Some nuance here… First, every transplant center has different protocol in how they determine eligibility. There are some general basic requirements nearly all centers follow but beyond that there’s a lot of variability.
Second, NKR leads the world in donor protections. NKR-affiliated transplant centers have better outcomes all around. They tend to do better, more thorough donor screenings. You can evaluate transplant centers here: https://www.kidneytransplantcenters.org/
About GFR, most equations (whether they are creatinine based or cystatin-c) do in fact use age to adjust. And many centers will run both tests, as well as additional tests like a nuclear renal scan to determine kidney function, size, etc. There are no clear ways to determine the future but there are lots of tests that indicate whether someone is a high or low risk for future kidney disease.
Also regarding age, there is a good reason most centers prefer to take kidneys out of middle age people rather than young people: life habits are more strongly established and future health is easier to estimate because many of the most risky activities the person will engage in are in the past.
Regarding the need/idea of “exceptional kidney function.” Most humans living in societies with modern medicine do not need two kidneys; most can live just fine with partial function of one kidney.
You are right to worry about future kidney health, particularly in the age of poor public health and pandemics. For instance, I believe there is a high likelihood that CKD will increase among donors who have caught COVID. And hospital-acquired COVID is not even reliably discussed in the data yet, so making a decision NOW about becoming a living kidney donor is definitely more of a gamble than it was pre-pandemic.
Every transplant center has an evaluation team. It is never just an individual doctor who makes a decision about a candidate. This is good and bad in my opinion, but it speaks to your last point about incentives.
Personally my experience felt like there were a lot of roadblocks to becoming a donor; they don’t make it easy. Someone needs to be pretty motivated to even get to the point where the team makes a decision and by then you have had access to all of your test results so you can consult with other doctors if you wish.
For the record, the screening process is not just looking at kidney health. It’s also looking for cancers, heart health, etc. They are looking for anything that could make your surgery dangerous, anything that could harm your recipient, and anything that suggests longterm negative health consequences for you post-surgery. They have strong incentives to keep their rankings high with good outcomes and I believe those incentives outweigh any incentives you mentioned.
Some nuance here… First, every transplant center has different protocol in how they determine eligibility. There are some general basic requirements nearly all centers follow but beyond that there’s a lot of variability.
Second, NKR leads the world in donor protections. NKR-affiliated transplant centers have better outcomes all around. They tend to do better, more thorough donor screenings. You can evaluate transplant centers here: https://www.kidneytransplantcenters.org/
About GFR, most equations (whether they are creatinine based or cystatin-c) do in fact use age to adjust. And many centers will run both tests, as well as additional tests like a nuclear renal scan to determine kidney function, size, etc. There are no clear ways to determine the future but there are lots of tests that indicate whether someone is a high or low risk for future kidney disease.
Also regarding age, there is a good reason most centers prefer to take kidneys out of middle age people rather than young people: life habits are more strongly established and future health is easier to estimate because many of the most risky activities the person will engage in are in the past.
Regarding the need/idea of “exceptional kidney function.” Most humans living in societies with modern medicine do not need two kidneys; most can live just fine with partial function of one kidney.
You are right to worry about future kidney health, particularly in the age of poor public health and pandemics. For instance, I believe there is a high likelihood that CKD will increase among donors who have caught COVID. And hospital-acquired COVID is not even reliably discussed in the data yet, so making a decision NOW about becoming a living kidney donor is definitely more of a gamble than it was pre-pandemic.
Every transplant center has an evaluation team. It is never just an individual doctor who makes a decision about a candidate. This is good and bad in my opinion, but it speaks to your last point about incentives.
Personally my experience felt like there were a lot of roadblocks to becoming a donor; they don’t make it easy. Someone needs to be pretty motivated to even get to the point where the team makes a decision and by then you have had access to all of your test results so you can consult with other doctors if you wish.
For the record, the screening process is not just looking at kidney health. It’s also looking for cancers, heart health, etc. They are looking for anything that could make your surgery dangerous, anything that could harm your recipient, and anything that suggests longterm negative health consequences for you post-surgery. They have strong incentives to keep their rankings high with good outcomes and I believe those incentives outweigh any incentives you mentioned.