Welcome to ISN

  COMGAN : Articles : Consensus Statement of the Amsterdam Forum

The Consensus Statement of the



on the Care of the Live Kidney Donor


Kidney transplant physicians and surgeons met in


, the


, from

April 1-4, 2004

for An International Forum on the Care of the Live Kidney Donor. Forum participants included over 100 experts and leaders in transplantation, representing over 40 countries from around the world, including















New Zealand

, North and

South America




Saudi Arabia





, and




The objective of the Forum was to develop of an international standard of care for the live donor with a position statement regarding the responsibility of the transplant community for the live kidney donor. The international transplant community recognizes that the use of kidneys from the living donor needs to be performed in a manner that will minimize the physical, psychological and social risk to the individual donor, maximizes the benefit to the recipient and does not jeopardize the public trust of the healthcare community. The donation decision should be performed in an environment that enables the potential donor to decide in an autonomous manner.


Because of the need for more transplantable kidneys, persons with conditions that may increase the health risks to potential donor and/or recipient are currently being considered and used as donors. The international transplant community recommends that the acceptance of such individuals as kidney donors be conducted in an ethical manner, accounting for the autonomy and safety of the donor and with rigorous attention to clinical outcomes.


In view of these considerations, the following recommendations were adopted:


Prior to live kidney donation, the donor must receive a complete medical and psychosocial evaluation to include:

  • quantification (as available) and assessment of the risk of donor nephrectomy on the individualпїЅs health, subsequent renal function, psychological and social consequences (including employability);

  • the suitability of the donorпїЅs kidney for transplantation to the recipient (anatomy, function, and risk for transmissible disease).


Prior to live kidney donation, the donor must be informed of:

  • the nature of the evaluation process;

  • the results and consequences/morbidity of testing and the possibility that conditions may be discovered that will impact the healthcare, insurability and social status of the potential donor;

  • the probable risks of operative donor nephrectomy, as assessed after the complete evaluation. These should include, but not be limited to the risk of death, surgical morbidities, changes in health and renal function, impact upon insurability/ employability and unintended effects upon family and social life;

  • the responsibility of the individual and health and social system in the management of discovered conditions;

  • the expected transplant outcomes (favorable and unfavorable) for the recipient and the specific recipient conditions which may impact upon the decision to donate the kidney.


Disclosure of recipient specific information must have the assent of the recipient.


The donor should be informed of alternative renal replacement therapies available to the potential recipient.


The donor should be capable of understanding the information presented in the consent process.


The donor should make a voluntary decision:

  • be free to withdraw from the donation process at any time.

  • be assured that medical and individual reasons for not proceeding with donation will be kept confidential.

  • should not be subjected to adverse pressures to donate.


After kidney donation the transplant center is responsible to:

  • oversee and monitor the postsurgical recovery process of the donor until that individual is stable.

  • encourage and facilitate the long-term follow-up and treatment of the kidney donor with preexisting or acquired conditions (related to uni-nephrectomy) that are thought to represent a health risk (such as, but not exclusive to, hypertension, obesity, diabetes, proteinuria). In the absence of an established follow-up process for individuals with preexisting conditions that may possibly place the donor at health risk), organ donation should be avoided.

  • identify and track complications that are important for informed consent disclosure.
    The center should work with the general healthcare community to provide optimal care/surveillance of the living kidney donor.


Consensus Caveats:

A donor advocate:

In order to minimize the appearance of a пїЅconflict of interestпїЅ, transplant centers should make efforts to assure that the medical and psychosocial assessment and the decision to donate incorporates health care professional(s) not involved in the care of the recipient. The concept of this recommendation is to provide a health care professional advocating the welfare of the potential donor.


Procedural safeguards should be utilized and explored to minimize coercion/ambivalence and enhance the probability of an autonomous decision, for example пїЅcooling off periodпїЅ and assessment of donor retention of information.


