About Living Kidney Transplantation

There are two kinds of kidney transplants: cadaveric and living donor.

A cadaveric transplant involves transplanting an organ obtained from a stable, heart-beating individual who has been declared 'brain dead' due to a traumatic event. Brain death, or the determination of death by neurological criteria, is the irreversible cessation of all functions of the brain. In these cases, consent for organ donation is obtained from the donorís family or next of kin. Artificial support is used to keep the other organs functioning until donation occurs. A person choosing this type of transplant must wait until a suitable donor becomes available.

A living donor transplant involves a kidney donated by a person who is alive and healthy. This is usually an immediate family member (parent, sibling or offspring) or a cousin, niece, nephew, aunt, uncle or non 'blood' relative like a godparent, close friend or spouse. Generally, the living donor has close emotional ties with the person to whom he or she donates a kidney. Living donation still requires a surgical procedure for the donor, but his or her remaining kidney takes over the needed kidney function after the donation occurs.

Living donor transplants have a number of advantages over cadaveric transplants.

First, there is still a great shortage of cadaveric kidneys. The person needing the transplant does not need to wait on a waiting list for the organ when he or she receives a living donor transplant. Living donor kidneys are less likely to reject and are more successful. When recipients and donors have similar tissue, which is often the case between immediate family members, transplantation success rates are improved. And, the kidney of the living donor is transplanted immediately following removal. This helps the kidney function quickly. The living donor transplant has a first year success rate of close to 95 percent, higher than with a cadaveric transplant.

Living donor transplants permit better planning of the surgery which enables both the recipient and living donor to be in optimal health at the time of surgery. Also, the transplant can be scheduled at the convenience of all involved.

Although kidney donation is not completely without risk, studies demonstrate that it is a safe procedure for healthy, normal individuals. These studies show that donation does not cause harm to the donor's remaining kidney, and that people with one kidney have the same life expectancy as people with two kidneys. Once recovered from the operation, donors can lead a normal, active lives. They are at no greater risk for kidney-related illness or accidents than the general population.

But while the risk of medical complication due to kidney donation is low, potential donors should discuss their concerns with the transplant coordinator and surgeon.

Yes! In fact, the Meet Some Patients page shows two sisters—one donor and one recipient—with the children born after their donation/transplantation. Donating a kidney does not prevent a woman from having children.

To be considered as a donor, a candidate must be:

1. Willing to donate.
2. Between 18 and 55 years old (or receive special approval from the transplant team).
3. Within normal weight ranges.
4. In excellent health with no current disease or illness (high blood pressure, diabetes, kidney stones, and cancer will prevent donation).
5. A compatible blood type (see chart below).
6. Able to pass the required medical evaluation.

All recipients and donors must be tissue-typed prior to surgery. Tissue-typing involves a series of blood tests, and no tissue is actually removed from the donor or recipient. The blood tests identify and compare inherited markers on the blood cells and help the transplant staff predict how well the recipient's body will accept the donated kidney. A successful transplant does not require identical markers on the recipient's and donor's blood cells.

Once an acceptable donor is identified, a medical evaluation is performed—with great care and consideration. The nephrologists and transplant team performing and reviewing the donor evaluation are very careful to protect the health of the donor. Approximately one-quarter of all willing donors are not accepted due to medical or other concerns.

The evaluation consists of three phases:

Phase I

Initiation of the Donation Process

1. Completed screening form.
2. Tissue typing, found to be an acceptable donor.
3. 24 hour collection to evaluate kidney function.

Phase II

1. Complete history and physical with height, weight, and blood pressure checks, with education regarding what it means to you to become a donor.
2. Multiple blood tests: routine chemistry, complete blood count, hepatitis and AIDS screens, clotting studies, viral studies, tissue-typing, etc.
3. Chest x-ray.
4. Microscopic urinalysis, urine culture.
5. Pregnancy and PAP tests for all females.
6. EKG — a short painless test to study the heart.
7. Interview with the Transplant Program social worker and financial coordinator.
8. A test called a spiral CT (a three-dimensional high density CT scan) is scheduled. During the test, dye is injected through a catheter. Then, x-rays are taken of the veins and arteries going to the kidneys. This is usually the last test completed and occurs after a final interview with the transplant/urologic surgeon. This test helps the surgeon decide which kidney to remove.

