Kidney - Living Donor Evaluation



Who can be a kidney donor?

 

There are several things to consider when thinking about live donation:  Is the potential donor healthy and medically suitable?  Do the potential donor and recipient have compatible blood types?  Is the person a willing donor?

 

Living donors should be 18 years of age or older.  This may include blood relatives such as brothers, sisters, parents, children, aunts, uncles, cousins, nieces and nephews.  It may include spouses, fiancés, in-laws, and close friends.  The University of Wisconsin Hospital and Clinics (UWHC) also has a “humanitarian” program where a person can donate a kidney to someone on the waiting list.

 

Any living donor needs to be in good physical and mental health.  They cannot have a history of chronic kidney stones, high blood pressure, diabetes, or a current cancer.  Some health problems such as frequent urinary tract infections, heart disease, or other major health issues need to be looked at on a case-by-case basis.

 

It is recommended that any potential kidney donor come to the recipient’s transplant evaluation. Although, if this is not possible, the potential donor can call the assigned coordinator after the recipient’s evaluation takes place to obtain the information and be tested.

 

The advantage of live donation to the recipient

 

Studies have shown that long-term success is better with a living donor kidney transplants.  With a living donor, the health of the kidney is well known.  The person is a healthy individual who has recently undergone a complete medical evaluation. 

 

Having a kidney from a living donor lets you plan for the surgery.  The transplant date is scheduled ahead of time.  Unlike a deceased donor transplant where the surgery date happens at any time.  The living donor has not had a medical trauma, like a person whose kidney is donated at the time of death.  Most often, the living donor kidney will start to work right away where as the deceased donor kidney may have some delay in starting to work for several days.

Who can receive my kidney? (A standard transplant)

 

What is a match?  Blood tests are needed to see if the donor and recipient are a good match.  This is also called tissue typing.

 

There are four blood types: A, B, AB and O.  A person’s RH factor (positive/negative) does not matter for matching with a kidney transplant but the blood type between the donor and the recipient must be compatible.  The chart below shows what a compatible blood type is for each blood group.

 

If a RECIPIENT is Blood Type:	The DONOR must  be Blood Type:
O	O
A	A or O
B	B or O
AB	A, B, AB or O

 

When the blood types are compatible, a cross match is done.  A cross match is the mixing of donor and recipient blood to see if the cells destroy each other.  A negative cross match (no reaction between the two blood samples) is needed to continue the donation process.

 

Antigen matching is the last test done.  Each of us is born with 46 special cells that make up the body’s genetic code.  These cells are called chromosomes.  The sixth chromosome influences our immune system.  It is the immune system that controls the rejection process after a transplant.  On this sixth chromosome we are matching six specific antigens.  Though it is thought the more antigens matched the better, matching them is not needed because of today’s improved anti-rejection medicines used.

 

For a standard transplant, you must be a compatible blood type and have a negative cross match.  You do not need to match any antigens with the recipient.

 

What if I am the Wrong Blood Type or the Cross-Match is Positive?

 

UWHC has a paired kidney-exchange, blood type incompatible and positive cross-match program.  These types of transplants are for a select group of individuals who meet specific criteria.  If the person who needs a transplant does not have a compatible standard live donor these options can be discussed.  Because of added risks involved with these types of transplants, it should be considered only if absolutely necessary. 

 

How do you begin the process of being a live kidney donor?

 

The potential donor must either come to the recipient’s evaluation or call the assigned coordinator to learn more about donation and to begin any testing.

 

First, a brief health history is taken.  If appropriate the blood samples for typing and matching can be drawn.  This can be done locally if the donor didn’t come to the recipient’s evaluation.  The coordinator will arrange for the blood work to be drawn at a local lab.

 

Blood samples drawn locally must be drawn on a Monday, Tuesday or Wednesday.  This is because the samples are shipped to UWHC to be processed and must arrive within 24 hours.  Our lab does not receive blood samples on the weekends, so it cannot be drawn on Thursday through Sunday.  The results from the blood typing are done in about one week.

