Living Kidney Donor Information

A living donor transplant provides the best opportunity for a quality kidney with the shortest waiting time, and enhances life expectancy for the recipient after transplant.

Types of Living Donation


Friend or Relative
When a friend or relative is interested in becoming a living donor for a patient they must complete our online referral form and fill out the living donor application.  Once it is determined, the living donor coordinator will contact the donor to schedule initial testing and living donor PTE.

Altruistic
There are some cases where a person chooses to be a living donor without having any personal connection to the patient, these donors are known as altruistic donors.  Although uncommon, these living donors are heroes to the families whose lives they are able to touch through this gift.  Matching altruistic living donors with recipients is done much like the process of matching a deceased donor kidney to a recipient.  We look at our waitlist and find the recipient who is a blood type match who has accrued the most wait time. 

Kidney Paired Donation (KPD)
Kidney Paired Donation, also known as “kidney swap” or “kidney paired exchange,” can happen on two levels: 1) within our own program and 2) nationally.  At this point in time, our transplant center offers KPD as an option only within our program.  KPD is when there is a mismatch between a living donor and his or her recipient (for example: a father donor, blood type A and son, recipient blood type B) and a mismatch between 1 or more other donors and recipients (for example: a mother, donor blood type B, and daughter, recipient blood type A).  KPD happens when the father is able to donate to the daughter and then mother to the son. (see the diagram below).  KPD is a great option for people who might have several incompatible donors and are not having luck finding a match.  


Living Donor Champion

 

As a recipient, it can be overwhelming to think about how to ask a friend or loved one to donate.  Another option to consider when being evaluated for transplant is a living donor champion.  A living donor champion is a friend or family member that, for whatever reason, is unable to donate his or her kidney to the recipient but still wants to do something to help.  Living donor champions can create Facebook pages, write letters, speak at events or churches on behalf of a recipient and ask for donors to come forward.  There have been several success stories with living donor champions.  Please talk with the living donor coordinator more about this option.

Eligibility

Parents, children, husbands, wives, friends, co-workers--even total strangers--can be living-donor candidates.  Living donor candidates should be:

  • In good physical and mental health
  • Free from high blood pressure, diabetes, cancer, HIV, hepatitis, or organ-specific diseases
  • At least 20 years old. (20-65 years of age)

These medical/physical criteria are very important for organ donation, but there are others. They play a critical role in finding good candidates for transplant. A good donor should also:

  • Be willing to donate: no one should feel that they MUST donate
  • Be well informed: a good donor candidate has a solid grasp of the risks, benefits, and potential outcomes, both good and bad, for both the donor and recipient.
  • Have good support: significant others should support your decision
  • Have no alcohol or substance abuse problems
  • Have psychiatric diagnoses well-controlled over an extended period of time

The transplant program must perform a minimum series of tests to assess the medical and psychosocial health of potential living kidney donors. It may perform additional tests it believes are needed to assess the potential donor's health and well-being. While there are not currently a required set of tests for potential living donors of other organs, the transplant program will perform many of the same tests as for living kidney donors as well as others appropriate for the organ to be donated.

Transplant programs also require written informed consent process that informs the prospective living donor of all aspects of and potential outcomes from living donation. For living kidney donation, the program is required to address certain specific issues in its informed consent procedure. Similar requirements are in development for living donors of other organs. For more information about requirements for medical and psychosocial testing and informed consent of potential living donors, consult the Organ Procurement and Transplant Network's website.

Tests
 

The living donor must first undergo a blood test to determine blood type compatibility with the recipient.

 

Blood Type Compatibility Chart
 

Recipient's Blood Type

Donor's Blood Type

O

O

A

A or O

B

B or O

AB

A,B, AB or O


If the donor and recipient have compatible blood types, the next step for the donor is a medical history review and a complete physical examination.  In the examination, doctors may commonly perform the following tests:

  • Tissue typing: the donor's blood is drawn for tissue typing of the white blood cells. This test checks the tissue match between six codes on the donor and recipient cells. While still required as part of the transplant process, tissue typing is rarely a consideration for living organ donation.
  • Crossmatching: a blood test is done before the transplant to see if the potential recipient will react to the donor organ. If the crossmatch is "positive," then the donor and patient are incompatible because antibodies will immediately react against the donor’s cells and consequently cause immediate loss of the transplant. If the crossmatch is "negative," then the transplant may proceed. Crossmatching is routinely performed for kidney and pancreas transplants.
     
  • Antibody screen: an antibody is a protein substance made by the body's immune system in response to an antigen (a foreign substance; for example, a transplanted organ, blood transfusion, virus, or pregnancy). Because the antibodies attack the transplanted organ, the antibody screen tests for panel reactive antibody (PRA). The white blood cells of the donor and the serum of the recipient are mixed to see if there are antibodies in the recipient that react with the antigens of the donor.
     
  • Urine tests: In the case of a kidney donation, urine samples are collected for 24 hours to assess the donor's kidney function.
     
  • X-Rays: A chest X-Ray and an electrocardiogram (EKG) are performed to screen the donor for heart and lung disease.
  • Arteriogram: This set of tests involves injecting a liquid that is visible under X-Ray into the blood vessels to view the organ to be donated. This procedure is done on an outpatient basis.
     
