Living kidney donation: One of the nation’s largest living kidney donor programs

A kidney transplant can happen as soon as a donor is found, approved and ready to donate. Getting a kidney from a living donor is better for the recipient because:

• The recipient will get transplanted sooner, ending or avoiding dialysis

• Living kidney transplant surgeries can be scheduled, making recovery easier

• The kidney may be a better match to the recipient, and will come from a person who has been tested to ensure they are very healthy

• A kidney from a living donor will last much longer than one from a deceased donor, lessoning their need for another kidney in the future

• Living kidney donation removes someone from the waitlist, so others can receive transplants

You do not need to be related to recipient. You do not need to have matching blood types. If you are older than age 18 and in good physical and emotional health you can apply to be a living donor. We offer many options for living kidney donation where you can save one life, or several.

Most expenses, including your donation evaluation, tests and surgery, are paid by the recipient's insurance. You will pay for your own travel expenses including food, gasoline and hotel. You will need time off from work and may not have paid leave for this use. UW Health works with several programs that may reimburse you for some of these expenses. Our social workers tell you what costs to expect, share information about tax benefits and explain ways to get help with expenses.

Not everyone who considers donation can or will donate. Our Independent Living Donor Advocate represents you, the donor to make sure your decision remains private. They are responsible for representing your wishes, discussing any issues and being your advocate.

If you would like to speak to someone who was a living donor, please call us at (608) 263-1384 and ask about our living kidney donor mentor program.

It's easy to assume that if you want to help, you will just offer to donate a kidney. In fact, you may be waiting to be asked or might think someone else is already going to donate. You may want to do some reading about living kidney donation. We support communication that clearly states that a living kidney donor is needed.

If you or a loved one needs a kidney transplant, quickly tell your close family and friends that a living donor kidney transplant is the best option. Some people who need a kidney transplant have a living donor champion - a person or people who help get the message out further. Our education materials will improve their chances of finding a living kidney donor.

Patients and living donor champions should let people know why a living donor transplant is needed.

1. Explain why a kidney transplant is needed and how kidney disease and dialysis is affecting the patient's life.

2. State why living donation is the best option. Read our Introduction to living kidney donation to learn important facts.

3. Highlight that a living donor does not have to be related to the recipient or have the same blood type. Our options for living kidney donation explain the ways anyone who is healthy enough to donate can donate.

There are many ways to share the story:

• Carry our wallet card and give it to people so they can learn more

• Telephone friends/start a phone tree

• Make a video

• Post a flier

• Local newspaper story

• Radio ad

• Billboard

• Write a message on a car window or t-shirts, get creative!

Direct donation happens when you are a good match with your intended recipient. This is often your family member or close friend, but your kidney may be a great match to a stranger. Your kidney is donated the same day it is transplanted into the recipient. Given your emotional connection to the recipient, the timing and ease of moving the kidney from you to your recipient, this is a common type of donation.

Non-directed donation happens when you want to donate a kidney, but do not know who will receive it. All non-directed donors at UW Health are listed with the National Kidney Registry. Your kidney may start a kidney exchange that could result in more transplants. Your kidney may go to someone on our wait list, or someone on the waitlist at another transplant center that participates in the National Kidney Registry. Timing for donation is based on when you and the recipients are ready.

A paired kidney exchange happens when you do not match your intended recipient. You will donate to someone else, and your intended recipient gets a kidney from a stranger. These exchanges can happen between two donors and recipients, or many donors and recipients. Paired kidney exchange is most common when a donor and recipient have different blood types, or the recipient has sensitivity issues, or other reasons why they are not a good match. We will list you and your recipient with the National Kidney Registry. Our team decides what types of donor kidneys we will accept for each recipient. When a match is found, we decide if it’s a good kidney for that recipient and if it is, surgery dates are set. If the match is not good, the donor and recipient will stay listed for future matching. Timing is based on when you and the recipient are ready.

A compatible share donation happens with your kidney matches your intended recipient, but a different donor might be a much better match. When kidneys are well-matched to the recipient, they last longer and cause fewer problems. Ways we look for better matching kidney can be for age, size or anatomy. Some donors may choose this option so they can help more people by starting a kidney exchange. We will list you and your recipient with the National Kidney Registry. Our team decides what types of donor kidneys we will accept for each recipient. When a match is found, we decide if it’s a good kidney for that recipient and if it is, surgery dates are set. If the match is not good, the donor and recipient will stay listed for future matching. Timing is based on finding a better match, and when you and the recipient are ready.

This type of donation happens if you are ready to donate now, but your intended recipient does not yet need a transplant but may in the future. It is a paired-exchange donation through the National Kidney Registry, but there is time between when you donate and when your intended recipient gets a kidney. A voucher will be provided based on the timing:

• Standard voucher: Given to your intended recipient who needs a kidney transplant within the next year.

• Family voucher: Given to up to five intended recipients who will not likely need a transplant within the next year. If any of these five people ever need a kidney transplant, they would get a living donor kidney.
  

This type of advanced donation helps if you are ready to donate but have a window of time when you can donate. This could happen if you have a job like teaching, or if you have a life event that must be avoided, like a wedding or travel.

Read our living kidney donation website and discuss it with your support system.

We use this online screening tool to gather information about your health to decide if you are healthy enough to donate a kidney. The tool asks questions about current and past health, family history and risk factors. Our team will review the responses and contact you. If you learn you are not able to donate, there are many other ways you can help. (See Donor Champion)

Evaluation day is an eight-hour day at the UW Health Transplant Clinic at University Hospital in Madison, Wis. We will share a large amount of information about living kidney donation. We are very careful and thorough as we evaluate your health. If you are very eager to donate you may question the amount of testing. Remember that our team must consider everything they know about your health when we decide if you can safely donate.

