*2.2.1 Clinical evaluation*

Potential donors should be healthy and neither too young nor too old. Medical history and physical examination could elicit risk factors for kidney disease such as: DM, hypertension, family history of kidney disease, herbal drug, non-steriodal anti-inflammatory drugs (NSAIDs), and other nephrotoxin use. History and/or presence of CLD could be suggested by jaundice and alcohol abuse. Also, history of psychiatric illness, malignancies, smoking and substance abuse, etc. should be sought and positive candidates excluded. Donors should not be morbidly obese and blood pressures should be <140/90 mmHg.

## *2.2.1.1 Donor work-up*

For various investigations see **Table 5**.

Absence of urinary markers of disease such as proteinuria, haematuria, pyuria and casts, may rule out kidney diseases in potential donors. Glomerular filtration rate (GFR) should ideally be measured but is often estimated using serum creatinine in most LRCs. Prospective donors are screened for chronic viral diseases.

*Organ Donation and Transplantation in Sub-Saharan Africa: Opportunities and Challenges DOI: http://dx.doi.org/10.5772/intechopen.94986*


#### **Table 5.**

*Workup for potential organ transplant donors.*

Notably, CMV positivity in a donor has implication for a CMV-negative recipient, who due to subsequent immunosuppressive drug use will likely succumb to its infection. Screening for TB (CXR, Mantoux test, sputum GeneXpert) is important in SSA because 1/3 of the population is infected with M. tuberculosis [58]. The ABO blood group compatibility with recipient is mandatory; however, Rhesus factor mismatch is not a major consideration for solid organ matching. There are many HLA antigens (Class I: HLA-A, B, and C; Class II: HLA-DR, DQ and DP), but the HLA A, B and DR are usually cross-matched between donors and recipients (i.e. tissue typing).HLA antibody cross-matching is important to prevent early graft rejection. It detects the presence of HLA antibodies in recipients that can react with donor's lymphocytes, i.e. donor specific antibodies (DSA).

HLA antibody cross-matching was originally based on complement dependent cytotoxicity (CDC) assays. It is done with recipient's serum on donor lymphocytes or pooled lymphocytes of previous donors within the transplant centre's population to determine the Panel Reactive Antibodies (PRA). Reactive Antibodies (PRA). The PRA estimates the recipient's chances of tolerating allografts from that population and is useful for deceased donation.

Solid phase assays, ELISA or flow cytometry (Luminex)-based are now available and preferred. Most transplant centres in SSA, outsource tissue typing and HLA antibody cross-matching. Protocols require at least two HLA antibody crossmatches, with the last, just before the transplant procedure.

Imaging evaluation using ultrasonography and doppler in prospective donors should demonstrate normal kidneys (sizes and echotexture) and renal blood flow.

The CT-angiography helps to rule out solitary kidney or detect the presence of multiple or abnormal renal arteries, which have surgical implications for nephrectomy in donors and anastomoses in recipients.

## *2.2.2 Counseling*

Counseling donors on short and long-term risks associated with organ donation is necessary. Possible complications such as pain, post-operative infections, blood loss, deep venous thrombosis and pulmonary embolism can occur. Studies have shown that peri-operative mortality and morbidity during organ donation,

are about 0.03% and 10% respectively [59]. Some studies show that with careful selection, kidney donors live long, although hypertension, proteinuria and reduced GFR can occur over time [60]. The risk of ESKD following kidney donation is about 0.3% [61]. Emotional consequences after organ donation should be anticipated therefore psychosocial assessment should be independently organized by the transplant team before and after donation.
