# Renal Transplant Donor Workup

> Living kidney donor workup for NEET-PG Surgery: ABO and crossmatch, measured GFR thresholds, CT angiography, THOA rules, NOTTO paired exchange and KDIGO safety.

- Canonical URL: https://prepelephant.com/topics/neet-pg/surgery/renal-transplant-donor-workup
- Exam / course: NEET-PG · Subject: Surgery
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Renal Transplant Donor Workup", PrepElephant, https://prepelephant.com/topics/neet-pg/surgery/renal-transplant-donor-workup

## Direct answer

One healthy person volunteers a kidney to another, and the living-donor workup exists to answer three questions in strict order: is the pair immunologically compatible (ABO blood group, HLA typing, and a complement-dependent cytotoxicity crossmatch — a positive crossmatch forbids transplantation because of hyperacute rejection), is the donor safe to lose a kidney (measured GFR — KDIGO regards 90 mL/min or more as acceptable, 60-89 as individualised, below 60 as a contraindication; blood pressure, glucose tolerance, proteinuria under 300 mg a day, body mass index, stone disease, malignancy screening, and CT angiography defining arterial anatomy, since accessory renal arteries occur in roughly a quarter), and is the donation lawful and freely given (the Transplantation of Human Organs Act 1994, amended 2011, permits near-relatives to donate, requires authorisation-committee approval for others, criminalises organ commerce, and underpins NOTTO's coordination of deceased donation and paired kidney exchange for ABO or crossmatch-incompatible pairs). A psychological assessment and an independent donor advocate close the evaluation.

## What you must remember

- **Immunology sequence:** ABO first, then HLA typing, then crossmatch; the positive cytotoxicity crossmatch is an absolute bar — hyperacute rejection on the table is its consequence.
- **GFR standards (KDIGO):** measured, not merely estimated — 90 mL/min or greater acceptable, 60-89 individualised by age and risk, under 60 declined; Indian programmes commonly seek 80 or above for younger donors.
- **CT angiography:** maps the number and position of renal arteries (accessory arteries in about 25-30%), early branching, venous variants and collecting system; the left kidney with its longer vein is usually chosen for laparoscopic harvest — unless its anatomy is the more complex, in which case the donor keeps the better kidney.
- **Exclusion screens:** uncontrolled hypertension, diabetes, proteinuria above 300 mg daily, active or recent malignancy, recurrent or infected stones, obesity by programme threshold, significant psychosocial coercion; HIV infection is an absolute contraindication.
- **Indian infections panel:** hepatitis B and C with viral loads (management per current guidance rather than blanket exclusion), syphilis, and cytomegalovirus serostatus — a donor-positive, recipient-negative mismatch shapes post-transplant prophylaxis.
- **The legal frame:** THOA 1994 with the 2011 amendment (which recognised swapped and paired transplants and widened near-relatives); authorisation committees for unrelated donors; NOTTO-ROTTO-SOTTO as the national-regional-state hierarchy; punishment for trading in organs.
- **Paired kidney exchange:** ABO- or crossmatch-incompatible couples swap donors through NOTTO's registry, sometimes in chains — the exam's favourite Indian answer to incompatibility.
- **Long-term donor care:** slightly raised but low absolute end-stage renal disease risk, annual blood pressure and creatinine checks for life — a follow-up commitment, not a farewell.

## Walking a real pair through the pathway

A 32-year-old wife wishes to donate to her 40-year-old husband with chronic kidney disease stage 5. Step one: blood groups — she is O, he is A; incompatible. The options fork here: ABO-incompatible transplantation with desensitisation (plasmapheresis and rituximab, higher rejection risk and cost) or registration for paired exchange through NOTTO, waiting for a compatible swap. Assume a swap succeeds: step two is tissue typing and crossmatch against the new recipient — negative. Step three is her medical file: measured GFR, glucose tolerance test, blood pressure including ambulatory readings, urine protein, CT angiography showing two left arteries — the right kidney is chosen. Step four is institutional: the hospital authorisation committee verifies identity, relationship documents and absence of inducement, as THOA requires. Step five is laparoscopic donor nephrectomy with the described post-operative course, and step six is lifelong annual donor review. Every refusal point along this ladder — immunological, medical, legal — is a potential exam stem.

## Where students slip

The first error is trusting estimated GFR: guidelines require measured clearance (isotopic or 24-hour creatinine), and the MCQ phrases the trap as a normal creatinine in a young hypertensive. The second is treating the positive crossmatch as negotiable — it is the one result that stops a transplant outright. The third is forgetting law in a clinical paper: THOA's near-relative definition, authorisation-committee approval for unrelated donors and NOTTO's exchange registry are recurring one-liners. The fourth is the side-choice question — the left kidney is usual for its longer vein, but anatomy and split function decide, and the donor keeps the better kidney.

## Frequently asked questions

### Which test prevents hyperacute rejection?

The complement-dependent cytotoxicity crossmatch between donor cells and recipient serum. A positive crossmatch is an absolute contraindication to proceeding.

### What GFR can a living kidney donor have?

Measured GFR of 90 mL/min or more is acceptable, 60-89 is individualised, and below 60 declines the donor — per KDIGO guidance. Estimation alone is insufficient.

### Which law governs organ donation in India?

The Transplantation of Human Organs Act 1994, amended in 2011, with NOTTO coordinating nationally. Unrelated donation requires authorisation-committee approval.

### What is paired kidney exchange?

Swapping donors between ABO- or crossmatch-incompatible pairs through the NOTTO registry. It converts two impossible transplants into two possible ones.

### Why is CT angiography essential in donor workup?

It maps accessory arteries, early branching, veins and the collecting system, deciding which kidney is harvested. The donor keeps the better-functioning kidney.