 

How is a living donor evaluated?

 

Once the blood typing is done and the most suitable donor is identified, a complete medical evaluation can be scheduled.  The medical evaluation is done on one person at a time.  If, for some reason, the first person tested is not able to be the donor, another person can then be evaluated.

 

It is best if the medical work-up takes place at UWHC.  This allows the potential donor a chance to visit the hospital and meet the doctors, coordinator and other members of the transplant team.  The work-up is done as an outpatient and most often takes a full day to complete.  If you don’t live nearby, we can set some testing up closer to your home with the help of a local doctor or transplant center.  If the work-up is done outside of UWHC, it may take longer to complete.  All “humanitarian” donors must have the work-up at UWHC.  This evaluation usually requires at least two separate visits to complete.

 

The medical evaluation

• A complete history and physical
• An interview with a surgeon
• An interview with a medical doctor
• A chest X-ray
• An EKG
• A 24-hour urine collection
• A urinalysis with urine culture
• A spiral CT/CAT scan of your abdominal organs, your kidneys, and the kidney’s blood vessels
• Blood tests
• A Social Work/Health psychology evaluation

 

The  blood tests

• A glucose tolerance test (a screen for diabetes)
• Routine chemistry and hematology panels
• Clotting studies
• Viral infection screening

The  viral infection screening

• A hepatitis panel
• CMV and EBV screens
• HIV & Syphilis testing

During your workup, problems may be found that you did not know about.  These findings may disqualify you as a kidney donor.

 

Blood samples are drawn to make sure you and the kidney recipient will be a good match.  Other blood samples are drawn to make sure you are in good health.  The site where your blood is drawn might have a small amount of bruising or be painful.

 

Urine samples will be done.  This includes a 24-hour urine collection for protein and creatinine clearance.  This tells us how well your kidneys are working.  A urinalysis and a urine culture are also done.  These tests can detect any kidney problems or infection.

 

You will also have a chest x-ray and electrocardiogram to be sure you have no problems with your heart or lungs.

 

Glucose tolerance test (GTT) is a blood test that looks at your blood sugar levels.  This test is done to make sure you do not have diabetes or are at risk of having diabetes in the future.  For a GTT, you drink a sweet liquid after not eating for 12 hours.  A series of blood samples are drawn after drinking the liquid.  The test takes about 2 hours. 

 

The last test done is a Spiral CT/CAT scan.  This is a test that looks at where your kidneys are and their blood vessels.  It helps the surgeon decide which kidney should be used and whether laparoscopic surgery can be done.  It also evaluates other organs in the abdomen.  A CAT scan can see if there are problems.  If you have any known allergies to contrast dyes, seafood or shellfish, be sure to tell us before having this test.  If you have any of these allergies, you will receive medication before the test, or they may do an MRI scan instead.

 

After all the tests are finished, it takes about one week to gather the results.  More tests or consults with other doctors may be needed once the test results are reviewed.  These often, but not always, can be done closer to your home. 

 

Once a person is approved to donate, the date for the transplant can be set.

 

 

If you are not suited to donate a kidney, further care may be advised.  You should follow up with your local doctor.  The cost of this follow up care will be your responsibility.  With your permission, records from the donor evaluation will be sent to your local doctor.  Having certain diagnoses could make it harder to obtain private health or life insurance in the future.   

 

What does it cost to donate a kidney?

 

The recipient’s insurance and/or Medicare will cover the donor medical work-up, the hospital stay, any doctor charges, and a clinic visit after the surgery.  If you receive any bills for the work up or hospital stay, please call the transplant office.

 

Unfortunately, there is no way to pay for travel costs or time off work.  These are a donor’s responsibility.  If you are working, and have disability insurance, the time needed off from work to donate a kidney may be a covered benefit.  Other employers may require you to use your sick time.  You should check with your employer to see what benefits you may have. 

