2288 Volume 7 . Number 11 - 1996 The Evaluation of Living Penal Transplant Donors: Clinical Practice Guidelines1 Developed by the Ad Hoc Clinical Practice Guidelines Subcommittee of the Patient Care and Education Committee of the American Society of Transplant Physicians, Bertram L. Kasiske,2 Mark Ravenscraft, Eleanor L. Ramos, Robert S. Gaston, Margaret J. Bia, and Gabriel M. Danovitch T hese guidelines are designed to help physicians and patients in the evaluation of potential living kidney donors. Although the guidelines are meant to be comprehensive, they cannot cover every possible clinical situation. Indeed, each potential living donor is unique and It is not possible to define an evaluation process that can anticipate every possible contin- gency. Thus, these guidelines are not intended to be enforced too rigidly, nor should they replace good clinical judgment. Their limitations need to be clearly recognized. The guidelines were developed by the Ad Hoc Clini- cal Practice Guidelines Subcommittee of the Patient Care and Education Committee of the American Soci- ety of Transplant Physicians (ASTP). Work began in September 1994, and was completed in December 1995. The areas covered were arbitrarily divided into sections. Each member of the ad hoc committee was assigned to be a reviewer for one or more sections. Sources of Information included literature located using MEDLINE, bibliographies in pertinent publica- tions, personal experiences, and opinions of cob- leagues. Draft versions of the guidelines were reviewed and discussed by the committee. A consensus draft version was reviewed by the full Patient Care and Education Committee and the Board of Directors of the ASTP. Individuals who were not members of the committee, but who had published research reports and reviews of specific topics covered by the guide- lines, were also asked to review sections pertinent to their areas of expertise. Revisions were made as sug- gested by these individuals, who are listed in the acknowledgements. Because transplantation is a rap- idly changing field, some areas of these guidelines may soon become outdated. We cannot predict what new developments may affect the way in which pa- tients are evaluated for transplantation, nor can we know when such information is likely to become avail- able. However, we feel that these guidelines should be reviewed and updated in 3 yr. 1 Received January 25. 1996. Accepted May 28, 1996. 2 correspondence to Dr. B.L. Kasiske, Division of Nephrology, Hennepin county Medical center, 701 Park Avenue. Minneapolis, MN 55415. Reprint requests should be sent to the American Society of Transplant Physicians, 6900 Grove Road, Thorofare, NJ 08086-9447. 1046-6673/071 1-2288$03.00/0 Journal of the American society of Nephrology copyright © 1996 by the American society of Nephrology This document is divided into sections: ( 1 ) an over- view algorithm with annotations; (2) a detailed algo- rithm; (3) annotations for specific steps in the detailed algorithm: and (4) references cited in the annotations. The algorithm is designed to be followed in sequence, as suggested by the arrows. Hexagons contain specific questions to be answered, rectangles contain sug- gested actions, and rounded rectangles enclose direc- tions for moving between sections. None of the actions suggested in the algorithm should be taken without careful review of the corresponding annotations. The numbers of the specific annotations correspond to the numbers in the algorithm enclosures. OVERVIEW ANNOTATIONS This is an overview of the more detailed algorithm that follows. The detailed algorithm is designed to present, In a comprehensive manner, the major Issues involved in the evaluation of potential living donors. Above all, this evaluation should ensure that the potential donor is both willing and able to donate a kidney. The sequence of the evaluation was chosen to maximize the probability that expensive and invasive tests would only be performed after other measures failed to exclude a potential donor. However, the exact order of the evaluation will need to be adapted to the specific situation unique to each individual patient and transplant center. Blood typing, which is relatively inexpensive, is often the first test obtained in the evaluation of a living donor. If the donor has a blood type that is incompat- ible with that of the recipient, there is no need for further evaluation. Indeed, the ABO blood group bar- rier has only rarely been crossed in renal transplan- tation ( 1-3). Many centers also perform a cross-match as part of the initial evaluation to obviate the need for further work-up if an individual has a positive cross- match. If the potential donor and recipient are blood group compatible and cross-match negative, a prelim- mary medical evaluation can then be carried out. If the donor is not excluded on the basis of this prelim- mary assessment, a more extensive evaluation is then performed. In the end, a renal angiogram is obtained and a final cross-match is carried out just before transplant surgery. Ensuring the safety and well-being of the potential