"It is clear that the excellent results seen here reflect very strict criteria," Ibrahim said. "Transplant centers now are willing to consider older donors and people with mild hypertension." That could mean that in decades to come the outcomes for these less-healthy donors "might look different," he said.
It might indeed, because "the average age of living donors continues to increase," noted Dr. Jane Tan, an assistant professor of medicine at Stanford University and co-author of an accompanying editorial.
"Many of the patients I see have been waiting for seven years," Tan said. "Spouses want to donate, people in their 60s. We don't know what the consequences will be."
And the newly reported study was done in a primarily white population, which is also a potential limitation on its findings, Tan said. "About 12 percent of kidney donors are African-Americans," she said.
A study now being started could fill in that gap, Ibrahim said. Performed in collaboration with the Mayo Clinic and the University of Alabama, the study will include more than 8,000 kidney donors, many of them blacks. "We hope to have results in two to three years," he said.
A balance of possible benefits and dangers must be made when considering less-than-ideal donors, Ibrahim said. "Take a 65-year-old donor with mild hypertension," he said. "There might be less severe consequences than for a 20-year-old with hypertension."
"The standards by which we screen kidney donors are quite rigorous right now," Tan said. "We believe it is safe, but we want to ensure that we have donor safety in mind."
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