  • Psychiatric and/or psychological evaluation: The donor and the recipient may undergo a psychiatric and/or psychological evaluation.
     
  • Gynecological examination: For all female donors, a complete gynecological examination is required. For all females, a mammogram is also required. In general, the transplant nurse coordinator, in conjunction with your physician, can arrange testing.
     
  • Final blood test: Usually completed within 10 days of surgery, the last blood test is another crossmatch. It is the final comparison of the donor's blood cells and recipient's blood serum to make sure that the recipient has not created any antibodies that would attack the donated organ.

While these tests are commonly done, an individual transplant program may require other tests it finds necessary to help ensure the health and suitability of a potential donor.

 

Risks
 

Living donation is major surgery. All complications of major surgery apply. These include:

  • Pain
  • Infection at the incision site
  • Incisional hernia
  • Pneumonia
  • Blood clots
  • Hemorrhaging
  • Potential need for blood transfusions
  • Side effects associated with allergic reactions to the anesthesia
  • Death

The best source of information about risks and expected donor outcomes is your transplant team. In addition, it’s important to take an active role in learning more about these potential surgical risks and long term complications.


Long-Term Organ Specific Donor Complications
 

Kidney

  • Hypertension
  • Kidney failure
  • Proteinuria
     

Lung

  •  Intra-operative ventricular fibrillation arrest
  •  Postoperative pulmonary artery thrombosis
  •  Bronchopleural fistula
  •  Pleural effusion
  •  Empyema
  •  Bronchial stricture   
  •  Pericarditis
  •  Arrhythmias
  •  Chylothorax
  •  Pneumothorax
  •  Hemoptysis
  •  Dyspnea  


Liver

  • Bile leakage
  • Hyperbilirubinemia
  • Small bowel obstruction
  • Biliary stricture
  • Portal vein thrombosis
  • Pulmonary embolish
  • Intra abdominal bleeding 
  • Pancreatitis
  • Bleeding duodenal ulcer
  • Renal failure
  • Gastric perforation
  • Gastric outlet obstruction
  • Plueural effusion


Pancreas

  • Splenectomy
  • Pancreatitis
  • Diabetes


Intestine

  • Short bowl syndrome
  • Small bowel obstruction
  • Dysvitaminosis
  • Weight loss
  • Diarrhea

 

Psychological Concerns
 

You may also have negative psychological symptoms right after donation or later. You and/or your recipient may face surgical complications. The transplanted organ may not work right away. There is also the chance it will not work at all. Donors may feel sad, anxious, angry, or resentful after surgery. Donation may change the relationship you have with the recipient.

Living donors must be made aware of the physical and psychological risks involved before they consent to donate an organ. You should discuss your feelings, questions and concerns with a transplant professional and/or social worker.

 

About the Surgery
 

A nephrectomy is the surgical removal of a kidney. This removal can be done by one of two ways:

  • Laparascopic nephrectomy
  • Open nephrectomy

 

Laparoscopic Donor Nephrectomy
 

Laparoscopic nephrectomy, also known as "keyhole surgery," is a minimally invasive surgical procedure for obtaining a kidney from a living donor that can make the process easier.

In this procedure, the surgeon makes two or three small incisions close to the belly button. The kidney is removed through the central incision. Through one of the other openings, a special camera called a laparoscope is used to produce an inside view of the abdominal cavity. Surgeons use the laparoscope, which transmits a real-life picture of the internal organs to a video monitor, to guide them through the surgical procedure.

In comparison to the standard operation, it results in a smaller incision, reduces recuperation time and usually shortens hospital stays. Many donors are discharged from the hospital after two days and return to normal activity within four weeks.

Not all donors can undergo laparoscopic nephrectomy. You may not qualify for the procedure if:

  • You have had multiple previous abdominal surgeries
  • You are significantly overweight
  • There is abnormal anatomy of the kidney

Your doctor will complete an evaluation to determine if laparoscopic donor nephrectomy is a possibility.

 

Open Nephrectomy
 

Open nephrectomy has been the standard for the last 35 years and involves a five- to seven-inch incision on the side of the chest and upper abdomen. A surgical instrument called a retractor is usually needed to spread the ribs to gain access to the donor's kidney. Sometimes it is necessary to remove part of a rib for better exposure.

The operation typically lasts three hours, and the recovery in the hospital averages four to five days. Donors can usually return to normal activity within four to 12 weeks.

 

Recovery
 

Donors usually stay in the hospital for four to seven days after surgery. Although recovery time varies, most donors can resume normal activity one month after surgery and can return to work within six weeks. It is important to talk to your doctor about what to expect.

Every transplant hospital is required to report data on the health and status of living donors at certain time frames up to two years after donation. The information learned about donor outcomes can help future potential living donors make informed decisions. Ask the staff at the transplant program about their follow-up procedures, including office visits and laboratory tests.

Although studies have shown that kidney donation does not affect the completion of a safe pregnancy and childbirth, it is typically recommended to wait to become pregnant at least six months after surgery.

Be sure to talk with your physician or gynecologist about your interest in donation and the effect it could have on future pregnancies.

 

Ethics

If inducement, coercion or financial compensation for the kidney itself are suspected we cannot move forward with that living donor as these practives are illegal.  Please consult the OPTN website policy 12 for more information on living donation policies and procedures.