Medical judgment versus donor autonomy:

Donor consent and autonomy is necessary but not sufficient to proceed to kidney donation.
Medical evaluation and concurrence is essential. Donor autonomy does not overrule medical judgment and decision making.


Minors as donors:

Minors less than 18 years of age should not be used as living kidney donors.


Donor Registry:

An international registry for пїЅsentinel eventsпїЅ after living kidney donation (death, or the need for dialysis or kidney transplantation by the donor) should be established and maintained. Appropriate prospective research should be performed on the long-term outcomes of donors considered to be at potential increased risk for adverse outcomes.



The Forum was convened by the Ethics Committee of The Transplantation Society, administered by the National Kidney Foundation U.S, and sponsored by the following: Novartis Transplantation and Immunology; Fujisawa Healthcare, Inc.; Roche Pharmaceuticals; Genzyme Corporation; Wyeth Pharmaceuticals; the International Society of Nephrology, the National Kidney Foundation of Singapore; and The Transplantation Society.




1.Ghods A J:Renal transplantation in Iran, Nephrol Dial Transplant 17 : 222, 2002.

2.No evidence of accelerated loss of kidney function in living kidney donors: results from a cross-sectional follow-up. Fehrman-Ekholm I, Duner F, Brink B, Tyden G, Elinder CG. Transplantation. 2001 Aug 15;72(3):444-9.

3.Kidney donors live longer. Fehrman-Ekholm I, Elinder CG, Stenbeck M, Tyden G, Groth CG. Transplantation. 1997 Oct 15;64(7):976-8.

4.Morbidity and mortality after living kidney donation, 1999-2001: survey of United States transplant centers.. Matas AJ, Bartlett ST, Leichtman AB,  Delmonico FL. Am J Transplant. 2003 Jul;3(7):830-4

5.Pregnancy after donor nephrectomy. Buszta C, Steinmuller DR, Novick AC, Schreiber MJ, et al and  Braun WE. Transplantation. 1985 Dec; 40(6): 651-4.

6.Pregnancy after donor nephrectomy.  Wrenshall LE, McHugh L, Felton P, Dunn DL, Matas AJ. Transplantation. 1996 Dec 27; 62(12): 1934-6.

7.Living kidney donors in need of kidney transplants: a report from the organ procurement and transplantation network. Ellison MD, McBride MA, Taranto SE, Delmonico FL, Kauffman H.  Transplantation. 2002 Nov 15;74(9):1349-51.

8.Terasaki PI, Cecka JM, Gjertson DW, Takemoto S.  High survival rates of kidney

transplants from spousal and living unrelated donors.  N Engl J Med.1995; 333:  333-336. 

9.Ozdemir FN, Guz G, Sezer S, Arat Z, Haberal M. Ambulatory blood pressure monitoring in potential renal donors. Nephrol Dial Transplant. 2000 15(7):1038-40.

10.Textor SC, Taler SJ, Larson TS, Prieto M, Griffin M, Gloor J, Nyberg S, Velosa J, Schwab T, Stegall M. Blood pressure evaluation among older living kidney donors. J Am Soc Nephrol. 2003 Aug;14(8):2159-67.

11.Praga  KI 2000;58:2111

12.K/DOQI clinical practice guidelines for chronic kidney disease: evaluation,  classification, and stratification. Am J Kidney Dis 2002;39(2 Suppl 1):S1-266.

13.Lindeman RD, Tobin J, Shock NW. Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc 1985;33:278-285.

14.Rule AD, Gussak HM, Pond GR, Bergstralh EJ, Stegall MD, Cosio FG, et al.  Measured and estimated GFR in healthy potential kidney donors. Am J Kidney Dis 2004;43(1):112-9.

15.Flanigan WJ, Burns RO, Takacs FJ, Merrill JP. Serial studies of glomerular filtration rate and renal plasma flow in kidney transplant donors, identical twins, and allograft recipients. Am J Surgery 1968;116:788-794.