Phase III

Before the kidney donation is approved, the results of all of these tests are reviewed again by the Transplant Team, as a result of the above findings, other testing may be required. The donor's safety takes precedence over donating a kidney because there is always the alternative of cadaveric donation for the potential transplant recipient.

Next, the donor will be evaluated by the surgeon performing the kidney removal, with the surgeon's approval, the surgery will be scheduled.

The donor evaluation may be coordinated by the recipient's transplant team. Tests may be completed at the donor's transplant center, or at a transplant center close to you. Some potential donors have been evaluated in different states or even different countries.

All clinic, hospital, and reasonable physician's charges from donor evaluation are covered by the End-Stage Renal Disease Program, whether or not the donor is accepted. You can discuss any questions, at any time, with the Transplant financial coordinator.

University Hospital's renal transplant team, including the social worker, is available to counsel donors and their families before and after the decision is made. Also, the transplant coordinator can put you in contact with other donors willing to discuss their experience. The social worker and financial coordinator address financial needs and family concerns and makes referrals, if necessary, to other community resources. Of course, donors are also encouraged to discuss any questions with their family physician.

Bills for the removal of the kidney, physicians' services, surgery, radiology, anesthesia, and pathology should be given to the financial coordinator at SUNY Upstate. Medicaid or Medicare will generally cover all but about $400 of the surgery and hospitalization. In most cases, the donor's insurance company—or the recipient's insurer—will cover the remaining amount. A donor should clear this with the insurance company prior to surgery. The transplant financial coordinator at University Hospital will assist you with this process. Expenses for travel, meals, and lodging prior to and following the evaluation and surgery are not covered by Medicare or other insurance resources. Other expenses, not paid, be discussed further during your evaluation, ie., telephone, television use while hospitalized.

Many patients are admitted the day of surgery (following completion of their workup as outpatients) or the night before surgery. In some cases, a short pre-hospitalization stay at a hospital-associated hotel may be arranged. In any case, a few routine tests will be performed several days before admission to make sure the donor is still in good health. A member of the Transplant Team will also meet with the donor prior to admission. Once admitted to the hospital, the donor will have another opportunity to discuss final concerns with a provider.

Surgery is usually scheduled early in the morning, lasts about three hours. and is performed under general anesthesia. There are two surgical options: laproscopic or open nephrectomy, which will be discussed in detail during your evaluation. Once the kidney is removed, it is immediately transplanted into the recipient. The donor's remaining kidney then takes over the work previously done by two kidneys. After the surgery, the donor is moved to the recovery room for observation, then returned to a hospital room when fully awake.

Immediately after the surgery, the donor can expect to be tired from the operation and anesthesia and experience pain from the incision. Medication will be given to relieve the discomfort, which will decrease as the donor becomes more active. Usually pain medicine is not needed after the first week or two. As the incision heals, the pain will become less severe, but tenderness, tingling, and itching may continue for a number of weeks.

This depends on the donor's surgical procedure: laproscopic kidney removal-hospital stay is 2–3 days; open procedure-hospital stay is 4–5 days. At the time of discharge, a follow-up appointment will be scheduled.

Pain medication may be necessary for several days after discharge, but no other medicine is routinely needed, and no long-term diet changes are necessary.

Laproscopic kidney donors tend to return to work in 2–3 weeks, while open kidney donors return to work return to work in 6–8 weeks. Restrictions will be discussed based on procedure performed. Generally, sexual activity can be resumed in one to two weeks after discharge from the hospital. There are no long-term restrictions on physical activities, except for contact sports, which could injure the remaining kidney.

There will be a 6 month and 1 year follow up withthe transplant team.We recommend that all kidney donors see their doctor once a year for routine check ups. This annual visit should include a physical, blood-pressure check, urinalysis, and basic blood tests.