 

Although it is not required, we recommend that you have a local doctor and medical insurance before you donate a kidney.  

 

If you live in Wisconsin, you may qualify for benefits under the Wisconsin Donor Tax Exemption Bill.  Also, State of Wisconsin employees may qualify for special leave time under Act 125.  The social worker or coordinator can give you more details about this.

Although it is not required, we recommend that you have a local doctor and medical insurance before you donate a kidney.  

 

Two Different Types of Donor Surgery - Open versus Laparoscopic

 

Laparoscopic surgery is a less invasive type of surgery.  Often the recovery time and pain are less.  Special instruments and a video monitor are used to look at the kidney and blood vessels and to remove the kidney.  A donor must meet certain standards for this type of surgery, and not all donors are able to have the surgery done this way. 

 

A person who is significantly overweight, has had major abdominal surgery, and/or has complex left and right-sided kidney anatomy may not be able to have this type of surgery.  Your coordinator and doctor will discuss this with you. 

 

The laparoscopic method uses four small incisions (about 1 inch each) on the abdomen for the instruments and the tiny camera.  There is also one larger incision (about 3-4 inches) made below the belly button.  This is where the kidney is taken out.  Laparoscopic surgery may take about 4 hours to do.  This is slightly longer than the open method.

 

Even though this is a more technically difficult surgery to perform, most donors at our center have the laparoscopic surgery.  It is important to know that if problems occur during a laparoscopic surgery, the surgeon may have to convert to the open method to remove the kidney.  This very rarely happens but is a possibility. 

 

Open surgery allows the surgeon to see the kidney and blood vessels directly.  This surgery is used in patients with more complex kidney anatomy, such as several blood vessels, major past abdominal surgery, or a larger body size. 

 

With open surgery, the incision is on the right or left side of the abdomen and extends around the side.  The doctor will decide which kidney is best to remove.  The open incision is about 8-10 inches in length.  Open surgery will take about 2-3 hours. 

 

The Hospital Stay

 

The donor will come to the hospital as an outpatient the day before the surgery for a pre-surgery work-up and anesthesia visit.  If you do not live nearby, hotel accommodations the night before surgery will be provided.  The morning of surgery you will check in at First Day Surgery.

After the surgery you will be taken to your hospital room.  Your nurse will get you up to walk about 4-6 hours after surgery.  The average hospital stay is 3-4 days.

 

Please bring comfortable loose fitting clothing and walking shoes.  Walking often helps prevent pneumonia and blood clots.  It also helps restore normal bowel function.

  

Once discharged from the hospital you will recover at home for another 2-6 weeks.  It may take as long as 4 to 6 weeks before you feel back to normal.  We ask you to restrict your daily routines, such as no driving, heavy lifting or strenuous activities.  You should not lift more than 5-10 pounds or do strenuous activities/exercise for about 4-6 weeks.  You should be able to resume driving when you are no longer taking any pain pills.  Your surgeon will let you know when you can begin to increase what you are doing.

 

What long-term follow up is needed?

 

You will have check-ups at UWHC at one month and six months after surgery.

 

After that time, we suggest that you see your local doctor yearly for a complete check-up after giving a kidney.  This exam should include a physical exam, a blood pressure, blood creatinine level and urine testing to see how your kidney is working.  The cost of this annual check-up will be your responsibility.

 

Hotel Accommodations

 

If you are coming from out of town you and your family may want to stay in Madison the night before any clinic visits or the hospital stay.  The UWHC Housing Office, (608) 263-0315, has a list of nearby hotels to choose from.  A discount rate is given when you make the reservations through the hospital accommodations office.

 

Phone Numbers

 

Transplant office number:  (608) 263-1384

Fax Number:  (608) 262-5624

 

Main Hospital number 1-800-323-8942 (you will need to  ask for the transplant office telephone number listed above or the department number you want to reach)

 

The Spanish version of this Health Facts for You is #6543.

 

 

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 03/21/2011

Copyright © 03/21/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. UWH #5285

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