Personal paper: Risk of diabetic nephropathy in potential living related kidney donors

Diabetic nephropathy is the leading cause of end stage renal failure in New Zealand.1 Cadaveric organs are in short supply here, as elsewhere, and we need to consider living related donation. Kidneys from living related donors also provide a better graft and improved survival of transplant patients. However, donors from ethnic groups who have a high incidence of end stage renal failure because of diabetes and glomerulonephritis are also at increased risk of developing diabetes.2 This risk is compounded by environmental factors such as obesity. In New Zealand the ethics of living related donation within the diabetic family are being questioned.

Renal transplantation is preferred to dialysis in diabetic patients who are fit enough for surgery. It is associated with an improved quality of life, lower morbidity and mortality, reduced long term costs, and greater incremental benefit in diabetic patients compared with patients without diabetes.3 The main reason for not transplanting kidneys into suitable candidates is the low availability of compatible organs for transplantation. Some ethnic groups object to donating body parts after death for cultural and spiritual reasons. The resulting underrepresentation of these ethnic groups in the donor pool further reduces the likelihood that patients with end stage renal failure from these ethnic groups will receive an organ. Organ donation from living relatives is therefore particularly encouraged in these groups.

Diabetes and the development of nephropathy once diabetes has occurred are familial and cluster in families. 4 5 It is therefore important to be able to advise a potential donor of his or her personal risk of developing end stage renal failure.