Book Review

Educating, Evaluating, and Selecting Living Kidney Donors Robert W. Steiner ( Ed ). Dordrecht : Kluwer Academic Publishers ; 2004 . 164pp. , ISBN 1-4020-12713 ( Hb ); ISBN 1-4020-2276-X ( e-book ). Live donor kidney transplantation is now relatively common practice for most North American and European transplant centers. The rates of this procedure have been increasing over the past few years in order to meet the demands created by the shortage of cadaveric organs. Despite this, however, there is a relative paucity of information available to guide transplant centers in their evaluation of prospective live kidney donors. Indeed, there is very little standardization of the process of donor assessment, and what may be acceptable to one particular transplant center may be rejected by another. This book of eight chapters written by internationally recognized leaders in the field including the editor, Dr. Robert Steiner, is a timely addition that fills a significant void. The first chapter enunciates basic principles of donor evaluation that apply to all centers involved in counseling live donors, and outline the justification for live donor transplantation. The second and third chapters provide quality-of-life and outcome data. The authors emphasize that risk applies to everyone contemplating kidney donation and that the donor needs to be able to assess the degree of risk against the anticipated benefit to him or herself (not the recipient). Transplant centers bear the responsibility for ensuring that the potential donor can make an informed decision, and should be convinced that the donor's decision is rational. Donors deemed to be incapable of making an informed decision must be disqualified. Chapters four and five offer pragmatic guidance regarding the evaluation of medical problems that are commonly seen in potential donors, including microscopic hematuria, isolated proteinuria, hypertension, nephrolithiasis and abnormalities of glucose metabolism. This includes estimates of the incremental risk that these abnormalities confer to the donor for developing end-stage renal disease after kidney donation. The risk estimates are based on data extracted from a thorough review of background literature, and probably represent the most complete compendium of such information currently available. Many physicians involved in the assessment of potential donors will find this quantitative risk information to be indispensable in discussions with any person being assessed for kidney donation. Chapter six, which discusses the risk of diabetes and diabetic nephropathy, focuses more on risks related to the recipient, and perhaps could have provided information more relevant to the position of the potential donor, particularly in situations where type 2 diabetes is prevalent in the donor population. The latter part of the book addresses the issue of donor education and understanding. Dr. Steiner underscores the importance of clarity in communicating risk to donors, and the tools he has developed to this end are described in some detail. In effect, these represent a test of the ‘health literacy’ of the potential donor. This is a strategy which should be considered by all centers involved in live donor transplantation, and would be applicable to organs other than kidney. Those looking for a prescriptive approach to live donor assessment may be disappointed, for the book does not offer a simple set of criteria for accepting or excluding prospective live donors. Rather, the authors charge the reader/evaluator with the responsibility of giving individualized factual and wherever possible quantitative information to prospective donors regarding the risks of donation. The book is readable and organized, with a point-form summary at the beginning of each chapter. The chapters are well referenced, and provide a comprehensive bibliography for those wishing to go to the primary literature. In some ways this is a provocative book. Not every reader will be happy with the lack of specific directives or simple criteria for donor evaluation. However, the wealth of information regarding risk estimates to donors makes this book valuable reading for anyone involved in the evaluation of live donors. Perhaps it will provide the impetus to develop standardized criteria by which potential organ donors are evaluated, and lead to the establishment of donor registries.

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