Where Will my New Kidney Come From?
The Organ Shortage
There is a severe shortage of organs for transplant. This means that the wait for a kidney transplant can be many years. The UW Transplant Program has long been a leader in trying to find new ways to increase the number of good organs that can be used for transplant. When you are told you need a kidney transplant, you have options as to where your new kidney will come from. It is vital that you explore these options fully.
Live Donor Kidney Donation
A kidney from a living donor is the best choice.
There are some things to keep in mind when thinking about using a live donor.
- Is the person willing to donate?
- Is the donor healthy and medically able?
- Do you and the donor have well-matched blood types?
There are many benefits from getting a living donor kidney.
- Better health: Because you were able to avoid a long wait time, you are more likely to be in better health when you receive your transplant.
- Better quality kidney:
- Studies have shown better success with a living donor kidney transplant.
- With a living donor, the health of the kidney is well known. The person is over 18 years of age and a healthy person who has had recent complete health testing.
- Kidneys from living donors often function right away after transplant. This is because the donor and recipient surgeries are performed at the same time, so the kidney transplant takes place right away.
- Perhaps best of all, long-term outcomes are better with a living donor kidney. The five year success rates for people who have received a kidney from a living donor are about 10% higher than those who receive their kidney from a deceased donor.
- A better match: The donor has a series of health testing to make sure that they are in good health and that the kidney is healthy. Tests are done to check the matching between the donor and the recipient, and when it is a family member, the matching is often better.
- Better prepared: The transplant can be planned for a time when both the donor and the recipient are in the best health for surgery.
Who can donate?
Any living donor must be in good physical and mental health. They cannot have had chronic kidney stones, high blood pressure, diabetes, or current cancer. Some health problems such as frequent kidney or bladder infections, heart disease, being obese, and the donor’s age, or other major health issues need to be looked at on a case by case basis. Also, in most cases they must be ABO blood type and crossmatch compatible with you.
Related/Unrelated Live Donation
The two most common living donors are someone who is blood related to the recipient: brother, sister, parent, child, aunt, uncle, cousin, niece or nephew; and someone who is very close to the patient: spouse, fiancés, in-laws and close friends.
Other Live Donor Options
Humanitarian Donation
There are times when a person comes forward and wants to donate a kidney but does not have a certain person in mind to receive the kidney. We have a system to closely assess these people to decide if they can donate. These kidneys are offered to the first person on the waiting list who is a match with the donor. The donor may remain unknown or if they choose or can be known to the recipient.
To learn more about Humanitarian Donation, and to speak with a program staff member, please call (608) 263-1384.
Paired Exchange Live Donation
There are instances when a person cannot donate a kidney to their friend, family member, or loved one because they are not a match. This may be because their blood types do not match, or there can be other matching issues. The paired kidney donation exchange program gives a willing donor the opportunity to help their intended recipient receive a living donor kidney from another individual.
If there is another recipient and donor in the same situation, the paired kidney donation exchange program can be an option. If medically appropriate, each donor could donate his or her kidney to the other recipient. In this way, both recipients would receive a matching kidney from an unrelated living donor.
Donors Recipients
A B
C D
We are, currently, participating in the National Kidney Registry. With this program, a kidney from a live donor could be sent to UWHC for you, and your donor’s kidney could be sent elsewhere in the United States. This increases our chances of finding you a matching kidney. For more information please go to www.kidneyregistry.org, speak directly to your transplant coordinator, or call the Paired Exchange Coordinator at 608-263-4298.
Desentization Before Live Donation
In some cases donors who are NOT compatible with the recipient in terms of ABO blood type or crossmatch testing may still be able to be donors. The UW Health Transplant Program kidney desensitization process uses immunosuppressant drugs and a plasma treatment to remove rejection-causing antibodies from the bloodstream. This process is done both before and after transplant. It allows patients who would likely reject the kidney transplant to successfully receive their transplant.
During this process harmful antibodies are removed from the blood stream of patients who are incompatible with their donor through either blood-type or tissue sensitivity. These tissue antibodies, which fight foreign tissues like those found on a donated organ, can cause the organ to reject. These types of antibodies are often produced after being exposed to foreign tissue, such as a past transplant, blood transfusion, or pregnancy. The antibody removal process is called plasmaphoresis, which is like hemodialysis.
To learn more about this, and to speak with a program staff member, please call 608-263-4298
Deceased Donor Kidney Donation
Some patients may not have a living donor. They will need to go on the list to wait for a deceased donor transplant. Deceased donor kidneys are allocated according to the United Network for Organ Sharing (UNOS) guidelines. The Organ Procurement Organization (OPO) contacts the UW Transplant Program when a kidney is available and tells them who is number one on the UNOS list to receive the kidney. Below are the types of deceased donor kidneys that patients may be offered:
Donation after Brain Death
The most common type of organ donor is a person who suffered from a head injury that caused brain death. “Brain death” occurs when someone does not get enough oxygen, causing the brain to stop working. This is often due to trauma or a stroke. Doctors can tell when someone is brain dead by testing certain reflexes controlled by the brain and by using machines that look at blood flow to the brain. The brain controls breathing so people who are brain dead are in a hospital on a breathing machine called a ventilator. Because of the breathing tube and certain medicines, the person’s body can function even after brain death. This allows the heart to keep beating and supply the kidneys and other organs with blood and oxygen until a transplant team removes the organ.
