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Division of Transplantation

Information for Transplant Donors

Introduction

Most of us don't think about our kidneys very often. They simply do their work and quietly help to keep us healthy and free to think about other things.

Sometimes though, when the kidneys do fail, they become a source of great concern, not only for the person whose kidneys have failed, but for their family members as well.

Family members often have many questions about kidney disease, its treatments and available treatment options and how it may affect them as it did their loved one. Many family members, both potential donors and recipients, are reluctant to bring up the topic of organ donation: recipients because they are afraid of making family members feel pressured to donate a kidney, and donors because they may be unaware of living donor transplantation, or more often because they are unsure of what to expect and how it will affect their own lives. For these reasons many who could benefit greatly by receiving a kidney, and family members who might genuinely wish to give this precious gift, avoid the topic altogether.

There are many misconceptions regarding kidney donation and transplantation i.e., most people are unaware of the fact that many people live long, perfectly healthy lives with only one kidney, regardless of the reason for their having one kidney (some people are born with only one kidney, others are lost to trauma).

Many people are also unaware of the fact that kidney disease affects not one kidney, but both. The second kidney does not work as a “spare” in case of kidney disease. What happens to one kidney, happens to both.

The purpose of this booklet is to offer you information which you may find helpful in understanding kidney failure and the option of living donor kidney transplantation.

The highly skilled transplant surgeons at University Hospital of Brooklyn have performed well over 2,400 transplants over the past 25 years, many of them from living donors.

If after reading this booklet you would like more information, the Transplant team at University Hospital would be happy to answer any questions that you may have.

Please feel free to call us at any time.

General Overview

The kidneys are bean shaped organs that sit in the lower back. Most people have two kidneys which help clear the bloodstream of waste products or toxins while maintaining the proper balance of fluid in the body through the production of urine.

There are many reasons why kidneys fail. Most often, kidney failure is the result of long standing disease. Kidney disease generally affects both kidneys equally and the second kidney does not compensate for failure of the first. For this reason, many people live long and healthy lives with one kidney while those with kidney failure lose function in both kidneys simultaneously. Therefore, all kidney donors are carefully screened for potential kidney disease. If there is any risk to the health of the donor he or she will not be considered for organ donation.

When the kidneys fail, the body is unable to excrete toxins adequately. Some people with kidney failure continue to produce urine, but it is inefficient and cannot clear waste products from the body. These waste products can only be eliminated through dialysis. Unfortunately, even the best dialysis cannot substitute for a well functioning kidney.

Today there are several treatment choices for people with kidney failure, but no treatment offers more promise than transplantation. A successful kidney transplant recipient leads a full life, with freedom from dialysis treatments, diet and fluid restrictions and frequent medical care.

Types of Transplants

There are two types of kidney transplants: cadaveric and living donor. Both types of transplants are done at University Hospital of Brooklyn.

A cadaveric kidney transplant involves transplanting a kidney from an unrelated person who has experienced complete and irreversible brain death. Potential recipients are registered with a national computer system for matching with compatible cadaver donor kidneys. There are approximately 20,000 people waiting for cadaver donor kidney transplants in the United States, with over 2,500 waiting in the New York area. The waiting time for a cadaver donor kidney can vary greatly depending on blood and “tissue type” as well as the availability of donor organs. The approximate waiting time in the New York area is between two and five years at present. For some the wait is long and difficult. For others, the new organ comes quickly, functions immediately and continues to work with few problems. Once transplanted, the success rate for cadaver donor kidneys is greater than 85%.

A living donor transplant involves removing a kidney from a person who is alive and healthy. Living donors will generally have close emotional ties with the person to whom they donate. With a living donor, there is the important benefit of having the transplant done under ideal conditions, i.e., at a time that is best for both the donor and the recipient. In addition, when there is a blood relationship, there is usually a closer “tissue” match between the donor and recipient. A good tissue match transplanted under ideal conditions offers the best outcome for kidney transplantation. The success rate for living donor transplantation is greater than 95%.

