Becoming A Living Donor

Can I be a donor?
In order to qualify as a living kidney donor, you must be in good physical condition; free from diabetes; high blood pressure; cancer; heart and kidney disease. Your overall health and emotional well being are of primary concern to the transplant team.

Living donation offers several important advantages over deceased donor kidneys. For example, the rejection rate is significantly lower and a living donor transplant can be scheduled when convenient for both the donor and recipient. This could quite possibly shorten the dialysis period for the recipient who might otherwise wait for months to years for a suitable transplant.

After donation most people can lead an active, healthy life with only one kidney. The remaining kidney enlarges and is able to do approximately 80 percent of the work that two kidneys had previously done. The incidence of high blood pressure in donors is not higher than the general population. Most women who donate do not have any increased risk with pregnancy or childbirth. Although isolated cases of renal failure have occurred after donation, it is rare.

What testing will be done?
The living donor must first undergo a blood test to determine blood type compatibility f the donor and recipient have compatible blood types, the next step for the donor is to have an appointment at the Transplant Services Clinic, where the transplant surgeon will review their medical history and perform a complete physical exam.

Several blood tests will be ordered, also. These tests will include tissue typing, screens for transferable diseases such as hepatitis and HIV, complete blood count, and metabolic panel. An antibody screen will also be ordered to determine if there are antibodies in the recipient that will react with the antigens of the donor.

Urine tests will also be ordered. A urine culture will be done to determine if there is a current urinary tract infection. Urine samples will also be collected for 24 hours to assess kidney function.

A chest x-ray and electrocardiogram (EKG) are performed to screen for heart and lung disease.

If you have a family history of diabetes, a two hour glucose tolerance test may be ordered. This blood test is performed to test the body’s ability to use sugar appropriately. An abnormal test result could indicate a tendency toward the development of diabetes.

Another specialized x-ray called a 3-D helical CT scan will be performed at a later date. This test will demonstrate the anatomy of the kidneys, thus helping to determine which kidney will be used for the transplant.

After your initial testing is completed, you will meet with a nephrologist and he will review your test results and discuss the risks of donation with you. He will also discuss your case with the kidney transplant surgeon to determine your eligibility for donation.

You will also be scheduled to meet with a living donor advocate. They will discuss questions like: What motivated you to want to donate? Are you committed to donation or were you pressured? Do you have a support system, like friends and family, to help you after you donate? This is also an opportunity for you to explore with the advocate, any concerns you have about donation.

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

• Open Nephrectomy
• Laparascopic Nephrectomy

Open Nephrectomy
Open nephrectomy has been the standard for the last 35 years and involves a five to seven inch incision on the upper abdomen. A surgical instrument called a retractor is usually needed to gain access to the donor's kidney. Rarely, is it necessary to remove part of a rib for better exposure. The operation typically lasts three hours.

Laparoscopic Donor Nephrectomy
Laparoscopic nephrectomy 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 also lasts approximately 3 hours but results in a smaller incision, reduces recuperation time and usually shortens hospital stays. Your doctor will complete an evaluation to determine if laparoscopic donor nephrectomy is a possibility. You may not quality for the procedure, depending on your history of abdominal surgeries, your weight and your kidney anatomy.

What is my financial responsibility?
Medical expenses associated with living donor evaluation are covered the Transplant Center. The living donor will not incur any expenses for the evaluation. However, expenses related to another health concern that may be identified during the evaluation process will not be covered.

The actual donation surgery expense is covered by the recipient's insurance. The transplant center will charge a recipient's insurance an "acquisition fee" when he or she receives a transplant. The medical costs related to the donation procedure and required postoperative care are also covered by this fee. In some instances, the actual itemized bill for the donor procedure is submitted to the recipient's insurance.

Anything that falls outside of the transplant center's donor evaluation is not covered. These costs could include travel, lodging, lost wages and other non-medical expenses. Be sure to discuss with your social/financial worker any concerns related to your specific circumstances.