Donation after Cardiac Death (DCD)
Sometimes a patient’s trauma is so severe that doctors cannot save their life, but they do not meet the measures for “brain death.” The doctors then discuss with the patient’s family whether or not to remove life support. If the family chooses to remove life support, the machines are turned off, and the patient is allowed to die peacefully. Sometimes these patients can be organ donors. Transplant teams are called and are present when the life support is turned off. After the patient’s heart stops beating and is declared dead by their doctor, the transplant teams can remove the organs. This is called Donation after Cardiac Death (DCD). Because the heart has stopped beating in these donors, there is a lack of blood flow for a short time to the organs as they are removed. Because of this, kidneys from DCD donors may sometimes take a few days to start working after the transplant. But the outcomes for patients who receive a kidney from a DCD donor are the same as with a brain death donor.
Standard Criteria Donor (SCD)
A SCD kidney comes from a donor who does not have other health problems that can affect the function of the kidneys. SCD kidneys are from donors who are:
- Younger than 60 years old
- If between the ages of 50-59, no history of
- high blood pressure
- impaired kidney function (Creatinine greater than 1.5)
- stroke or aneurysm
Extended Criteria Donor (ECD)
An ECD kidney comes from a donor who reached brain death but has health problems that may cause damage to the kidney. ECD kidneys are from donors who are:
- Older than 60 years
- Between 50-59 years old with 2 of these:
- High Blood Pressure
- Impaired kidney function (Creatinine which was greater than 1.5)
- Died from a stroke or an aneurysm
Because these kidneys may have some damage there are some risks.
- A delay in the kidney working after transplant, which can last from a few days to a number of weeks. This is called delayed graft function (DGF). Because the kidneys may not work right away, patients may need dialysis treatments for awhile after transplant and may have a longer than normal hospital stay. About 1-2% of kidneys may never work well enough after transplant to allow you to avoid dialysis.
- An ECD kidney may not work as long as a standard donor kidney. How long a kidney works is called “long-term graft survival”. It is 80% at 3 years for a standard kidney and 72% at 3 years for an ECD kidney.
There are some benefits to accepting an ECD kidney. An ECD kidney improves your chances of staying alive longer by getting a transplant sooner. This is especially true for patients who have many health concerns and those having trouble with dialysis treatments or access.
Patients must sign a consent that they are willing to accept an ECD kidney. If you agree to receive an ECD kidney, you will be placed on the list for either a SCD or an ECD kidney, whichever would become available first.
Do you ever put in two kidneys?
Yes. National data as well as our experience has shown that if you get 2 ECD kidneys, the function is similar to that of one Standard criteria kidney. Therefore, you may be offered 2 ECD kidneys even if you did NOT consent to one ECD kidney. The two kidneys are placed on one side of the body. Your incision is the same as if you were getting one kidney.
Another situation when 2 kidneys are used is when we have a child donor. This is referred to as “en bloc” because the kidneys are put in together on one side of your body. Statistics have shown that 2 child kidneys have similar outcomes of one adult sized kidney.
What will I be told about my donor?
Patient confidentiality laws limit how much we can tell you about your donor. We cannot tell you the donor’s age, gender, or personal or health history. Guidelines for allocating kidneys are set by the United Network for Organ Sharing (UNOS). The Organ Procurement Organization (OPO) informs the UW Transplant Program when a kidney is found and who is number one on the UNOS list to receive the kidney. The OPO has a thorough screening for all would-be donors to attempt to find any illness that could affect the transplant organ or the patient who receives it. Screening for such an illness can be limited by time constraints between the time that the donor was injured and the organ obtained. We use our best knowledge and judgment to attempt to ensure every organ we transplant will function and will in no way harm the patient who receives it.
“High Risk” Donors
You may be offered an organ from a deceased donor that is thought to be high risk for spreading certain infections according to the Center for Disease Control (CDC) guidelines. Donors are considered “high risk” because of what the CDC deems to be a high risk behavior such as prostitution, intravenous drug use, or homosexuality. It is not the norm to accept organs from such donors unless we feel that the good far outweighs the would-be risk. Blood tests are done on potential donors to look for a virus such as HIV, Hepatitis B or Hepatitis C. No test is perfect, and false negative results rarely occur. Using data from organ, tissue, and blood donors we know there is a small chance, between 1 in 60,000 to 1 in 2,000,000, that an infectious agent could be passed on. We believe that the risks of getting this type of kidney are very small or we would not suggest that you accept it. The transplant coordinator will inform you at the time that the kidney is offered if it is from a high risk donor. You would then decide whether to accept this type of kidney. If you choose not to accept the kidney, you will not lose your place on the waiting list.
What will I be told about my donor?
Patient confidentiality laws limit how much we can tell you about your donor. We cannot tell you the donor’s age, gender, or personal or health history. Guidelines for allocating kidneys are set by the United Network for Organ Sharing (UNOS). The Organ Procurement Organization (OPO) informs the UW Transplant Program when a kidney is found and who is number one on the UNOS list to receive the kidney. The OPO has a thorough screening for all would-be donors to attempt to find any illness that could affect the transplant organ or the patient who receives it. Screening for such an illness can be limited by time constraints between the time that the donor was injured and the organ obtained. We use our best knowledge and judgment to attempt to ensure every organ we transplant will function and will in no way harm the patient who receives it.
How do I choose?
There are risks and benefits for each of the above types of kidney transplants. Members of the transplant team can provide more information about this topic. They can help you choose the type of transplant that may be best for your own case.
The Spanish version of this Health Facts for You is #6757.
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: 12/09/2010
Copyright © 12/09/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6695
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