Table 3.

Guideline recommendations for GFR assessment in living kidney donor candidates

GuidelineGFR assessmentGFR-based criteria
British Transplantation Society (2018) (52)mGFR in everyone after initial screening using eGFRProvides age and sex-specific GFR criteria
KDIGO (2017) (11,12)eGFR, followed by confirmation with mGFR, CrCl or eGFRDonor candidates with GFR ≥90 ml/min per 1.73m2 should be considered acceptable, and those with GFR ≤60 ml/min per 1.73m2 should be excluded
Decision to approve donor candidates with GFR 60–89 ml/min per 1.73m2 should be individualized on the basis of demographic and health profile in relation to the transplant program’s acceptable risk threshold
OPTN (2021) (47)mGFR or 24-hour CrClNo specific recommendations provided
Canadian KPD Protocol (2015) (54)eGFR on two separate occasions, followed by 24-hour CrCl on two separate occasions or mGFRProvides age-specific criteria
ERBP (2013) (53)eGFR; mGFR when more exact knowledge of GFR is needed or where is doubt regarding the accuracy of eGFRRecommends age-dependent GFR cutoffs, such that the GFR of the remaining kidney will be >37.5 ml/min per 1.73m2 at the time the donor reaches age 80
CARI (2010) (61)eGFR, at least on two separate occasions or CrCl; mGFR if there is doubt regarding the accuracy or eGFR or CrClRecommends against accepting kidneys from donors with GFR <80ml/min per 1.73m2
Amsterdam forum (2005) (62)eGFR or CrCl; mGFR may be used in patients with borderline GFR determinationGFR <80 ml/min per 1.73m2 or body-surface area-adjusted GFR <2 SD below normal on the basis of age and sex generally preclude donation
Additionally noted successful transplantation from some, usually elderly living donors with GFR as low as 65–70 ml/min per 1.73m2, indicating a need for individualization in donors with GFR <80 ml/min per 1.73m2
  • mGFR, measured GFR; KDIGO, Kidney Disease: Improving Global Outcomes; CrCl, creatinine clearance; OPTN, Organ Procurement and Transplantation Network; KPD, kidney paired donation; ERBP, European Renal Best Practice, CARI, Caring for Australians and New Zealanders with Kidney Impairment.