Living-Donor Kidney Transplantation
Living-donor kidney transplantation allows an individual to donate one of their two healthy kidneys to someone whose kidneys have failed. It is an altruistic act on the part of the donor. In fact, a living donor’s sole reason for donating his or her kidney must be an unselfish wish to help the recipient. Most often, a living donor is a blood relative, a spouse, or a personal acquaintance of the recipient.
The Thomas E. Starzl Transplantation Institute’s Kidney/Pancreas Transplantation Program is among the nation’s most active, and has become the largest for living-donor kidney transplantation in the northeastern United States. Since 2002, more than 400 living-donor kidney transplants have been performed at UPMC.
The advances in surgery and care that now allow friends and relatives to donate one of their kidneys are helping to overcome the organ donor shortage and save lives. In recent years, patients have received almost as many kidneys from living donors in the United States than deceased donors.
Currently, more than 70,000 people are waiting for a kidney transplant in the United States. In addition to helping to close the gap between the number of patients awaiting a kidney transplant and the number of kidneys available, living donation offers several other advantages:
- Shorter wait times for suitable organs
Once a living donor has been identified, the removal of the donor kidney and transplantation into the recipient can be planned and performed electively. Recipients avoid the wait times associated with receiving a kidney from a deceased donor.
- Healthier recipients
Because the wait time is shorter, recipients may receive a transplant while they are still in relatively good health and before their kidney disease reaches severely advanced stages.
- Increased chance for successful outcome
Healthier recipients have a better chance at a successful transplant outcome. One year after transplantation, more than 98 percent of UPMC’s living-donor recipients are still alive.
(Statistic source: Scientific Registry of Transplant Recipients, www.ustransplant.org)
Additional Living Donation Topics:
Who can donate a kidney?
Generally, any individual may be considered for living donation who is:
- 18 or older
- not pregnant at time of donation
- in good general health
- of a blood type compatible with the recipient
(Exceptions to this consideration are evaluated through the Starzl Institute's ABO-incompatible Program, which offers positive cross-match using plasmapheresis, intravenous immunoglobulin, and paired exchanges.)
The donor's sole reason for donating must be an unselfish wish to help the recipient.
If you are interested in donating a kidney, you will be carefully evaluated by the Starzl Institute’s Kidney/Pancreas Transplantation Program. The evaluation will include testing and methods to determine who may safely donate a kidney and be the best help to the recipient.
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Evaluating a Potential Donor
Doctors make their decision by looking at two main factors:
- As a donor, you must be able to tolerate the surgical removal of the kidney. It is also very important to ensure the donor will remain healthy after the operation, with no increased risk of vulnerability to kidney failure.
- The recipient must be able to benefit from the donor kidney.
The following tests will be done as part of the donor evaluation. The tests are usually performed in this order:
Initial history and physical exam
Reviewing a potential donor’s medical history and performing a physical exam helps to ensure that he or she has no identifiable medical problems. Such problems could prevent completion of the evaluation tests -- they could also prevent the surgery itself. At least two physicians perform the exam and take the donor's medical history. These include a transplant surgeon and a specialist in kidney disease (nephrologist). The transplant nephrologist is also well versed in living-donor kidney transplantation.
The transplant surgeon and nephrologist from the Kidney/Pancreas Transplantation Program will review in detail all of the tests performed on the potential donor. They also will review the results of the additional tests below before deciding whether the surgery is safe. At that point, the donor will be informed that he or she is cleared to donate.
Written informed consent for live donor assessment and living-donor kidney transplantation surgery
After clearing the donor to proceed further, the specialists and donor will discuss the next steps. Even before the physical exam, the patient receives videos, brochures, and articles so that he or she can learn more about living-donor kidney transplantation. At this stage, the specialist will thoroughly explain the upcoming tests and any potential risks related to them, as well as the surgery itself and its potential risks. The specialists also will provide the donor with a written informed consent form regarding these issues. The postoperative course and routine for follow-up visits also will be discussed in detail. After the donor has had enough time to read and understand the consent form and all questions have been answered, the donor will be asked to sign this form.
Anesthesia history and physical exam
A specialist who will administer general anesthesia during the surgery (give the donor anesthesia that makes him or her fall asleep) performs this part of the evaluation. This specialist, called an anesthesiologist, will explain to the donor the type of anesthesia that will be used for the procedure. He or she also will detail potential risks. The donor is then asked to read, understand, and sign a written informed consent form for anesthesia. (This is a separate consent form from the one discussed above for the donor evaluation and living-donor kidney transplant surgery.)
Social work visit
A social worker conducts an interview with the potential donor. The social worker reviews plans for the donor's care upon discharge from the hospital after the living-donor kidney transplant surgery. Key parts of this plan include:
- housing arrangements
- discharge medications
- transportation to and from postoperative appointments
- support for personal, emotional, and physical needs
- financial considerations
Financial counseling
A financial counselor will consult with the potential donor. The organ recipient's health insurance almost always covers the donor's surgery and hospital stay.
