miguel Ángel, Pereira Palomo Porfirio
Unidad de Gestión Clinica de Urologia y Nefrologia, Hospital Universitario Virgen del Rocio, Sevilla.
Nefrologia. 2010;30 Suppl 2:47-59. doi: 10.3265/Nefrologia.pre2010.Nov.10691.
Donor protection should always be taken account during the selection and assessment of a living donor. On these terms, the evaluation of a potential donor must include these issues: 1) The donor act is altruistic, consciousness and out of coercion; 2) Life expectancy and quality of life of the recipient will improve after the living donor kidney transplantation; 3) The donor has normal renal function and the potential risk of developing nephropathy in the long term follow up is scarce (familiar nephropathies and other processes that may increase the potential risk for renal disease in the future, like severe hypertension, diabetes, etc must be ruled out). The glomerular filtrate should meet criteria for the normal function corresponding to age furthermore the absence of proteinuria and urine smear is normal; 4) The screening in the donor should contemplate those clinical situations or diseases non related to the kidney function but might elevate the surgical and/or anesthesia risk besides disease transmission to the recipient (as neoplasia or infections); 5) The surgical act is possible without technical difficulties and always performed after a negative result of the crossmatch between donor and recipient. The living donor evaluation process will follow a different schedule based on each particular case and the center facilities. Any case, the mentioned process is divided in two parts: The first one contains an initial screening (using non invasive and low cost tests) that allows discarding contraindications for donation (in both donor and recipient). In a second phase the assessment of the donor varies with donor characteristics. However, a test for renal function is mandatory besides imaging techniques (like angioTC), screening for transmissible diseases and a detailed evaluation for psychosocial aspects preferably made by professional. Moreover Spanish policy on living donation requires a report with information about the consent for donation developed by an independent board (ethics committee) besides the consent for donation given at the civil registry.
在选择和评估活体供体时，应始终考虑供体保护。基于这些条件，对潜在供体的评估必须包括以下问题：1）供体行为是利他的、出于自觉且非受胁迫的；2）活体供肾移植后受者的预期寿命和生活质量将得到改善；3）供体肾功能正常，且在长期随访中发生肾病的潜在风险很小（必须排除家族性肾病和其他可能增加未来患肾病潜在风险的情况，如严重高血压、糖尿病等）。肾小球滤过率应符合相应年龄正常功能的标准，此外无蛋白尿且尿涂片正常；4）对供体的筛查应考虑那些与肾功能无关但可能增加手术和/或麻醉风险以及疾病传播给受者的临床情况或疾病（如肿瘤或感染）；5）手术操作可行且无技术困难，并且总是在供体和受体交叉配型结果为阴性后进行。活体供体评估过程将根据每个具体病例和中心设施遵循不同的时间表。任何情况下，上述过程分为两个部分：第一部分包含初步筛查（使用非侵入性和低成本检测），以排除捐赠的禁忌证（供体和受体双方）。在第二阶段，根据供体特征对供体进行评估。然而，除了成像技术（如血管CT）、传染性疾病筛查以及最好由专业人员进行的详细社会心理方面评估外，肾功能检测是必需的。此外，西班牙关于活体捐赠的政策要求除了在民事登记处给予的捐赠同意书外，还需一份由独立委员会（伦理委员会）编制的关于捐赠同意信息的报告。
