2025 Volume 13 Issue 1 Pages 29-34
In Japan, where living donor kidney transplantation is predominant, establishing appropriate donor renal function criteria is essential to ensure donor safety. National guidelines define both standard and marginal donor criteria based on glomerular filtration rate (GFR). While several studies suggest an association between lower pre-donation GFR and increased risks of end-stage renal disease (ESRD) in donors or inferior graft function in recipients, the scientific validity of the current marginal donor criteria remains inconclusive. To improve donor selection and minimize post-donation ESRD risk, it is crucial not only to assess renal function and other clinical parameters individually but also to develop integrated risk assessment models for more accurate eligibility determination. In addition, donor-specific factors such as age and comorbidities must be considered in a comprehensive risk evaluation. The establishment of a long-term, structured follow-up system for donors is equally important to maintain post-donation health. Future prospective studies and evidence-based refinements of marginal donor criteria are warranted to ensure both donor safety and recipient outcomes.
