Editing Kidney transplantation (section)

==Evaluation of kidney donors and recipients==
Both potential kidney donors and kidney recipients are carefully screened to assure positive outcomes.

===Contraindications for kidney recipients===
Contraindications to receive a kidney transplant include both [[Heart failure|cardiac]] and [[pulmonary insufficiency]], as well as hepatic disease and some cancers. Concurrent [[tobacco use]] and [[morbid obesity]] are also among the indicators putting a patient at a higher risk for [[surgical]] complications.{{citation needed|date=April 2024}}

Kidney transplant requirements vary from program to program and country to country. Many programs place limits on age (e.g. the person must be under a certain age to enter the waiting list) and require that one must be in good health (aside from kidney disease).  Significant [[cardiovascular disease]], incurable terminal infectious diseases and [[cancer]] are often transplant exclusion criteria.  In addition, candidates are typically screened to determine if they will be compliant with their medications, which is essential for survival of the transplant.  People with [[mental illness]] and/or significant ongoing [[substance abuse]] issues may be excluded.{{citation needed|date=April 2024}}

HIV was at one point considered to be a complete contraindication to transplantation.  There was fear that [[immunosuppressing]] someone with a depleted immune system would result in the progression of the disease.  However, some research seem to suggest that [[immunosuppressive drug]]s and [[antiretrovirals]] may work [[Synergy#Drug synergy|synergistically]] to help both [[HIV]] [[viral load]]s/[[CD4]] cell counts and prevent active rejection.{{citation needed|date=April 2024}}

===Living kidney donor evaluation===
As candidates for a significant elective surgery, potential kidney donors are carefully screened to assure good long term outcomes.  The screening includes medical and psychosocial components.  Sometimes donors can be successfully screened in a few months, but the process can take longer, especially if test results indicate additional tests are required.  A total approval time of under six months has been identified as an important goal for transplant centers to avoid missed opportunities for kidney transplant (for example, that the intended recipient becomes too ill for transplant while the donor is being evaluated).<ref>{{Cite journal |title=The Evaluation of Living Kidney Donors: How Long Is Too Long? |url=https://www.ajkd.org/article/S0272-6386(18)30794-7/fulltext |access-date=2024-03-15 |journal=American Journal of Kidney Diseases |date=2018 |pmid=30244695 |last1=Weng |first1=F. L. |last2=Morgievich |first2=M. M. |last3=Kandula |first3=P. |volume=72 |issue=4 |pages=472–474 |doi=10.1053/j.ajkd.2018.07.001 |pmc=6175537 }}</ref>

The psychosocial screening attempts to determine the presence of psychosocial problems that might complicate donation such as lack of social support to aid in their post operative recovery, coercion by family members, or lack of understanding of medical risks.<ref>{{Cite web |title=Guidance for the Development of Program-Specific Living Kidney Donor Medical Evaluation Protocols |url=https://optn.transplant.hrsa.gov/professionals/by-topic/guidance/guidance-for-the-development-of-program-specific-living-kidney-donor-medical-evaluation-protocols/ |access-date=2024-03-15 |website=hrsa.gov}}</ref>

The medical screening assesses the general health and surgical risk of the donor including for conditions that might indicate complications from living with a single kidney.  It also assesses whether the donor has diseases that might be transmitted to the recipient (who usually will be [[immunosuppressed]]), assesses the anatomy of the donor's kidneys including differences in size and issues that might complicate surgery, and determines the immunological compatibility of the donor and recipient.  Specific rules vary by transplant center, but key exclusion criteria often include:
* [[diabetes]];
* uncontrolled [[hypertension]];
* morbid obesity;
* heart or lung disease;
* history of cancer;
* family history of kidney disease; and
* impaired kidney performance or [[proteinuria]].[https://optn.transplant.hrsa.gov/professionals/by-topic/guidance/guidance-for-the-development-of-program-specific-living-kidney-donor-medical-evaluation-protocols Guidance for the Development of Program-Specific Living Kidney Donor Medical Evaluation Protocols - OPTN]