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Guidelines created by the Amsterdam Forum (1) recommend that individuals with diabetes be excluded from donating but do not address donors in the prediabetes state.In their donor evaluation review, Pham (17) suggested that IFG or IGT be considered relative contraindications for donation and evaluated on an individual basis.The demographic of living donors has changed in recent years with more nonwhite and Hispanic populations, at greater risk for diabetes and hypertension, donating than a decade ago (3–5).
Both measurements represent impaired glucose physiologies. A normal fasting glucose can be present without IGT in a 2-hour OGTT, and, conversely, glucose intolerance can be present with a normal fasting glucose (13).
A more recent validation using the San Antonio Heart Study (SAHS) population confirmed high sensitivity and specificity when compared with the SAHS and Atherosclerosis Risk in Communities (ARIC) prediction models (area under the receiver operating characteristic curve was 0.818) (16).
The use of the Diabetes PHD instrument is not often used to exclude donors because there is no consensus as to what constitutes “unacceptable risk.” However, these tools can be used to guide donors in the process of informed consent.
Most US centers do not accept donors with diabetes or impaired glucose tolerance (IGT), but several centers accept donors with impaired fasting glucose (IFG) if the 2-hour oral glucose tolerance test (OGTT) is normal (6,7). If donors with IFG develop diabetes, then would diabetic nephropathy occur earlier or more frequently than in patients who have diabetes and have two kidneys?
Are we putting kidney donors with glucose intolerance at more risk for cardiovascular complications because both IFG and reductions in GFR (8,9) are risk factors for cardiovascular disease (CVD)?