Dual Kidney Transplants – Downstate leads the way in performing this procedure

Among its many outstanding accomplishments, SUNY Downstate was the first to perform dual kidney transplants as a means of increasing the number of organs available for transplant at a time when the organ donor shortage has significantly increased the waiting period for organ transplantation. Using this procedure, both kidneys from an older donor are transplanted into a single recipient, thereby expanding the use of kidneys that might not otherwise have been transplanted. The first dual transplant in New York State was done at SUNY Downstate in 1996 and the procedure has been overwhelmingly successful. SUNY Downstate remains the leader in performing this innovative procedure in New York State and the Tri-State area.

Laparoscopic Donor Surgery is available at Downstate Medical Center

SUNY Downstate is among the premier transplant centers performing laparoscopic donor nephrectomies for living donor surgery. Using this technique, surgeons are able to remove the donor’s kidney using a laparoscope which requires only a small incision in the lower abdomen of the donor. Laparoscopic surgery results in much less post -operative pain than traditional donor surgeries and also results in minimal scarring. The donor is usually discharged from the hospital one to two days after surgery and is usually able to return to work within two to three weeks

The Decision Process

Making the decision as to whether or not to donate a kidney takes a great deal of thought and should only be made when all the pros and cons have been considered. This decision should never be made under pressure from anyone.

Donating a kidney takes a great deal of love and courage. Each family member must weigh the pros and cons of donating a kidney and make a personal decision as to whether or not this is something that they would like to pursue.

Donating a kidney to someone with kidney failure can be one of the most rewarding experiences of a lifetime, however, people considering kidney donation frequently experience mixed emotions. It is quite natural for a potential donor to be afraid, anxious, or even hesitant when they first consider kidney donation. The University Hospital of Brooklyn Transplant Division offers quarterly donor education meetings where people who have donated a kidney speak openly about their experience. Recipients are not permitted at these meetings so the discussions can be quite frank.

Once the decision is made, the transplant team will work with family members throughout the screening process and the surgery to be certain that this gift of life is a lasting gift. The Transplant Surgeons and Transplant Coordinators are always available to talk with you and your family both before and after you decide to become a donor. You should feel free to discuss financial needs and family concerns which could arise. All discussions are strictly confidential.

Donor Information Group

The University Hospital of Brooklyn Donor Information Group meets periodically to openly discuss the living organ donation experience. The purpose of the meeting is to offer those who are considering donation of a kidney to a loved one the opportunity to meet and freely discuss the organ donation experience with those who have already donated one of their kidneys to a loved one. Discussions are lively and informative and offer potential donors the opportunity to learn the pros and cons of kidney donation from the most reliable source of all, those who have donated. In order to insure a free exchange of information, potential recipients are excused from the session. Meetings are coordinated by the UHB pre transplant coordinator who facilitates the flow of information. Anyone who is considering living donor transplantation is urged to attend the session It is a memorable, invaluable experience which will surely help in the decision making process.

The Screening Process

The first step is determining compatible donor blood type. Blood samples will need to be drawn from both the donor and the recipient.

RECIPIENT BLOOD TYPE COMPATIBLE DONOR BLOOD TYPE

IF YOUR BLOOD TYPE IS:
O
A
B
A

YOU MAY RECEIVE A KIDNEY FROM:
O
A, O
B, O
AB, A, B, O

Just as there are blood types which determine compatibility for blood transfusions, there are tissue types called human leukocyte antigens (HLA) which determine compatibility for organ transplants. If a person receives a kidney from a member of the family, the chances of success for the transplant are increased because family members are likely to have similar or sometimes identical tissue types. Inherited HLA markers in the blood are identified and compared between the donor and the recipient. The better the HLA match between the donor and the recipient, the less likely the recipient’s body will recognize the kidney as foreign. Therefore, chances for a successful transplant are greater and the recipient may require fewer drugs to control rejection. Appointments for tissue typing may be made by calling the Kidney Transplant Office.

Potential donors and recipients with compatible blood and tissue types are further tested for compatibility with a test known as a “crossmatch”. In this test, the recipient’s blood is mixed with cells from the donor’s blood. If antibodies in the recipient’s blood destroy the donor cells, the test is said to be incompatible and the transplant cannot take place because the kidney will be rejected.

