Who can be evaluated as a living donor?
Who cannot donate a kidney?
What is included in the evaluation for donation?
What is HLA-typing or "tissue typing?" What is tissue crossmatch?
What is an ultrasound and renal arteriogram?
Is there a risk to the surgery?
Are there long-term health risks?
How long will the donor need to be hospitalized and when can they return to work?
Does the donor have to pay any of the costs of the evaluation or the surgery?
What are the benefits to the donor?
Will giving a kidney affect the donor's lifestyle?
What are the advantages of receiving a living kidney transplant?
Suppose a person decides against donating a kidney?
To donate a kidney, you must volunteer without any pressure from anyone else and understand the risks of surgery. A donor must be between 18 and 60 years of age. Most of the time, the donor is a parent, sibling, aunt or uncle of the child in need of the transplant, but this is not required. Ultimately, the final decision of whether a living donor is appropriate will be made by the transplant team. In general, the major blood type of the donor should match or be compatible with the recipient. Rh positive or negative status in the blood group is not important in transplant as it is in blood donation. If the donor and intended recipient have incompatible blood and/or tissue types, other options, called paired kidney exchange or donation chains, may be available. Speak to your transplant coordinator about these options.
Anyone with a history of prior or current kidney disease, human immunodeficiency virus (HIV) or cancer cannot be a donor. The donor should not be significantly overweight or have a history of alcohol abuse. Some kidney diseases are inherited and therefore, a parent of a child with one of these diseases may not be appropriate for donation. A donor cannot have high blood pressure, diabetes, mental illness or heart disease, and must not have any serious infectious disease that may harm the recipient. A donor must have the appropriate mental capacity to make the decision to donate. There must be no financial reward of any kind for the donor.
1. Initial blood type and tissue typing, blood crossmatch with potential recipient (arranged through transplant coordinator)
2. Psychology evaluation
3. Social work evaluation
4. Routine examination by your family doctor
5. Urine sample and culture
6. 24-hour urine collections, done twice (all urine in a 24-hour period must be collected for accurate results)
7. Blood work
8. Gynecological examination and Pap smear for all women and a mammogram for all women over 35
9. PSA for males over 45 years of age
10. Electrocardiogram (EKG)
11. Chest x-ray
12. History and physical examination by an adult kidney specialist
13. Radiology (X-ray) testing (Renal ultrasound and renal arteriogram)
14. Surgical evaluation and meeting with the surgeon who will remove the kidney
HLA typing is a blood test that determines the major antigens or proteins that make each person different. Six antigens are important in kidney transplant. Tissue typing will let us know how many antigens the donor shares with a recipient, or what the "match" is.
A crossmatch is a test done with the donor's and recipient's blood. This tells us if the transplant is possible with that particular donor. (In the case of incompatible cross-matches, the Paired Kidney Exchange program may be an option.) If a patient has had blood transfusions or transplants in the past, he may not be able to receive a kidney transplant from certain people. Donors can think of this as a "mini-transplant in a test-tube."
A renal ultrasound is an x-ray test that shows the size, number, position and structure of the kidneys. A renal arteriogram is an x-ray test that shows the number, size and location of the renal arteries (vessels that supply blood to the kidneys). A dye is injected into a large artery in the groin. This dye flows into the renal arteries so that they can be seen by x-ray.
Most of the time, the operation goes very smoothly for a healthy donor. Death from kidney donation is very rare, but any procedure involving the kidney has some risk. In addition, every time anesthesia is given or someone has surgery, there is a possibility of a complication. The most common risks for living kidney donation include bleeding, infection and incisional hernia. There is always the chance that re-operation is necessary. The kidney specialist talks to a potential donor about her health, test results and risk of problems with kidney donation.
Current research shows that donation does not increase a donor's risk for kidney failure or put the donor at more risk for future health complications.
Most people stay in the hospital three to seven days after surgery. Most people can return to work in three weeks.
Both the donor's insurance and the recipient's insurance cover most of the cost of kidney donation and testing. However, each insurance plan is different.
Some costs may not be covered—pay lost from taking time off from work, travel costs and insurance "co-pays" required by some plans. A social worker and a transplant financial counselor can discuss specific insurance coverage and reimbursement concerns.
There are no direct health benefits to the donor, but there may be psychological benefits. Many donors feel rewarded and very happy from helping a loved-one or person in need. Many times they can see the life of that person improved greatly after the transplant.
Not usually. After recovery from surgery, the donor is able to return to normal routine — work, drive a car and play sports as before. Donation does not change life expectancy. Many studies show that it does not increase the chance of developing kidney failure in the future. The donor can work in most types of employment without a problem. However, the military and some police and fire departments may not take individuals who have only one kidney. Insurance companies have different rules about providing health and/or life insurance to people who have one kidney. The potential donor must speak with a social worker about these kinds of issues.
A patient often must wait years on the waiting list for a cadaver kidney. If there is a living donor, the surgery can be planned. A date is picked that works well for the donor and the recipient. In that way, the recipient does not have to wait a long time for the kidney transplant. The result of living kidney transplant also tends to be better than for cadaver kidney transplant.
After a kidney transplant, most patients can lead a more active and healthy lifestyle. Most patients are able to go to school or work full-time. They can eat a varied choice of foods and their diet is not as restricted. Most patients feel less tired and are better able to travel. These activities may have been hard to do while the patient had long-term kidney failure or was receiving kidney dialysis.
Deciding to donate a kidney is very hard and sometimes complicated. This decision should be completely voluntary and free from family pressure. The HUP or Penn donor advocate should discuss any concerns with the donor about donation. If the donor, the donor advocate or the evaluating physicians of the donor feel that a kidney should not be donated, then the evaluation will stop. Whatever choice is made, the transplant team will always support that choice. If you complete the full evaluation and you have any second thoughts about not being a donor, you can and will be given an opportunity to opt out of donation, even if it is at the last moment. This decision is confidential and does not need to be shared with the recipient or their family.
The recipient may be listed for a deceased donor kidney from the national donor organ procurement program (UNOS). Learn more about the kidney transplant waiting list and receiving a kidney from a deceased donor. Patients may also have the option of life-long kidney dialysis if transplantation is not an option.