Living kidney donation is an altruistic act, often directed toward a family member or friend, and requires a rigorous health screening. A history of cancer does not mean automatic disqualification. However, the decision is complex and depends entirely on the specific type, stage, and time elapsed since the cancer was treated.
Standard Health Requirements for Living Donors
A potential living donor must meet strict baseline health requirements to ensure safety during and after the procedure. The evaluation screens for pre-existing conditions that could compromise the donor’s remaining kidney function or increase surgical risk. Donors must not have uncontrolled medical issues that place them at a higher risk for long-term complications.
Conditions such as active diabetes mellitus, which severely damages kidney blood vessels, are generally absolute exclusions. Uncontrolled high blood pressure (hypertension) is also a disqualifier, as it can lead to end-organ damage and put undue strain on the remaining single kidney. Severe obesity (BMI over 35 kg/m²) increases both surgical complications and the long-term risk of developing kidney disease.
The transplant team also screens for active infectious diseases, including certain strains of Hepatitis or HIV, though protocols are evolving for some conditions. Furthermore, any donor must demonstrate a normal baseline kidney function, typically an estimated Glomerular Filtration Rate (eGFR) of at least 80 mL/min/1.73m². They must also not show significant protein in the urine (proteinuria). These general health standards must be met before an individual’s cancer history is reviewed for conditional acceptance.
Cancer History: Absolute Exclusions and Conditional Acceptance
The primary concern when evaluating a cancer survivor is the risk of recurrence in the donor and the possibility of cancer transmission to the recipient. The remaining single kidney would be vulnerable to damage if aggressive chemotherapy or radiation were needed for a future recurrence. Therefore, certain high-risk malignancies are considered absolute exclusions for living donation.
Cancers with a high rate of recurrence or metastasis, such as malignant melanoma, lung cancer, and most hematological malignancies (leukemia or lymphoma), generally disqualify a donor. Any cancer that is active or incompletely treated is an absolute contraindication. The goal is to ensure the donor’s risk of future health issues is statistically similar to that of the general population.
Conversely, a history of certain low-risk or highly localized cancers may be considered for conditional acceptance after a mandatory waiting period. Examples include small, localized basal cell or squamous cell carcinomas of the skin that were completely removed. Early-stage, low-grade thyroid cancer or small, localized kidney tumors successfully removed long ago may also be acceptable. The required time since remission or completion of treatment is a criterion, often ranging from five to ten years, depending on the cancer’s biology and the transplant center’s protocol.
The Specialized Donor Evaluation Process
For a potential donor with a history of malignancy, the evaluation extends beyond standard medical and psychosocial screening. The transplant team requires a comprehensive review of the donor’s entire cancer history to assess long-term risk. This specialized review necessitates obtaining full pathology reports, operative notes, and detailed treatment summaries from the original oncology team.
A formal clearance from the donor’s treating oncologist is mandatory, confirming the individual is considered cancer-free with a low risk of relapse. The transplant workup includes specific diagnostic tests, such as high-resolution CT scans or CT Urograms, to confirm the anatomical health of the kidneys and rule out any current tumors. A survivor’s imaging may be specifically scrutinized for signs of recurrence or suspicious masses.
Specific tumor markers, if relevant to the past cancer type, may be checked to assure that no active disease is present. The entire file is then reviewed by a multidisciplinary selection committee, which includes a nephrologist, surgeon, and social worker. This detailed process ensures that the risk of cancer recurrence is minimal and that donation will not compromise the donor’s long-term health.
Long-Term Health Monitoring After Donation
For the cancer survivor who successfully donates a kidney, long-term health monitoring becomes a dual responsibility: maintaining the health of the remaining single kidney and continuing cancer surveillance. Transplant centers are legally required to follow all living donors for a minimum of two years post-donation. This follow-up typically occurs at regular intervals, such as six, twelve, and twenty-four months after the surgery.
These mandatory checks include monitoring blood pressure, testing for proteinuria, and measuring renal function through blood tests for estimated Glomerular Filtration Rate (eGFR). After the required two-year period, it is strongly recommended that the donor continues to have annual check-ups with their primary care physician for lifelong monitoring of these kidney health indicators. The donor must also remain vigilant about routine cancer surveillance, such as mammograms, colonoscopies, or PSA tests, as recommended by their oncologist.
Donation does not increase the risk of developing a new cancer. However, any future cancer diagnosis must be treated with only one kidney remaining. Therefore, continued adherence to cancer screening guidelines, independent of the donation, is paramount for the donor’s overall well-being. This combined focus on renal health and oncology surveillance ensures the best possible long-term outcome.