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Living Donor Transplant

by Dr.P.N.Gupta

Q. Who can be evaluated as a living donor?
Ans.
  • To donate a kidney, you must volunteer. A person should not be forced to donate a kidney. They must also understand the risks of surgery. A donor must be at least 18 years old, and preferably not older than 65 years of age. Most of the time, the donor is a parent, sibling, aunt, uncle or child of the person in need of the transplant. The major blood type of the donor should match with the recipient. Donors above the age of 65 yrs & ABO incompatible donors can be considered in special circumstances.
Q. Who cannot donate a kidney?
Ans.
  • Anyone with a kidney disease, human immunodeficiency virus (HIV) or cancer cannot be a kidney donor. A donor cannot have diabetes, mental illness or heart disease. A donor must not have any serious infectious disease that may harm the recipient. A donor must be mentally able to make this decision and there must be no financial reward of any kind for the donor. A donor with mild high blood pressure controlled with 1-2 drugs and no target organ damage may be acceptable as a donor if there are no other contraindications.
Q. What is included in the evaluation for donation?
Ans.
  • ABO blood group
  • Psychology evaluation
  • Routine examination by physician
  • Blood and urine tests
  • Women will need a gynecology exam and a mammogram for some women (breast cancer screen).
  • Human leukocyte antigen (HLA) testing or “tissue typing” and crossmatch
  • Electrocardiogram (EKG) and cardiac evaluation
  • Chest x-ray
  • History and physical examination by an adult kidney specialist
  • Radiology (X-ray) testing (Renal ultrasound and renal arteriogram), DTPA scan for each kidney function
  • Surgical evaluation and meeting with the surgeon who will remove the kidney
Q. What is HLA-typing or “tissue typing”? What is a tissue crossmatch?
Ans.
  • HLA typing is a blood test that determines the major antigens or proteins that make each person different. Six antigens are important in kidney transplant. Tissue typing will let us know how many antigens the donor shares with a recipient, or what the “match” is.
  • A crossmatch is a test done with the donor and recipient’s blood. This tells us if the recipient has antibodies against the donor HLA antigens. In short if cross match is +ve then transplant with that donor is not possible. Patient who have had multiple pregnancies or received multiple blood transfusions or multiple transplants are at high risk of developing antibodies against donor HLA. Donors can think of this as a “mini-transplant in a test-tube.”
Q. What is an ultrasound and CT angiogram?
Ans.
  • A renal ultrasound is an x-ray test that shows the size, number, position and structure of the kidneys. A CT angiogram is an x-ray test that shows the number, size and location of the renal arteries (vessels that supply blood to the kidneys). A dye is injected into a peripheral vein. This dye flows into the renal arteries so that they can be seen by x-ray.
Q. Is there a risk to the surgery?
Ans.
  • Most of the time, the operation has no serious risks for a healthy donor. Every time anesthesia is given or someone has surgery, there is a risk. Death from kidney donation is very rare (about 3 in 10,000). This risk is much less than each one of us takes in our day to day activities. The kidney specialist talks to a potential donor about his or her health, test results and risk of problems with kidney donation.
Q. Are there long-term health risks?
Ans.
  • Donation does not increase a donor’s risk for kidney failure or put the donor at more of a risk for future health complications. Laparoscopic donor surgery has made it possible to reduce the pain and stay in hospital and early return to work.

Q. How long will the donor need to be hospitalized and when can they return to work?
Ans.
  • Most people stay in the hospital 3-7 days after surgery. Most people can return to work in 2-4 weeks.
Q. What are the benefits to the donor?
Ans.
  • There are no direct health benefits to the donor, but there may be psychological benefits. Many donors feel rewarded and very happy from helping a loved-one or person in need. Many times they can see the life of that person improved greatly after the transplant.

Q. Will giving a kidney affect the donor’s lifestyle?
Ans.
  • Not usually. After recovery from surgery, this donor is able to return to normal routine — work, drive a car, and play sports as before. It does not change life expectancy. Many studies show that it does not increase the chance of developing kidney failure in the future. The donor can work in most types of employment without a problem. However, the military and some police and fire departments may not take individuals who have only one kidney. Insurance companies have different rules about providing health and/or life insurance to people who have one kidney.

Q. What are the advantages of receiving a living kidney transplant?
Ans.
  • Chronic kidney failure patients can lead a meaningful quality of life either having a kidney transplant or by being on maintenance hemodialysis (thrice a week, 4 hrs each) or on CAPD daily done at home, 4 exchanges.
  • Kidney transplant is the best form of treatment for kidney failure patients, much better than being on either maintenance hemodialysis or chronic peritoneal dialysis in terms of longevity of life (survival), quality of life and cost.

Q. Suppose a person decides against donating a kidney?
Ans.
  • Donating a kidney is a very hard and sometimes complicated decision. It should be voluntary and free from family pressure. If the donor or family doctor of the donor feels that a kidney should not be donated, then this should not be done. Whatever choice is made, the physicians will support that choice.

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Transplant – Recipient FAQs