16.Velosa JA, Griffin MD, Larson TS, Gloor JM, Schwab TR, Sterioff S, et al. Can a  transplanted living donor kidney function equivalently to its native partner? Am J Transplant 2002;2:252-259.

17.Rodriguez-Iturbe B, Herrera J, Marin C, Manalich R. Tubular stress test detects  ubclinical reduction in renal functioning mass. Kidney Int 2001; 59:1094-1102.Silveiro SP, da Costa LA, Beck MO, Gross JL. Urinary albumin excretion rate and glomerular filtration rate in single-kidney type 2 diabetic patients. Diabetes Care. 1998 9:1521-4.


Risk estimate references


Bia MJ, Ramos EL, Danovitch GM, et al:
Evaluation of living renal donors.
Transplantation 60:322-327, 1995



Renal Data System: Excerpts from the USRDS 2000 Annual Data Report: Atlas of End Stage Renal Disease in the

United States

Am J Kidney Dis
3S:S1-S239 (sup 2) Dec 2000


Hyman DJ, Pavlik VN.
Characteristics of patients with uncontrolled hypertension in the

United States

NEJM 345:7, 479-486, 2001


Schlessinger SD, Tankersley MR, Curtis JJ.
Clinical documentation of end-stage renal disease due to hypertension.
Am J of Kid Dis, 23L:5, 655-660, May 1994


Klag MJ et al. Blood pressure and end-stage renal disease in men.

N Engl

J Med, 1996. 334 (1): p 13-18.


Tomson C, Porter T.
Asymptomatic microscopic or dipstick hematuria in adults: which investigations for which patients?
A review of the evidence.
BJU Int, 90:3, 185, August 2002.


Abuelo JG: The diagnosis of hematuria.
Arch Intern Med 143:967-970, May 1983


From P, Gross M, Ribak J, et al.
The effect of age on the prevalence of asymptomatic microscopic hematuria.
Am J Clin Pathol, 86:5, 656-7, November 1986.


Froom P, Ribak J, Benbassat J.
Significance of microhematuria in young adults.
Brit Med J, 288:20-2, January 1984.


Topham PS, Harper SJ, Furness PN, et al.
Glomerular disease as a cause of isolated microscopic hematuria.
Q J of Med, 87:329-335, 1994


McGregor DO, Lynn KL, Bailey RR, et al.

Clinical audit of the use of renal biopsy in the management of isolated microscopic hematuria.
Clin Nephrol, 49:6, 345-8, June 1998.


Response to email inquiry, USRDS 2002 at


, November 2002


Iseki K, Ikemiya Y, Iseki C, Takashita S, Proteinuria and the risk of developing end stage renal disease. Kidney Int. 2003; 63:1468-74.


Glowacki LS, Beecroft ML, Cook RJ, et al.
The natural history of asymptomatic urolithiasis.
J of Urology, 147: 319-321, Feb 1992




: Evaluation of hematuria in adults.
West J Med 152:305-308, Mar 1990


Kannel WB, Stampfer MJ, Castelli WP, Verter J: the prognostic significance of proteinuria: The Framingham study.
Am Heart J 1347-1352, Nov. 1984


Diehl HS,



: Albuminuria in college men.
Arch Int Med 45-55, 1931


Levitt JI: The prognostic significance of proteinuria in young college students.
Ann Int Med 66:4:685-696, Apr 1967


Kasiske BL, Ma JZ, Louis TA, Swan SK.
Long-term effects of reduced renal mass in humans.
Kidney Int. 1995 Sep; 48(3):814-9.


Kiberd BA, Clase CM.
Cumulative risk for developing end-stage renal disease in the


J Am Soc Nephrol 13: 1635-1644, 2002


Steiner RW, Gert B.
A Technique for Presenting Risk and Outcome Data to Potential Living Renal Transplant Donors.
Transplantation 2001, 71:8, 1056-1057.


Steiner RW, Gert B. Ethical selection of living kidney donors. Am J Kid Dis, 36:4, 667-686,200


Scroll to Top