NEW YORK (Reuters Health) - A consensus document outlining new guidelines for kidney transplantation from living donors was presented this week at the 20th International Congress of the Transplantation Society, held in Vienna, Austria. Among other issues, the guidelines address informed consent, proper medical and psychosocial screening and potential conflicts of interest.

The United States and Norway lead the world in live kidney donations, with more than 20 transplants per million inhabitants in 2002. Live donations are less common in other countries, particularly those outside of Europe.

Because of the wide variation across cultures and societies, the Society's Ethics Committee convened a panel of more than 100 international experts to develop guidelines designed to ensure the lowest possible risk for donors while maintaining the maximum benefit for recipients.

There may arise conflicts of interest, presenter Dr. Ferdinand Muhlbacher, of Klinishe Abteilung fur Transplantation in Wien, Austria, told Reuters Health, particularly for potential donors whose risk profile is not optimal.

"Sometimes you may have an overweight, slightly hypertensive and slightly diabetic patient," he explained. "Is this a suitable donor? For the recipient it probably does not matter, but for the safety aspect of the donor, it is certainly a concern."

For that reason, the guidelines stipulate that donors be fully informed about the evaluation process, risks they face, and possible consequences of kidney donation. They should also be told what they can expect in terms of care should difficulties arise.

The Ethics Committee maintains that the donor should be given a "cooling off period" to reconsider their decision, and that they retain the right to cancel the procedure, without pressure from the hospital or doctors.

There was some controversy when the guidelines were being developed, Dr. Muhlbacher said, especially regarding the responsibilities of institutions in countries without free access to health care.

But ultimately, the statement "makes clear society has an obligation towards organ donors," he said, even if negative health consequences arise many years later.

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