Due to organ shortage and difficulties for availability of cadaveric donors, living donor transplantation is an important choice for having allograft. Live donor surgery is elective and easier to organize prior to starting dialysis thereby permitting preemptive transplantation as compared to cadaveric transplantation. Because of superior results with living kidney transplantation, efforts including the usage of “Medically complex living donors” are made to increase the availability of organs for donation. The term “Complex living donor” is probably preferred for all suboptimal donors where decision-making is a problem due to lack of sound medical data or consensus guidelines. Donors with advanced age, obesity, asymptomatic microhematuria, proteinuria, hypertension, renal stone disease, history of malignancy and with chronic viral infections consist of this complex living donors. This medical complex living donors requires careful evaluation for future renal risk. In this review we would like to present the major issues in the evaluation process of medically complex living kidney donor. 1. Introduction Advances in immunosuppressive therapy, refinement in surgical techniques and in public awareness, altruism, and goodwill have allowed an increase in the number of living donor kidney transplantation; whereby, virtually all biological related, unrelated and medically and psychosocially suitable individuals can be considered as donors [1–6]. Live donor surgery is elective and easier to organise prior to starting dialysis than when the renal donor is a cadaver. In addition, living donor transplants have the advantage of being performed with minimal delay, thereby permitting preemptive transplantation (transplantation prior to dialysis). There is also increasing evidence that patients who undergo preemptive transplantation have improved graft survival compared to those who undergo a period of dialysis before transplantation [7]. Because of superior results with living kidney transplantation, efforts including the usage of “medically complex living donors” are made to increase the availability of organs for donation [8]. The term “complex living donor” was used first by Reese et al. [9] in the International Forum on the Care of the Live Kidney Donor which was held on April 2004 in Amsterdam [7]. The objective of this meeting was to develop international consensus on the standard of care and define the responsibility of the transplant community for the live kidney donor [7–9]. The term “complex living donor” is probably preferred for all suboptimal donors where
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