The Medical Evaluation

Potential donors will be carefully tested to be certain that the transplant will pose no risk to the health of the donor. Potential donors should be in excellent health with no current disease or illness and should not be extremely overweight. Physical condition is a more critical factor in determining the suitability of a living donor than is age, but all donors must be 18 years or older. All potential donors will be interviewed and tested to assess any risk factors towards donation. Routine testing will include:

Once these tests are completed, a medical evaluation is performed with great care and consideration. The medical doctors and transplant surgeons reviewing the donor testing are very careful to protect the health of the donor. Sometimes, a potential donor will not be accepted for donation due to medical or other concerns.

The specific testing for donation can be done at University Hospital of Brooklyn or through your private medical doctor.

Expenses for your evaluation are covered by the recipient’s Medicare through the End-Stage Renal Disease Program, or Medicaid, regardless of whether or not you are accepted as a donor.

If the recipient is not eligible for Medicare or has other insurance, it is the responsibility of the recipient to call and check with their insurance carrier to see what expenses are covered for their donor.

Admission to the Hospital

As with the donor evaluation, hospitalization and surgery are paid for by the recipient’s insurance. Both donor and recipient are admitted to University Hospital of Brooklyn either the day before or the morning of the scheduled surgery. Routine blood testing and admitting procedures will be done.

The Procedure

After the Procedure

You will be allowed to eat after the test but strict bed rest must be maintained for several hours after the test. The transplant nurses will closely evaluate your status and observe for any complications.

The Transplant

Donating a kidney is a surgical procedure. Two skilled teams of surgeons will simultaneously operate on the donor and recipient in two adjoining rooms.

THE DONOR: Once the donor is under general anesthesia, laparoscope and surgical instruments are placed into the abdomen through small puncture sites on the side where the kidney will be removed. The kidney is freed utilizing Laparoscopic techniques and carefully removed through a 2 to 3 inch incision in the lower abdomen. The kidney is examined, flushed with a special cold solution, and carried into the recipients operating room where a second team of surgeons begins to transplant the kidney into the recipient. The small incisions are closed and the donor is taken to the recovery room.

THE RECIPIENT: Under general anesthesia, an incision is made in the lower abdomen, just above the groin. This allows the new kidney to be attached directly to the bladder. In most cases, as soon as the kidney’s artery and vein are connected to the blood vessels in the recipient, the kidney will begin working and producing urine while still in the operating room. The recipient’s incision is then closed and the recipient taken to the recovery room.

The operation for the donor and recipient each take about 3 to 4 hours to perform.

The Recovery Period (Donor)

After the surgery you will feel tired from the operation and anesthesia. You will also experience some pain from the incision. You will be given pain medication to relieve the discomfort. The discomfort decreases as you become more active.

You will be encouraged to get out of bed and ambulate on the first day after the surgery. You may drink on the morning after surgery and begin to eat by that afternoon. Intravenous fluids will be administered to you in the meantime. The average length of hospital stay for the donor is between 2 days.

As the incision heals, the pain will become less severe, but tenderness, tingling, and itching may continue for a number of weeks. You will be asked to return to see the doctor within one week of discharge from the hospital.

The Future

You will probably be able to return to work and fully resume your normal activities about 2-3 weeks after the surgery. During this time, you should not lift anything heavier than 20 pounds.

Driving may be permitted 1 week after the surgery.

Sexual activity can be resumed as soon as you feel comfortable after discharge from the hospital. Donating a kidney will not affect your sexual nature or activity, however, some positions may be more comfortable than others in the early postoperative period. Donating a kidney will not affect your diet or fluid intake. You may eat and drink as you always have, but it is recommended that you not add extra salt to your food.

Donating a kidney does not prevent women from having children or men from fathering children.

There are no long term restrictions on physical activities except that rough contact sports which could cause injury to your remaining kidney should be avoided.

It is recommended that all kidney donors see their doctor once a year for a routine check up. This may be done through your private medical doctor or through University Hospital. The transplant surgeons will discuss these and other issues with you at the time of discharge.

Once you have recovered from the transplant surgery, you can lead the same normal, active life that you did prior to surgery with only one kidney. Thousands of transplants are performed every year and thousands of people live long, healthy lives with only one kidney.

Remember though that You are extra special ...You have given a loved one the greatest gift... the Gift of Life.