Q&A on Living Donation

Table of Contents:

General Information on Living Donation
Where Do I Start?
The Evaluation Process
Making the Decision
Financial and Insurance Issues
The Surgery
What to Expect After Donation
For Transplant Candidates

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3. The Evaluation Process

  1. What tests are used to determine if someone can be a kidney donor?
  2. Can I get tested as a donor without the recipient knowing?
  3. Can smokers be living donors?

What tests are used to determine if someone can be a kidney donor?

Potential donors will have blood, urine and radiology tests to determine suitability for donation. A full physical examination will be done, and psychology evaluation may also be required. Time will be allotted for asking questions and addressing any concerns the donor may have.

Before surgery, special x-rays will be taken of the donor's kidneys, including either a renal arteriogram or spiral CT scan to check the anatomy of the kidney. Additional blood tests called tissue or HLA typing may also be done to determine the quality of matching between the donor and the recipient. The closer the match, the lower the likelihood of rejection of the transplanted kidney.

The following process is used to determine if someone can be a donor. This is a general description of the testing process, and may vary from center to center:

  1. A financial consultation will be used to determine financial and insurance coverage for the testing process and the donation itself. Generally, if the donation is to a family member or friend, the recipient's insurance will pay for testing and surgery expenses. However, the donor might be responsible for travel expenses (if the donor and recipient live in different towns/states) and follow-up care, in addition to lost wages. Since donors are never financially compensated, be sure to ask the financial counselor and/or social worker at the transplant center for assistance with these issues.
  2. Immunological Tests: A blood sample is taken for the following tests:

    • ABO test to determine the donor's blood type: O, A, B, or AB

      In living donation,

      Donors with: Blood type A
      Can give to: Blood types A & AB

      Donors with: Blood type B
      Can give to: Blood types B & AB

      Donors with: Blood type AB
      Can give to: Blood type AB only

      Donors with: Blood type O
      Can give to: Blood types A, B, AB and O

      * O is the universal donor; that is, it can be given to A,B,AB, and O blood types.

      Recipients with: Blood type O
      Can receive from: Blood type O only

      Recipients with: Blood type A
      Can receive from: Blood types A and O

      Recipients with: Blood type B
      Can receive from: Blood types B and O

      Recipients with: Blood type AB
      Can receive from: Blood types A, B, AB and O

      * AB is the universal recipient; that is, it can receive O, A , B, or AB blood types.

      Please note that there are some programs that may help donor/recipient pairs with blood types that are incompatible: paired exchange and plasmapheresis. Click here for more information.

    • Tissue typing is used to identify the donor's particular HLA antigens and determine if the donor and recipient are compatible.
    • Family analysis: If an entire family is being tested, blood samples will be taken of all potential donors to determine compatibility. This takes approximately one week before the results are known.

      Some transplant centers use a Skin Crossmatch to determine compatibility. A small piece of skin is removed from the potential donor's arm under local anesthesia. This is an outpatient procedure.

      The cells of the skin are closer to the genetic composition of the cells in the kidney. The process takes the skin cells of the donor and incubates them against the sera of the recipient. If the skin cells are destroyed, resulting in a "positive crossmatch", the transplant cannot take place.
  3. Laboratory Tests: A blood sample is taken to:

    • Assess the hematological system
    • Assess clotting mechanism
    • Assess baseline kidney function
    • Screen for abnormal electrolyte balance
    • Screen for unsuspected tendency toward glucose intolerance which might occur post
    • transplant with steroids
    • Screen for venereal disease
    • Screen for pancreatitis
    • Screen for liver abnormalities, which might
    • delay the transplant until the cause is found (fluid overload, acute or chronic hepatitis)
    • Determine whether or not the patient has Hepatitis B
    • If HbsAB is positive (and the HbsAg is negative), the patient has developed antibodies to Hepatitis B either through vaccination or exposure
    • Look for past or present viral activity
    • If the donor is CMV positive, the recipient may need to receive Cytogam and gancyclovir post transplant to prevent reactivation of the disease
    • Screen for the HIV virus
  4. An EKG will be performed to assess heart function. A chest x-ray will be used to assess the lungs for the presence of any abnormalities.
  5. A medical history review and physical examination. An extensive review of all systems, including previous illnesses and surgeries and past family medical history. Any abnormalities found are investigated further before invasive tests are performed.
  6. A psychological evaluation will be used to:

    • Provide emotional support and information to the donor
    • Assess the donor's motivation. If the potential donor does not want to donate, the transplant team can help the donor decline in a way that preserves the family relationships.
    • Evaluate if there is family pressure or financial incentive to donate.
    • Give the donor an opportunity to express him or herself more fully than she might to the physician, or with the recipient or family present.
    • Help the staff work with the donor and family prior to, and after surgery.
  7. Female donor candidates may undergo a gynecological exam and mammography.
  8. Kidney Function Tests: Urine samples are taken to:

    • Screen for kidney disease or any abnormalities
    • Determine the absence or presence of a urinary tract infection.
    • Assess the amount of protein excreted in a 24-hour period. An increased secretion of protein would need to be evaluated before resuming the evaluation; the creatinine clearance is to determine adequate kidney function and to ensure that the 24 hour collection is an adequate one.
    • Determine glomerular filtration rate (GFR) which measures "how fast" the kidney can clear a known substance.
  9. An intravenous pyelography test may be used. This test involves an injection of dye into a vein in your arm. The dye circulates through your body, into your kidneys, and then into your urinary tract. X-rays are taken to identify the structure of the kidney, veins, arteries, the ureter, and other anatomy.
  10. A Helical CT Scan is done in some transplant centers. The helical CT scan is used to evaluate the internal structure of the kidney and look for the presence of cysts, tumors, etc.
  11. Some transplant centers will perform a renal arteriogram if there is a question of an abnormal finding on the Helical CT Scan. The renal arteriogram is an x-ray which looks at the vasculature of each kidney: the number of blood vessels to and from each kidney, or any evidence of vascular disease that might rule out donation. This test requires an observation period post-exam of 6-8 hours and in some instances may require hospitalization. This is the last test done.
  12. When the tests are completed, the results are presented to the transplant team (surgeons, nurses, social workers, financial counselors, etc.) to determine if the person is a suitable candidate for donation. The length of the testing process depends upon the availability of the donor for testing, the results of the completed tests, and the individual policies and procedures of the transplant center involved.

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Can I get tested as a donor without the recipient knowing?

It may not possible to be tested anonymously. You will need to ask the "Kidney Transplant Coordinator" or "Kidney Transplant Social Worker" at the recipient's hospital about this issue.

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Can smokers be living donors?

Smoking is considered a risk to the potential donor. Because smoking damages the lungs, it may put the donor at a higher risk of developing pneumonia after surgery. Potential donors should be honest with the transplant center about smoking habits to ensure that the donation and transplant are successful.

Different transplant centers have different policies regarding smoking and living donation. Living donors may be asked to quit smoking prior to the donation, and if the person is a heavy smoker, he or she might be asked to see a pulmonary doctor to check breathing.

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