Survey of The Suitability and Acceptance of The Marginal live Kidney Donors Among Nephrologists & Transplant Surgeons

Survey of The Suitability and Acceptance of The Marginal live Kidney Donors:

Dear Colleague,

We would like to invite you to participate in a short survey about the suitability and acceptance of living kidney donors in certain challenging conditions. Most of these conditions are in the grey zone, where there are no clear guidelines or consensus toward them.The purpose of this survey is to form a consensus about the evaluation of marginal live kidney donor.
Participation is voluntary.

This survey is for nephrologists and transplant surgeons. Please do NOT complete the survey If you are NOT a practicing (nephrologist or transplant surgeon) or if you are still in training.

Please choose the best option for the given scenarios.

Thanks in advance.

On behalf of the research group

Ziad Arabi, MD

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This is not an AST/ ASTS survey but an external study which is approved by the institutional review board at King Abdulaziz Medical City in Riyadh, KSA. “ERA-EDTA’s endorsement is for the promotion of education in general, therefore the specific content of the survey is the responsibility of the organizer”. ASTS’ role is also limited to facilitating the distribution of the survey. For inquiries, please feel free to contact Dr. Ziad Arabi: arabizi@ngha.med.sa. Your answers are anonymous, and the data, if reported in a publication, will be shown in aggregate form only. Your participation serves as your consent.
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Question Title

* 1. The donor is obese (BMI 30-35) with normal (fasting blood sugar and hemoglobin A1C) and no family history of diabetes):

I will allow this donor to donate now if the donor is intending to lose weight later.

I will allow this donor to donate once he/ she demonstrates some weight loss.

I will NOT consider this donor to donate until he achieves a BMI: 30.

I will NOT consider this donor to donate until he achieves a BMI: 25.

I will deny this donor because obesity is a chronic problem and relapse is likely.

Question Title

* 2. The donor is obese and has a strong family history of diabetes (but normal fasting blood sugar and hemoglobin A1C):

I will allow this donor to donate now if the donor is intending to lose weight later.

I will allow this donor to donate once he/ she demonstrates some weight loss.

I will NOT consider this donor to donate until he achieves a BMI: 30.

I will NOT consider this donor to donate until he achieves a BMI: 25.

I will deny this donor because obesity is a chronic problem and obese donors tend to regain weight after donation.

Question Title

* 3. The donor is morbidly obese (BMI 36-40) with normal fasting blood sugar, hemoglobin A1C and Negative family history of diabetes

) I will allow this donor to donate now if the donor is intending to lose weight later.

I will allow this donor to donate once he/ she demonstrates some weight loss.

I will NOT consider this donor to donate until he achieves a BMI: 30.

I will NOT consider this donor to donate until he achieves a BMI: 25.

I will decline this donor because obesity is a chronic problem and obese donors tend to regain weight after donation.

Question Title

* 4. The donor is obese and has impaired fasting blood sugar:

I will allow this donor to donate now but the donor needs to lose weight later and to follow his/her blood sugar.

I will allow this donor to donate once impaired BS is resolved due to some weight reduction.

I will allow this donor to donate once impaired BS is resolved and BMI is below 30 due to weight reduction.

I will allow this donor to donate once impaired BS is resolved and BMI is below 25 due to weight reduction.

I will decline this donor because this donor is at high risk to develop diabetes.

Question Title

* 5. A young donor with normal weight and normal fasting blood sugar but mildly elevated Hgb A1C (e.g. Hgb A1C = 5.7- 6)

I will allow this donor to donate now after giving him/her the appropriate advice to manage pre-diabetes.

I will repeat A1C in 3 months and I will decline the donor if still elevated.

I will ask for 2 hrs. GTT and I 'll decline the donor if both GTT and HbA1C are elevated.

I will decline this donor donate due to his/her A1C and young age.

Question Title

* 6. A young donor with normal weight and normal Hgb A1C but impaired fasting blood sugar:

I will allow this donor to donate now after giving him/her the appropriate advice to manage pre-diabetes.

I will repeat A1C in 3 months and I will decline the donor if still elevated.

I will ask for 2 hrs. GTT and I 'll decline the donor if both GTT and HbA1C are elevated.

I will decline this donor donate due to his/her impaired fasting sugar and young age.

Question Title

* 7. A middle age (e.g. 55 years old) donor with diabetes for one year and controlled with monotherapy and diet.

I will allow this donor to donate now.

I will allow this donor to donate if his diabetes gets controlled without any medication (with diet only).

I will advise him against donation, but I may allow him/her to donate if no alternative donor is available.

I will not clear this donor to donate even if there is no alternative living- donor is available.

Question Title

* 8. The donor is post-gastric sleeve due to morbidly obesity (BMI 36-40) and his diabetes has resolved with weight loss:

I will accept this donor for immediate donation (once surgically doable).

I will consider this donor for donation once BMI is below 30.

I will consider this donor for donation once BMI is down to 25.

I will consider this donor for donation if two years passed after bariatric surgery without obesity relapse.

I will not consider this donor for donation.

Question Title

* 9. Just turned 18 -years-old woman wants to donate her older sibling:

I will accept her for donation after counselling her about the increased risks of preeclampsia after donation.

I will advise her not to donate because of the increased risk of preeclampsia but I will allow her to donate if she insists and accepts the risks.

I will not consider her for donation at this age.

Question Title

* 10. Just turned 18- years- old man who wants to donate his older sibling:

I allow him to donate after counselling him about the future risk after donation.

I will advise him not to donate because of his young age and the future risks of CKD and ESRD.

I will not consider him for donation at this age.

Question Title

* 11. 18- years- old man wants to donate to his 75-year-old father.

I allow him to donate after counselling him about the future risk after donation.