There are three parts to the evaluation:

1. Medical tests

   • Health history and physical exam

   • Blood and urine test

   • Chest x-ray

   • 3D reconstruction CT/CAT scan and MRCP of abdomen

   • Electrocardiogram (EKG) to record the electrical signals in the heart

   • Other tests/consults as needed

2. Meetings with living donor team members

   • Social worker

   • Nephrologist (kidney specialist)

   • Transplant surgeon

   • Dietician

   • Transplant nurse coordinator

   • Independent living donor advocate

3. Education about living donation

   • Donation process

   • Risks

   • Donation options

   • Surgical procedure

   • Pain management

   • After-surgery care

After evaluation, our living donor experts will review the results of all your tests. This experienced team decides if donation is a good option for your or if more tests are needed. We will share information with you, answer your questions and discuss options for donation.

You are approved to donate a kidney if you are medically approved, emotionally prepared and have no psychosocial risks to donation. If you are not approved to donate, it’s because our experts have decided that the medical, emotional and/or psychosocial risks of living donation are too high. You may experience a range of emotions including sadness, disappointment, relief and/or confusion. Remember, the time and effort put into this process is a powerful act of support. Transplant recipients often say that what was most meaningful to them was their loved one’s desire to help. You can still help the recipient by being their donation champion and/or by providing family and/or pet support, meals, driving assistance and/or companionship for the donor or recipient.

UW Health has six different ways a living kidney donor can donate. Some may be better for you or the recipient. These options allow you to donate even if your blood type, anatomy and/or timeline for surgery does not match with your recipient.

This is the time when you will make your final decision about donating your kidney. You can choose to not donate at any time in the process. Our independent living donor advocate is ready to talk with you if your decision to donate changes. Your privacy is always protected, including all your decision-making concerns. We will also discuss financial considerations, caregiving and family roles and the support you will need while healing. We will also discuss body image, because you will have small scars on your abdomen and some donors say they feel different about their body and overall physical appearance. (Donors can speak with their surgeon to discuss options to lessen scarring.) Some donors also experience mood changes and feel depressed or struggle to cope while they are recovering and are limited in normal daily activities. Some donors have changes in relationships with their family or the recipient of their kidney.

After the donation decision is made, we will either schedule your surgery or wait for a match for paired-exchange donation. Before surgery, you will meet with the medical team, who will check for any changes in your health. They will teach responsible pain management, discuss ways to improve your recovery and answer any questions.

You must bring these things to the hospital:

• Any medications you take every day

• Comfortable clothes that will be loose around the incision

• Walking shoes

We suggest you bring:

• Personal and comfort items such as toothpaste, shampoo, pillows

• Books or other things to stay busy

Do not bring any items of value.

The big day!

This is an outline of your surgery day:

1. Arrival at University Hospital

2. First Day Surgery, third floor near F elevators

   • Drink recovery juice three hours prior to OR time

   • Meet surgeon/anesthesiology

   • Get IV placed

3. Operating Room 3-5 hours

   • Transfer to operating table from hospital bed

   • Positioning with pillows and blankets

   • Put to sleep for surgery

   • Catheter placement

4. Recovery Room ≥ 1 hour

   • Wake up

   • Adequate pain control

   • Memory may be fuzzy

5. Transplant Unit B4/6

   • Day of surgery

     • Up and walking

     • Clear liquids/ice chips

     • Pain management

     • Deep breaths/coughing

     • Interrupted sleep for overnight vital checks

     • May be able to eat solid food for dinner

   • Remainder of stay (1-3 days)

     • Remove catheter

     • Walking 3-5 times/day

     • Bowel movements

     • Checking vitals

     • Pain management

     • Eating solid foods

There are two types of donor surgeries: laparoscopic and open. Almost all donor surgeries (more than 99 percent) are done with the laparoscopic method where a few tiny incisions (5-10 mm) are made and a camera and instruments are inserted. The kidney is removed through a small incision at the pant line.

This is a safe procedure, but all surgeries have risks. Risks include:

• Significant bleeding (rare)

• Blood transfusion (rare)

• Return to the operating room (very rare, <1 in 100)

• Wound complications (rare)

• Developing high blood pressure (risk may be slightly higher for donors)

• Renal failure over lifetime (after donation = <1 in 100)

• Death during the surgery (very low, estimated at 3 in 10,000 individuals)

You will recover on the transplant unit at University Hospital. Common issues for donors include bloating, nausea and tiredness. You will be up and walking very quickly and can return to a regular diet. Our team follows a rapid recovery program. With responsible pain management, you will go home two days after donation. Before you leave the hospital, you will be scheduled for your first follow-up visit at the transplant clinic, which happens 1-2 weeks after donation.

You may experience soreness with activity, a poor appetite and unusual bowel habits. This checklist includes important reminders to improve recovery:

• Take as much time off from work as is needed, depending on job role

• Use responsible pain management and don't drive while on narcotic pain medications

• Go for a walk, but limit strenuous activities

• Avoid constipation by eating a diet high in fiber

• Rest

• Contact the transplant team if needed

You will recover at your own pace. Most donors return to their regular lifestyle by six weeks after donation. We encourage you to be committed to your health and wellness. We recommend a healthy diet and exercise to support good health and the remaining kidney. Six months after donation, and annually near the donation date, you must complete blood and urine tests and have your blood pressure checked. For your lifetime, we recommend that you have an annual physical, including blood pressure monitoring and blood and urine tests that monitor kidney function.