In Reply We appreciate the comments provided by Drs Lin and Huang. In theory, randomized trials could generate unbiased estimates of donor risk; however, randomized trials of living kidney donation are not ethically feasible. The best possible approach is to conduct a multicenter prospective cohort study that enrolls donors and nondonors with similar indicators of baseline health and follows them with minimal loss to follow-up for outcomes. We conducted such a study to produce estimates of kidney donation–attributable risk with a low risk of bias, achieving the highest score for methodological quality on the Newcastle-Ottawa Scale.
