Donating a kidney is a big decision and potential donors have many questions. Here are some frequently asked questions based on publicly available sources, as well as a set of links to good resources for additional information.
What is a Living Donation?
Q: What is living donation?
A: An alternative for individuals awaiting organ transplantation from a deceased donor, living donation takes place when a living person donates an organ or part of an organ for transplantation to another person.
Q: What are the advantages of living donation over non-living donation?
A: A living donor transplant may reduce a patient’s time on dialysis and/or years of waiting for a deceased donor organ.
Q: What is the process for determining whether I can be a living kidney donor?
A: To qualify as a donor, you’ll undergo a screening process. Requirements vary somewhat among hospitals, but generally you must be at least 18 years of age (donors are usually 18-60 years old), pass a psychological evaluation, have two healthy kidneys and meet basic health requirements (heart disease, hypertension and clotting disorders are among the medical conditions that may disqualify donors). Gender and race are not factors in determining a successful match. Lab tests are also required, including blood work, cardiovascular exams, a metabolic evaluation, a renal evaluation and a tissue compatibility test. You might also undergo psychological and financial assessments. For more information, check out this page.
Who Can Donate?
Q: Who can donate?
A: Donors are often a close relative such as a parent, brother or sister, son or daughter but may also be individuals who are not related but have an established emotional relationship with the recipient such as a partner or close friend. Or a donor could be someone, known as a non-directed donor, who just wants to help someone in need.
Sometimes a donor and a recipient may be incompatible with each other because of blood group or tissue-type and in this case it may be possible for them to be paired with another donor and recipient in the same situation. This means that each recipient will benefit from a transplant that they would otherwise not have had (this is called paired donation). Donors may also offer to give a kidney to someone who is on the waiting list for a transplant but whom they have never met before (this is called non-directed altruistic donation).
Q: Do I need to be related to the person who may receive the kidney?
A: While it is commonly family members who offer to be kidney donors, there are often spouses, friends, members of the community or people from the same place of worship who can be highly successful kidney donors. Being related is not a requirement to donate a kidney. In the past, the conventional wisdom was that close tissue typing was necessary for a successful donation, and close tissue typing implied blood relationships. However, anti-rejection drugs are so powerful now that close tissue typing is less important when identifying a potential donor. Consequently, unrelated living donation has increased dramatically over the last 10 years. You will still need to go through the normal evaluation of donors (see this page). Also be prepared to discuss your motives for donation and the impact it might have on your relationship with the recipient and family.
Different Types of Donations
Q: What is “related living donation”?
A: Related living donors are healthy blood relatives of transplant candidates. They can be:
- Children over 18 years of age
- Other blood relatives (aunts, uncles, cousins, half brothers and sisters, nieces and nephews)
Q: What is “non-related donation”?
A: Unrelated living donors are healthy individuals emotionally close to, but not blood related to transplant candidates. They can be:
- In-law relatives
- Close friends
- Co-workers, neighbors or other acquaintances
Q: What is “non-directed donation”?
A: Non-directed donors are living donors who are not related to or known by the recipient, but make their donation purely out of selfless motives. This type of donation is also referred to as anonymous, altruistic, altruistic stranger, and stranger-to-stranger living donation.
Q: I’d like to donate to a certain person, but I’m not the right blood type. Are there any alternatives?
A: One of the first tests for living donors is determining whether the donor and recipient have compatible blood types. If they are not compatible, because of ABO incompatibility or a positive crossmatch, there are a couple of alternative ways to donate:
- Paired-Exchange donation
A paired exchange donation consists of two kidney donor/recipient pairs whose blood types are not compatible. The two recipients trade donors so that each recipient can receive a kidney with a compatible blood type. Once the evaluations of all donors and recipients are completed, the two kidney transplant operations are scheduled to occur simultaneously. More info can be found here.
- Kidney-Donor-Waiting-List-Exchange donation
If a paired exchange cannot be found, living donors in certain areas of the country may be eligible for living kidney donor list exchange. In this type of exchange, a kidney donor who is not compatible with their intended recipient offers to donate to a stranger on the waiting list. In return, the intended recipient advances on the waiting list for a deceased donor kidney. This type of living donation is also referred to as list-paired exchange and living donor/deceased exchange.
- Blood-Type-Incompatible donation
This type of donation allows candidates to receive a kidney from a living donor who has an incompatible blood type. To prevent immediate rejection of the kidney, recipients undergo plasmapheresis treatments before and after the transplant to remove harmful antibodies from the blood, as well as the removal of the spleen at the time of transplant.
- Positive-Crossmatch donation
The positive crossmatch process is similar to the process used for ABO-incompatible living-donor kidney transplants, where patients can receive kidneys from living donors with blood types incompatible with their own. Similarly, treating patients with plasmapheresis also greatly reduces the chance of organ rejection in patients with elevated antibody levels. Previously, these elevated antibody levels made tissue rejection almost certain. Positive crossmatch live donor kidney transplants are usually only performed if no other live donors (with a negative crossmatch) exist.
What are the Risks?
Q: Are there any risks to the living donor?
A: All operations carry some risk and this is no different for living donation. Donors are at risk of infections (eg chest, wound or urine) and, more rarely, bleeding or blood clots. There is a very small risk of death for the donor: this is estimated at 1 in 10,000 for this operation.
Q: Are there any long-term risks?
A: There is a possibility of a rise in blood pressure and excess protein in your urine. However studies have shown that there is no long-term effect on the health of the donor or your remaining kidney.
Q: Will I have to change my lifestyle after donating?
A: There is no specific reason why you should not be able to lead a normal healthy life as before.
Q: What are the long-term effects on me if I donate one of my kidneys?
