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other chronic conditions post-kidney donation. Anything else is trying to be heroic and potentially jeopardizing the health of the donor. Clearly, the authors do not see a problem with using a donor at risk as long as iothalamate GFR is 1 80 ml/min/1.73 m 2 . We firmly believe that if donor safety is a priority, then any donor at risk, irrespective of GFR, should not be considered a donor. In specific instances, patients who are obese or have glucose intolerance, may be considered for standard treatment and later considered for kidney donation. However, accepting these patients with risk factors because iothalamate GFR is 1 80 ml/min/1.73 m 2 is simply not acceptable, nor ethical, knowing the cumulative risk of chronic disease these factors may pose. One can argue that the risk of developing kidney failure in a donor who developed diabetes or hypertension later in life does not depend on whether the donor has one or two kidneys. This is probably true, but we have no scientific evidence to back this up, and therefore absolute caution is necessary. We believe that the currently available creatinine clearance and eGFR methods are easy to use, have no significant costs or side effects and the results should be within the normally accepted range ( 1 90 and ! 150 ml/min/1.73 m 2 ) in a ‘normal’ healthy individual for acceptance as a kidney donor. There is data to suggest that MDRD underestimates GFR at GFR 1 60 ml/min/1.73 m 2 , so the cutoff point of 90 ml/min/1.73 m 2 should pose no problem. In We read with interest the positive role of formal glomerular filtration (GFR) assessment of living kidney donors using radionuclide by Tan et al. [1] . Although they present a logical narrative of why formal assessment of GFR should be performed in all potential kidney donors, they fail to recognize that the kidney donor must be normal to ensure no immediate or long-term harm is incurred. Donor safety must always be the top priority and emotional issues around the growing waitlist, shortage of organs or both should not be an excuse to select suboptimal donors for increasing the donor pool. Patients in renal failure are already receiving some form of life-sustaining therapy and it is not rational to risk the health of another person for the sake of improving the quality of life of the recipient [2] . The authors wrote, ‘ We therefore recommend more accurate and rigorous testing of kidney function in donors who are compromised by middle or older age, hypertension or glucose intolerance. Such donors are prone to glomerulopenia, and hence at risk of developing progressive loss of kidney function following a halving of their nephron mass ’. In our opinion, we should not even consider these ‘compromised’ individuals as potential donors. Let us shoot straight and put an end to this ethical and emotional dilemma. A potential donor is either normal or not. Normal is defined as the absence of any chronic condition and risk factors for renal disease, hypertension, diabetes and Published online: February 18, 2011 Nephrology American Journal of

Title Page. Formal Assessment of Donor Kidney Function Should Be Mandatory