I will advise him not to donate because of the CKD risk and since the recipient might not get the mortality benefit given his age.

I will not consider him for donation under the current age and circumstances.

Question Title

* 12. Donor > 65 years- old- man to 18-years old recipient and expected prolonged waiting time for deceased donor:

I allow him to donate after counselling.

I will advise him to find a younger donor, but I will allow the donation if no alternative donor is available.

I will not consider him for donation at this age.

Question Title

* 13. The donor is multiparous women with mild and controlled hypertension (only on one blood pressure medication). She is NOT planning to have more children.

I allow her to donate after counselling her about the future risk after donation.

I will advise her not to donate but I will allow the donation if no alternative donor is available.

I will DECLINE this donor.

Question Title

* 14. The donor is primiparous women with mild and controlled hypertension (only one blood pressure medication). She is considering having children later.

I allow her to donate after counselling her about the future risk after donation.

I will advise her not to donate but I will allow the donation if no alternative donor is available.

I will DECLINE this donor.

Question Title

* 15. A 20 years old man with high blood pressure readings at the office and a non- dipping pattern at night on his 24 hrs. ambulatory blood pressure monitoring which is otherwise normal.

I allow him to donate after counselling.

I will advise him not to donate. However, I will allow the donation if no alternative donor is available.

I will DECLINE this donor.

Question Title

* 16. The donor is 35 yrs. old man non-smoker with isolated microscopic hematuria (4 RBC on repeated UA and trace hematuria on dipstick) and negative imaging.

I will allow this donor to donate without further testing.

I will ask for a renal biopsy.

I will ask for an alternative donor to avoid the hassle of kidney biopsy which may not change the management.

Question Title

* 17. The donor is an active smoker (2 PPD):

I will allow him to donate however he needs to quit smoking later.

I will advise him not to donate but I will allow the donation if no alternative donor is available.

I will DECLINE this donor.

Question Title

* 18. If the donor admits the use of illegal drugs intermittently (last use 2 months ago)

I will allow him to donate after psychiatric counselling.

I will advise him not to donate but I will allow the donation if no alternative donor and only after psychiatric counselling.

I will DECLINE this donor.

Question Title

* 19. A donor with sickle cell trait

I will clear him for donation after counselling.

I will advise him against donation. However, I will allow the donation if no alternative donor is available.

I will not clear him.

Question Title

* 20. A 40- years- old donor with a stable 5cm simple cyst of the left kidney:

I will allow him to donate his left kidney after counselling.

I will allow him to donate his right kidney after counselling.

I will advise him against donation. However, I will clear him if no alternative donor.

I will DECLINE this donor.

Question Title

* 21. Donor with 2 mm stone in the lower pole of the left kidney seen on CT scan otherwise asymptomatic:

I will allow him to donate his left kidney after counselling.

I will allow him to donate his right kidney after counselling.

I will advise him against donation. However, I will clear him if no alternative donor.

I will DECLINE this donor.

Question Title

* 22. A 30-years-old man with a history of a single episode of left renal colic 5 years ago. His current CT scan and urine collection are negative:

I will allow him to donate his left kidney after counselling.

I will allow him to donate his right kidney after counselling.

I will advise him against donation. However, I will clear him if no alternative donor.

I will DECLINE this donor.

Question Title

* 23. A donor with normal ultrasound but nuclear renogram showed a discrepancy of renal functions (split GFR of 30% in the right and 70% in the left):

I will allow him to donate his left kidney after counselling.

will allow him to donate his right kidney after counselling.

I will advise him against donation. However, I will allow the donation if no alternative donor is available.

I will DECLINE this donor.

Question Title

* 24. If the recipient has a low level donor- specific antibody against this donor (MFI <1000):

I will proceed with transplantation without desensitization.

I will refer the couples for desensitization.

I will refer the couples for a paired- exchange program.

I will advise him not to donate but I will allow the donation if no alternative donor is available.

Question Title

* 25. If the donor with incompatible blood group (ABO)

Refer now with desensitization protocol.

Refer now for paired-exchange program.

Add to deceased donor list and refer to paired-exchange program only if the expected waiting time on DD list exceeds 2 years.

Add to deceased donor list and refer to paired-exchange program only if the expected waiting time on DD list exceeds 5 years.

Ask for an alternative donor.

Question Title

* 26. If an 18- years- old wants to donate to his brother (40 years old) and with a family history on two uncles with unknown etiology of ESRD at 40 years. Donor evaluation is normal otherwise.

I will clear him to can donate after counselling.

I will advise him against donation. However, I will allow the donation if no alternative donor is available.

I will not clear him.

Question Title

* 27. An 18-years-old wants to donate to his mother 40 years and with a family history on two uncles with ESRD at 40 years. Donor evaluation is negative otherwise. He understands the risks of donation, but he insists to donate to his mother since he is the only available donor.

I will clear him to can donate after counselling.

I will advise him against donation. However, I will allow the donation if no alternative donor is available.

I will not clear him.

Question Title

* 28. I am:

A nephrologist.

A transplant surgeon.

Question Title

* 29. How many years have you been in practice:

<1 year

1-5 years

6-10 years

more than 10 years.

Question Title

* 30. Do you assess donors for pre- transplant workup?

On a weekly basis.

On a monthly basis.

Not on a regular basis.

I don’t do donor assessment.

Question Title

* 31. Do you assess recipients for pre- transplant workup?

On a weekly basis.

On a monthly basis.

Not on a regular basis.

I don’t do a pre-transplant assessment but I see post -renal transplant patients.

I don’t do a pre-transplant assessment and I do not follow renal transplant patients.

Survey of The Suitability and Acceptance of The Marginal live Kidney Donors Among Nephrologists & Transplant Surgeons