Living Donors - The Gift of Life
Today, living organ donation is a viable option for many transplant patients, yet the number of people waiting for a transplant far exceeds the number of donors. There are many benefits for both the donor and the recipient, such as improved health and better quality of life.
Benefits of Living Donation
There are many benefits to becoming a living donor. One of the most obvious benefits is that you can save a life, or drastically improve the quality of life for the recipient. Long-term survival is markedly improved among patients who receive a donor kidney compared with patients who remain on dialysis. When a recipient has a living donor, the wait time for transplant is shorter and the transplant can be scheduled. This allows for donations to take place when the recipient is in good health and when it is convenient for both the donor and the recipient, such as summer vacation or winter break.
Live organs that are transplanted last longer than cadaveric organs, and live organs begin to function more quickly than cadaveric donations. This helps ease the process for the recipient, and frees up a cadaveric kidney for another recipient.
Occasionally in life there are those moments of unutterable fulfillment which cannot be completely explained by those symbols called words. Their meanings can only be articulated by the inaudible language of the heart.Pamela Paulk, kidney donor
Types of Living Donation
There are two main types of living kidney donation: directed and non-directed.
Directed donation occurs when a donor and recipient know each other. The donor and recipient may or may not be related. In the past, for best results, donors and recipients needed to have matching blood types and the recipient’s body needed to be unsensitized. If a recipient is not sensitized, it means that the recipient’s antibodies should not attack blood and tissue from the donor, leading to organ rejection.
However, donors and recipients do not have to be an exact match. The Johns Hopkins Comprehensive Transplant Center developed a method, called plasmapheresis, that allows for a “non-matching” donor to still provide a kidney to a recipient. Through our Incompatible Kidney Transplantation Program (InKTP) and our Highly Sensitized Patient Protocol, more options are available for non-matching, directed donors and recipients.
Another directed donation option is to participate in a kidney swap, or exchange. Through this type of donation, a donor and recipient may trade kidneys with another donor/recipient pair. For example, if there were two donor/recipient sets, A and B, Donor A’s kidney would go to Recipient B, while Donor B’s kidney would go to Recipient A. When multiple donor/recipient pairs are used, this type of matching is called a Paired Kidney Exchange.
Non-directed donors, or altruistic donors, are individuals who choose to donate a kidney to an unknown recipient. This kind of donation has the potential to start a domino effect of kidney donations.
The criteria for live donation of a kidney:
- Must be in good physical and mental health
- Must be at least 18 years old
- Must have a body mass index (BMI) that is less than 35
Must be free from the following:
- Uncontrolled high blood pressure in certain individuals
- Organ diseases
- Infectious diseases
Donors who undergo kidney donation surgery at The Johns Hopkins Hospital will qualify for the following support and protections through the National Kidney Registry:
- Lost wage reimbursement up to $2,000 per week for up to six weeks while they recover from the donation surgery
- Travel and lodging reimbursement up to $5,000 in expenses for themselves and a caregiver
- Financial protection for complications that ensures donors are never responsible to pay for a post-surgical complication that is a direct result of their kidney donation
- Legal representation should a donor’s employment, health or life insurance be negatively affected by living donation
- Donor Connect the option for every donor candidate to speak with a living kidney donor who can answer questions, offer insights, and provide education based on their own kidney donation experience
Living donors also need a strong support system to rely on for emotional and physical needs during recovery.
The donation of any organ by a living person must be completely voluntary. Donors should be free from any pressure or guilt associated with the donation and cannot be paid for their donation. In 1984, the U.S. Congress passed the National Organ Transplant Act, which made it illegal to buy or sell organs.
What to Expect as a Living Donor
As with any surgery, it is also important to be aware of the risks associated with kidney donation. Your team can even connect you to a donor mentor – someone who has done what you are about to do and can share their personal experience with you.
The evaluation helps determine if, as the donor, you match the recipient. In the first stage of evaluation, you’ll undergo tissue typing and lab screenings. Blood and tissue typing checks to see if you and your recipient are compatible, and how well the kidney will be accepted by the recipient.
Comprehensive lab testing may include, but is not limited to, the following:
- Blood test
- Urine test
- Pap smear / gynecological exam
- Colonoscopy (if over age 50)
- Cancer screening
- Antibody screen
If these lab results are satisfactory, you’ll next meet with transplant physicians to discuss the procedure and its risks. The physicians and surgeons will review your results and will require additional testing, such as x-rays, electrocardiograms, or radiologic testing.
This testing will including a full day of appointments and diagnostic testing. During this time, you will also meet with our psychologist, Donor Advocate, and nurse coordinator. Further testing may also be required.
Once the work-up is completed, your case will be presented to the multi-disciplinary transplant team. This team includes surgeons, nephrologists, psychologists, donor advocates, and nurse coordinators. They represent you and make decisions that are in your best interest regarding the transplant.
It is important to note that, as a donor, you will have a different transplant team from your recipient. Your team cares for you exclusively. It is a common fear that donors are viewed as a kidney and not as a person; however, at the Johns Hopkins Comprehensive Transplant Center, organ donors are given the same considerations and respect as all of our patients.
Note: At any time during the evaluation process, up until the moment of surgery, you are entitled to change your mind about the donation. This decision is made with your physicians and is kept completely confidential.
If you are approved for the donation after all of the tests are completed, the surgery will be scheduled. The surgery is usually scheduled four to six weeks in advance. Typically, a living kidney transplant donor spends two days in the hospital, and will have an additional four to six weeks of recovery time. Donors who are from out of town should plan on spending an extra week in town after they discharged from the hospital.
During recovery, you will experience some pain and discomfort. This should be easily relieved with either a prescribed medication or over-the-counter pain relievers. For two weeks, you should avoid driving, and you should avoid picking up anything that weighs more than ten pounds for six weeks following surgery. You are encouraged to walk several times a day. If you have children, you may need initial help in caring for them.
Depending on the type of work you do, you may be able to return to your job as soon as two or as long as eight weeks after surgery. There will be follow-up tests to monitor your health.
As with any surgery, live kidney donation has its risks:
- Anesthesia, and possible allergic reaction to anesthesia
- Pain and discomfort
- Bleeding and blood loss which requires transfusion
- Blood clots
- Urinary tract infection
- Injury to surrounding tissue and other organs
A Johns Hopkins transplant surgeon led a study to monitor long-term survival among live kidney donors and found that long-term mortality was similar or lower for live kidney donors than their counterparts in the general public.
Donors should not take non-steroidal anti-inflammatory drugs (NSAIDS). Tylenol is the only over the counter pain reliever that should be used post donation.
Download this alphabetical list of common NSAIDS to avoid. This list is not all-inclusive.
As a living donor, you should be aware of the financial aspects of donation.
Covered by Recipient’s Insurance:
- Screening tests
- Some follow-up care
- Time off of work
- Travel expenses
- Expenses for treatment of unrelated conditions (For example, if a screening test shows cancerous cells, treatment for this condition would not be covered by the recipient’s insurance).
For travel expenses and other funds, the National Living Donor Assistance Center (NLDAC) offers a grant to donors. There are income qualifications that both the donor and the recipient must meet in order for the donor to be eligible.
If you are interested in becoming a living kidney donor, call 410-614-9345.