A: Though we’re born with two kidneys, we can function with just one. Frankly, there is inadequate medical research on the long-term consequences of living donation. The research currently available has shown there are few, if any, long-term effects on a living kidney donor. Mortality rates look to be the same or better than the general population. Some studies have revealed slightly higher incidence of high blood pressure and elevated levels of protein in the urine. There is also a possibility (0.1% to 1.1%) that a living kidney donor will develop End Stage Renal Disease and need a kidney transplant. However, much more rigorous research is needed to answer this question with confidence.
What Does the Surgery Entail?
Q: What if I live in a different part of the county from the person I am donating to?
A: You can still donate. The transplant team can arrange for your donor assessment to take place at a hospital near you if that is more convenient for you. Usually the donation will take place in the hospital where the person you are donating to is cared for. However, different arrangements can be made depending upon individual circumstances for both the donor and recipient.
Q: What does the surgery entail?
A: http://www.transplantliving.org/living-donation/about-the-operation/kidney/ and/or http://www.livingdonorsonline.org/kidney/kidney5.htm
Q: Will I require a blood transfusion during my surgery?
A: Although blood transfusion during this surgery is uncommon, it may be necessary. As a precaution, you may be asked to donate one or two units of your own blood before the surgery. If you do need a transfusion, your own blood can be used.
Q: How much time will I need to take off work?
A: Most transplant centers will try to arrange the tests before the operation around your work schedule to minimize disruption to your job. It is sometimes possible to arrange for some of this to be done locally if the donor lives a long way from the transplant center. The operation and recovery period varies depending on surgery, your individual recovery and the type of work you will be resuming. Many people that have a desk job are back to work in three weeks. If your job is physically demanding, you might need six weeks or more to resume all your prior activities.
Q: How long will I be in hospital?
A: This varies depending on your individual recovery. It is not uncommon for someone to have to spend 2 or 3 days in the hospital to recover.
Q: Will I need to take any medication after donating?
A: You will need to take some painkillers immediately after the operation and during the recovery period. However, you should not need any long-term medication as a result of kidney donation.
Q: What about follow-up?
A: You would usually be seen by the transplant team between two and six weeks after donation.
Q: Are there medications I should be careful about using after donation?
A: You should ask your doctor for guidance. Other living kidney donors report that they are advised to avoid or at least minimize use of medications that can be toxic to kidneys. A common example is ibuprofen, which is the main ingredient in pain relievers like Advil.
Q: If I am cleared to be a donor, how is it decided when the transplant will take place?
A: This decision is made jointly by the transplant team, by you, and by the recipient. The transplant team, particularly the physicians involved directly in your recipient’s care, will determine as accurately as possible the best time to do the transplant, based on the recipient’s medical condition.
Q: Once the transplant is scheduled, will it definitely happen?
A: A number of events could happen that may change the date of the transplant. For example, the recipient’s condition might deteriorate to the point where he or she is too sick for a transplant. Or, the recipient or donor might develop an infection or some other condition that would need to be treated before the transplant could be done.
Q: What are the odds my donated kidney will work…that it won’t be rejected?
A: Excellent. In fact, living kidney donation has the best track record of all forms of donation. Statistics from the Organ Procurement and Transplant Network show that the kidney donated from living donors is still functioning in 96% cases after one year, 81% of cases after five years, and 58% of cases after 10 years. Even so, you should be prepared mentally for the possibility of rejection.
Q: I’m ready to donate. Where can I get tested?
A: For detailed information on becoming a donor, go to the Scientific Registry of Transplant Donors list for the kidney transplant center nearest you.
What are the Financial Implications?
Q: I’m ready to donate. Who pays?
A: Most medical costs associated with living donation are covered by the recipient’s insurance (including U.S. Medicare). The government requires all certified transplant centers to charge a recipient’s insurance an “acquisition fee” when he or she receives a transplant. The medical costs related to the donor’s medical evaluation, transplant procedure and postoperative care, called the “donor protocol” are covered by this fee. Anything that falls outside of this protocol is not covered. These costs could include annual physicals, travel, lodging, lost-wages and other non-medical expenses.
Generally, any medical treatment needed following the donation, such as annual physical exams, are the donor’s responsibility and you should check with your insurance company. However, complications directly related to the donation should be covered by the transplant center. Note that some living donors have found themselves charged for these expenses. It is the position of Living Donors Online that donors should not pay for the treatment of complications from living donor surgery. Please contact them if you find you are being charged for these expenses.
Q: As a donor, will I be entitled to disability pay?
A: If your job provides disability insurance coverage, then you will most likely be entitled to disability pay. Check with your employer.
I’m Having Trouble Making the Decision
Q: Do some donors have trouble making the decision?
A: Some people make the decision easily. Others go through some soul searching before deciding. Being afraid of donating a kidney or feeling guilty about not wanting to donate, is quite normal. The only “right” decision is the one that makes you, the potential donor, feel comfortable. Finding out more information about living donation and what it involves may help you with this decision.
Q: Can I speak to somebody who has donated?
A: Your coordinator at your local transplant center should be able to arrange this for you. Also, ask about the Living Kidney Donors Network Mentors Program. http://www.livingdonorsonline.org/experiences/experiences.htm
Q: I’ve got lots of questions about donating. Who should I talk to?
A: The first place to go is the transplant team. Talk to the transplant coordinator, the surgeon, the social worker, or whomever you are most comfortable with. You should also consider talking with friends, family, religious leaders, and others you trust.
Q: What if I decide that being a donor isn’t for me?
A: You have the right to withdraw your offer at any time and you would be supported in your decision by the transplant team. The decision to become a living donor is a voluntary one, and the donor may change his or her mind at any time during the process. The donor’s decision and reasons are kept confidential.