Many potential donors are not up to date with recommended health maintenance and screening. The donor evaluation offers an opportunity to improve the health of the donor by addressing long-term health concerns such as routine cancer screening, obesity, tobacco smoking, and safe use of potentially organ-toxic medications, particularly those available over the counter. In general, the need and intensity of medical follow-up after living donation is dependent on the type of organ donated, donor age, and medical risk. Consensus guidelines for living donation recommend that donors should be actively followed for at least 24 months following donation by the transplant center, then lifelong by a primary-care physician [36].

In 2007, the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) notified transplant programs that federal regulations now require OPTN to develop policies regarding living donors and living donor recipients. Guidelines for the evaluation of kidney and liver donors are now posted on the OPTN website.

A consistent theme in this chapter is the need for more comprehensive and accurate data on donor outcomes. Several guidelines have been proposed over the years, but much of the work has been duplicative based on a paucity of good available data. The establishment of long-term comprehensive prospective studies and national registries would provide an important step toward this goal. Given the potential negative impact of reporting adverse outcomes on the reputation of individual hospital centers, the successful recruitment of future donors, and the ability to maintain and attract new insurance providers, universal reporting must be mandated. In addition, information on specific risks in minority populations, particularly ethnic subgroups with known health risk factors (i.e., African Americans, Native Americans, and Hispanics), is needed.

The ability to quantify risks associated with common conditions such as advanced age, obesity, hyperlipidemia, and tobacco use would help not only the donor but also the medical team, and the transplant community as a whole, to establish thresholds of acceptability and to develop appropriate recommendations for follow-up care. A better understanding of the interaction between these factors and recipient characteristics may be helpful not only in determining the acceptability of a donor, but also in choosing among donors for recipients who may have several potential options.

Medical outcomes like operative complications, readmission rates, development of disease, or death tell only part of the story. The impact of organ donation on quality of life may be just as important to an individual considering living donation . In the end, the medical selection of the living donor must recognize that the ultimate decision to proceed with living donation will be an individualized one made in a spirit of cooperation between the individual most affected, the donor, and the transplant medical team whose role is to safeguard the donor’s health and well-being.