Psychological or psychiatric evaluation
This consists of an interview with a psychiatrist or psychologist. This professional talks with the potential donor to ensure that he or she is able to handle the physical and emotional changes associated with living donation. The psychologist or psychiatrist discusses possible stresses that may result from the procedure and assesses the primary reasons for the donor’s decision to donate. It is important to make sure the donor is not making this decision under any kind of duress.
Extensive blood tests
These will help determine whether the potential donor has any transmissible diseases (such as HIV or hepatitis), any underlying kidney diseases, or any serious medical conditions that might make living-donor kidney transplantation unsafe for the donor or recipient.
Visit the Health Reference to read more about blood tests >
Echocardiogram and electrocardiogram (EKG or ECG)
These tests check the heart for its ability to function correctly. Echocardiograms involve the use of pictures created by sound waves bounced off the heart, and allow doctors to see how well the donor's heart is working and how well the heart valves are functioning. An electrocardiogram measures the electrical activity in the heart, which can also show whether there are problems with its ability to pump blood. Donors older than 50 will have a stress echocardiogram, meaning the pictures will be taken while the heart is under stress from exercise. It is important to make sure, especially with more mature donors, that the heart is working well enough to withstand transplant surgery. EKGs are done on every potential donor.
Visit the Health Reference to read more about EKGs and ECGs >
Pulmonary function tests (PFTs)
These consist of certain breathing tests to determine how well the lungs are working. PFTs are mainly performed when the donor is a heavy smoker or has lung problems.
Visit the Health Reference to read more about PFTs >
Helical or spiral CT angiogram with 3D reconstruction
A CT scan is a computerized x-ray that shows detailed pictures of internal organs. This type of CT scan is among the most sophisticated currently available, and allows doctors to get a detailed view of the donor's anatomy. Doctors look carefully at the kidneys and their vessels, seeking any abnormalities in structure that might prevent a successful transplant. Prior to this test, the radiologist performing the CT scan will provide more detailed information about the test and its potential risks.
Visit the Health Reference to learn more about CT scans >
Arteriogram (also known as angiogram)
In this semi-invasive x-ray study, a dye is injected into arteries going to the kidneys via a small tube placed through the groin. This dye, called an intravenous contrast dye, makes the arteries show up clearly in an x-ray scan. This test is rarely performed on potential kidney donors. Before the test, the radiologists performing the arteriogram will provide more detailed information about the arteriogram and its potential risks.
Review by the transplant committee
After the tests are complete, the donor's data are presented to a transplant committee. This committee includes transplant surgeons, transplant nephrologists, transplant nurse coordinators, a social worker, a psychologist or psychiatrist, and other transplant specialists. Together, they make the decision on whether or not to clear a donor for surgery. Evaluation and review of a donor may take from one to four weeks. Donors will be notified in writing of the committee's decision.
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The Donor Surgery
During living-donor kidney transplant surgery, the donor will have a nephrectomy -- the surgical removal of a kidney.
Some donors may undergo the traditional, open method of kidney removal, which involves an incision on the side of the body next to the kidney that will be removed. Usually, the left kidney is removed from donor because its longer connecting vein is easier to work with during the surgery to transplant it to the recipient.
Nearly all individuals who donate a kidney through the Starzl Institute’s Kidney/Pancreas Transplantation Program undergo a laparoscopic nephrectomy. Starzl Institute surgeons specialize in this minimally invasive technique, which results in less scarring for the donor and a faster recovery time. A donor usually spends two to three days in the hospital.
There are built-in risks for all surgeries, especially those done under general anesthesia. The risk of having some type of complication (either minor or major) from living-donor kidney transplant surgery is low. Most complications are minor and resolve on their own. In rare cases, the complications are serious enough to require another surgery or medical procedure.
The most common kidney donor-related complication is infection.
The donor's risk of death from donor surgery performed in the United States is even more rare — 0.03 percent, or one in 3,000. The main causes of mortality for the donor after this procedure are pulmonary emboli and unrecognizedbleeding.
Long-term function of the remaining kidney is usually the same as for someone who has both kidneys. The risk of developing high blood pressure or other kidney-related problems is the same as for the general population. Many studies have shown no difference in the long-term follow-up of living donors. Studies from Europe have suggested that kidney donors live longer than the general population.
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Contact Information
If you would like more information about becoming a kidney donor, contact living-donor kidney transplant nurse coordinators Gerri James, RN, CTCC, at 412-647-5470, or Diane Connors RN, MPH, CCTC, at 412-647-5065. Office hours are Monday through Friday (except holidays) from 8:30 a.m. to 5 p.m. You may also request to speak with individuals who have donated or received a kidney from a live donor by contacting Ms. James or Ms. Anderson.
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