Genetic testing in living kidney donor candidates.

PURPOSE OF REVIEW: This review focuses on genetic evaluation in biologically related living kidney donor (LKD) candidates and candidates with suspected inherited disease, highlighting how genetic testing can extend beyond traditional clinical assessment to inform donor selection and counseling.

RECENT FINDINGS: Genetic screening of LKDs can identify monogenic kidney diseases, enable exclusion of at-risk donors and support long-term donor health. Sequential testing that includes genetic confirmation in the intended recipient followed by targeted testing of related donors, has effectively excluded carriers of pathogenic variants while permitting safe donation in noncarriers. Despite these advances, many transplant clinicians have limited experience with test selection, result interpretation, and counseling. In addition, access to renal genetic counselors or clinical geneticists remains constrained.

SUMMARY: Genetic testing enables a more personalized and preventive approach to LKD evaluation. Ethical implementation requires genetic counseling, shared decision-making, and longitudinal follow-up. Ongoing research including registry data and long-term donor outcomes is essential to establish best practices for integrating genetic testing into LKD transplantation.