Is It Less Reasonable for an Old Person to Donate Than for a Young One?
Steiner expressed the provocative point of view that we take more risk when selecting a young donor than an old one. His arguments are that it is likely that we know all the risk factors of CKD and cardiovascular diseases in an old LKD. According to the USRDS, half of the new cases of ESRD in the USA (45% secondary to type 2 diabetes, 27% to hypertension, 8% to glomerulonephritis) occur after the age of 65. Racial variations in the outcome and incidence of CKD after donation have also been reported and indeed, it is known that black people are more prone to develop hypertension, diabetes, CKD and ESRD. The cumulative lifetime risk of ESRD for a 20-year-old in the USA has been calculated by computer simulation stratified by race and gender. It has been found to be 7.8% for a black woman, 7.3% for a black man versus 1.8 and 2.5% in white women and men, respectively. Lifestyle can also lead to the acquisition of risk factors for CKD, such as obesity or sedentariness. They are likely to be already present in the old subject but not in the young one. A normal evaluation in a young donor is seemingly reassuring, but a normal evaluation in the old one has a stronger predictive value.