Living Kidney Donors
Every year the number of people waiting for kidneys grows by 10%. Today there are more than 65,000 Americans desperately waiting for a kidney. With the demand growing and the supply remaining the same, alternative means of providing kidneys is being explored. Increasingly donors are coming from both family and friends of the recipient and from people who have no emotional relationship with the recipient but altruistically decide to donate their kidney. Living kidney donors now make up 35% of kidney donation, the rest come from cadavers (deceased donation).
Advantages of a Living Donor Kidney
Living kidney donation offers many advantages such as a kidney from a living donor functions longer (27 years) than kidneys from cadavers (11 years). The financial cost of a kidney transplant in lieu of on-going dialysis is dramatic. Dialysis cost $4,500 per month ($54,000 a year) while a transplant costs $7,500 the first year and $1,200 every following year.
Living with Only One Kidney
Living with only one kidney has now been followed up for over 30 years. People who have only one remaining kidney are not at a higher risk for renal failure than the rest of the population. Studies have shown that kidney donors live longer than the average population albeit this is because donors are selected on the basis of good health and are thoroughly screened prior to donation
Who can be a Living Kidney Donor?
Donors must be in good general health and free from high blood pressure, diabetes, cancer, kidney disease and heart disease. Individuals considered for living donation are usually between 18-74 years of age. Gender and race are not factors in determining a successful match. Donors must make the decision with fully informed consent, free from any external pressure and with the knowledge that there will not be any financial benefit from the donation.
What is the Process of donating a kidney?
In order to ensure that you are physically able to donate a kidney, some of the following tests most likely will be performed before the operation.
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.
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 usually done on an outpatient basis, but in some cases it may require an overnight hospital stay.
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 females 32 years and older, 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 48 hours 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.
What Type of Operation?
There are two types of operation to remove a kidney from a live person.
Laparoscopic Nephrectomy or “Keyhole Surgery”
The surgeon makes two to three small incisions close to the belly button. The kidney is removed through the central incision. A camera called a laparoscrope in inserted through one of the small incisions and provides an inside view of abdominal cavity. Surgeons use the camera to guide them through the procedure.
Some donors might not qualify for this surgery if:
-The donor has had multiple previous abdominal surgeries
-The donor is significantly overweight
-The kidney has an abnormal anatomy
In this minimally invasive surgery the donors often experience less pain and scarring, and return to normal activity more quickly. Donors can go home in as little as 2 days after the operation and resume normal activity in 2-4 weeks.
In this procedure a 5-7 inch incision is made on the side of the chest and upper abdomen. Recovery in the hospital is on average 4-5 days and donors usually resume normal activity in 8-12 weeks.
Donors who undergo the Laparoscopic Donor Nephrectomy are often discharged after 1-2 days in the hospital and resume normal activity in 2-4 weeks. Under the Open Nephrectomy donors are discharged after 3-5 days and resume normal activity after 8-12 weeks.
All the pre-operative testing, the transplant surgery and the post-operative care should be provided for by the organ recipients insurance. It is legal for the recipient to cover the live donors cost related to the operation, which may include travel expenses, lodging and lost wages due to time away from work. Live donorship should not change a donors Life, Disability, and Health Insurance cost. Contact you insurance agent to verify this.
The sense of satisfaction at having saved someone’s life cannot be measured by words. This sense of generosity is compounded because another person with kidney failure, completely unknown to them, will be able to receive a cadaver kidney from the transplant waiting list that the recipient would have needed without living donation
Making the Decision
Deciding to become a kidney donor is a one of the most altruistic gifts that one can give. It is a significant decision for both you and the recipient. To ensure you make this decision fully informed, review the following:
1) Below are some questions to guide you in the process
• How do I feel about organ donation?
• Do I know enough to make a logical and educated decision?
• Am I being psychologically pressured to be a living donor?
• What are the medical risks involved?
• Am I up to it physically? Are there current aspects of my health that I know should keep me from donating?
• Do I have a “support network” to help me through this process?
• Am I prepared to deal with the possible rejection of the organ?
2) Read the following 4 articles about the risk of live donation:
The long-term consequences of living-related or unrelated donation
Laparoscopic Live Donor Nephrectomy
Please review these websites for more information about the medical aspects of live donation:
Other information about live kidney donation:
4) Speak to your physician. This is meant only as a general guide to live kidney donation.
If you decide to become a living kidney donor, you will need to get these tests done to confirm that you are in good health and to find an appropriate match.