Living Donor

Because kidneys from live donors are removed under ideal conditions and the donor is in optimal health, these kidneys usually function immediately and the recipient usually has less rejection. Therefore, the recipient experiences better kidney function for a longer period of time. In addition, the recipient doesn't have to wait for a deceased donor kidney to become available, which can take several years.

First and foremost, the donation of a kidney must be a voluntary act. Family members or friends who are in good health and are willing donors are considered. The individual circumstances of each potential donor are discussed privately and testing is started to determine compatibility.

Non-related donors, such as spouses, friends, co-workers or acquaintances, are accepted as living donors. In these cases, careful consideration is given to such factors as the motives and the psychological implications for both donor and recipient. As in all transplants, the patient should discuss these issues with the physician or transplant nurse coordinator. Each case is evaluated on an individual basis.

A good match is obtained when the donor and recipient have compatible blood types and tissue. The more closely related two people are, the more likely their blood and body tissues will be alike.

Hennepin Healthcare is active in a paired exchange program that may still allow you to help your loved one or friend. Paired exchange donation allows individuals who wish to donate a kidney , but cannot because they are incompatible another option. In paired exchange donation, the donor and recipient are matched with another incompatible donor and recipient pair and the kidneys are exchanged between the pairs. The surgeries typically occur simultaneously.

One of the first steps for someone interested in donating is to complete the donor screening forms. These forms help the donor team determine if someone has any medical conditions etc. that would make donation not a good idea for them. If there are no concerns, the donor proceeds with several routine tests to determine donor health. These tests can be done on an outpatient basis, and include the following:

• Tests to determine blood type and tissue compatibility
• An interview with the social worker and independent living donor advocate to ensure there is a healthy motive to donate
• Blood, urine, and viral testing
• A complete history and physical exam
• Chest x-ray
• ECT (tracing of heart rhythm)
• CT angiogram of the kidneys (x-ray of the blood vessels of the kidneys)

Generally, the donor and recipient are seen in the transplant clinic several days before the operation. At this time, a final physical examination and blood tests are performed. The surgeon who will be removing the kidney discusses any final questions or concerns the donor and recipient may have. You will not need to go to the hospital until the morning of surgery.

Shortly before going to the operating room, the donor will be given medication to help him or her relax. A general anesthetic is administered in the operating room to put the donor to sleep during the surgery. At Hennepin Healthcare, removal of the kidney is usually performed with the aid of a laparoscope; a much less invasive, and less painful way of removing the kidney. If the donor is unable to have the kidney removed with the aid of the laparoscope, the surgeon will make an incision on the side from which the kidney is to be removed. The kidney is removed and taken to an adjoining operating room where the recipient has been prepared to receive the new kidney. Typically, the preparation for the surgery and the operation itself take approximately three hours. After the surgery, the donor is brought to his or her hospital room.

All major operations have some risks. The usual risks are bleeding, infection, or blood clot formation. Fortunately, they seldom occur. Everything possible is done to prevent these problems.

Although each situation is unique, donors typically have a rapid and uneventful recovery. As in any case following an operation, the donor feels tired, but this is a natural body reaction to surgery and the general anesthetic. If the kidney is removed through an incision, the donor can expect some pain lasting several days and some discomfort for several weeks as the muscles around the incision heal. The discomfort decreases over time and as the donor becomes more physically active. Pain medications are available to lessen the discomfort. At Hennepin Healthcare, most donors are able to have the surgery laparoscopically, which makes the recovery significantly shorter and less painful.

If the kidney is removed laparoscopically, most donors go home in two to three days. If an incision on the donor's side is used to remove the kidney, most donors will be in the hospital for four to five days.

The rate of recovery and return to normal activity is different for everyone. If laparoscopic surgery is performed, the donor has minimal pain and returns to normal activity much sooner. The donor can expect a lifting restriction of no more than 20 pounds for the first 3 weeks, with gradual increase after that. With open nephrectomy, donors typically experience tenderness and stiffness as the incision heals. Generally, donors are advised to avoid heavy lifting for six weeks after hospitalization.

After donation, living donors continue to have normal kidney function. No lifestyle changes or medications are necessary after one kidney is removed. We recommend avoiding taking nonsteroidal anti-inflammatory medications such as Advil, Aleve, or ibuprofen as they can be hard on the kidneys after prolonged or high dose use.

There is no evidence that donating a kidney has any effect on the ability to have children. Women are advised to notify their physician that they are functioning with only one kidney if pregnancy follows donation. There is an approximately 5% risk increase of toxemia during pregnancy for women following donation.

At present, it does not appear that kidney donation places an individual at risk for future health problems.

The donor's medical expenses related to the donation are paid for by the recipient's health insurance.

Generally, public and private insurance programs do not pay the travel, meals, lodging expenses, or lost income that donors incur. To cover the loss of income, many donors have used sick time from work, and others have used their vacation time. Some families pool their resources to help the family member who is donating.

Some people make the decision instantly, with few worries or problems. Others must go through some soul-searching before deciding. It is normal for a potential donor to have concerns about giving a kidney or to feel surprised about his or her own reluctance. The only "right" decision is the one with which the potential donor feels most comfortable.

The transplant staff will help in a nonjudgmental and professional manner. The donor has a team that works with them through the process. Each donor has an independent living donor advocate. This is someone who is not with the transplant program whose role is to solely support the donor and their decision. The transplant social worker talks with every potential donor (and spouse or family) to make sure the decision is the right one for the donor.

In a survey, living-related donors were asked, "If you could reconsider donating your kidney, would you make the same decision?" Ninety-one percent said "yes" without any reservations, while an additional five- percent stated that they would probably make the same decision. Three percent of the donors were unsure of the decision they would make, and one percent indicated that they would not give their kidney if they had to do it all over again.

Yes, we know of many living donors who are willing to discuss the process from a personal perspective. We can arrange to put you in contact with a living donor.

This information was developed to give you basic information on living kidney donation. It should help you begin to consider the possibility of becoming a kidney donor. Feel free to discuss this possibility with your family and friends, as well as with the transplant staff. Most important, remember that, when all is said and done, the only "right" decision is the one with which you feel the most comfortable.

For more information about living donors, contact the transplant coordinators at (612) 873-7700 or toll free at 1-888-345-0816.