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Have questions about living kidney donation?

There is a considerable amount of information about living kidney donation on this site. Click here to get started. You can also find answers to questions on the Links page. You can read about the experiences of other living kidney donors on the Experiences page.

Here are additional questions based on actual questions to Living Donors Online!:

Q1: What is the process for determining whether I can donate a kidney?
Q2: What are the long-term effects on me if I donate one of my kidneys?
Q3: I've been asked to donate but I just don't want to do it. What should I do?
Q4: I have a friend who needs a kidney and I'd like to donate but I'm not related. Is that OK?
Q5: I need money and I'd like to donate one of my kidneys. Can I do this?
Q6: I'm ready to donate. Who pays?
Q7: What are the odds my donated kidney will work...that it won't be rejected?
Q8: I've got lots of questions about donating. Who should I talk to?
Q9: I'm a female considering donation but I'd also like to have children after donation. What effect does donation have on pregnancy?
Q10: How significant is HLA matching...really?
Q11: Are there medications I should be careful about using after donating?
Q12: I'd like to donate to a certain person, but I'm not the right blood type. Are there any alternatives?

A1: What is the process for determining whether I can donate a kidney?
The short answer is you need to show three things: (1) you have blood and tissue types compatible to the recipient, (2) you are generally healthy, and (3) you have two healthy kidneys. You might also undergo psychological and financial assessments. For more information, check out this page.

A2: What are the long-term effects on me if I donate one of my kidneys?
Frankly, there is inadequate medical research on the long-term consequences of living donation, and some of the research available is limited in scope (e.g., one transplant center) or does not follow statistically rigorous procedures (e.g., inadequate sampling). The research currently available has shown there are few, if any, long-term effects on a living kidney donor. Mortality rates look to be the same or better than the general population. Some studies have revealed slightly higher incidence of high blood pressure and elevated levels of protein in the urine. There is also a possibility (0.1% to 1.1%) that a living kidney donor will develop End Stage Renal Disease and need a kidney transplant. This page describes the research results more completely. However, much more rigorous research is needed to answer this question with confidence.

A3: I've been asked to donate but I just don't want to do it. What should I do?
The decision whether or not to donate ultimately is yours. TDo not let people pressure you to donate. Next, make sure you have all the information you need to make an educated decision. There's information on LDO and on the links. Ask questions in the LDO Community Message Forum. If you are frightened of things you don't understand, then seek out the information that helps you understand. If you decide not to donate and are concerned about the reaction of friends and family, talk to the social worker or psychologist on the transplant team. They will be able to help you work out a way of declining gracefully.

A4: I have a friend who needs a kidney and I'd like to donate but I'm not related. Is that OK?
Yes. In the past, the conventional wisdom was that close tissue typing was necessary for a successful donation, and close tissue typing implied blood relationships. However,  anti-rejection drugs are so powerful now that close tissue typing is less important when identifying a potential donor. Consequently, unrelated living donation has increased dramatically over the last 10 years. You will still need to go through the normal evaluation of donors (see this page). Also be prepared to discuss your motives for donation and the impact it might have on your relationship with the recipient and family.

A5: I need money and I'd like to donate one of my kidneys. Can I do this?
No. Here's what Dr. Jeff Punch of University of Michigan says on the Transweb site: "Paid donation is illegal in the United States, Britain, Canada, Mexico, and all of Europe. In India, paid organ donation has been tolerated in the past, but the government there has passed a resolution intended to eliminate the practice. To date, no reputable organization pays for human organs anywhere in the world. Although paid donation may occur in some parts of the world, the lack of accountability of the unscrupulous individuals who engage in this practice means it is unsafe to either donate a kidney through such an organization or purchase a kidney in this way." In the US it is possible for a donor to reimbursed by the recipient for travel, housing, and lost wages related to the donation. The US law can be found here.

A6: I'm ready to donate. Who pays?
The transplant recipient's medical insurance (including US Medicare) covers the cost of the donor's testing, surgery, and recovery in the hospital. You are on your own as far as lost wages if you miss work for testing and surgery, but most enlightened employers cover this time off with sick leave and vacation pay. Alternatively, you might qualify for unpaid leave. Some progressive employers, such as United Network for Organ Sharing and some state governments, have arranged for paid leave specifically for living donors. Talk to your employer about the types of time-off benefits available to you.

Generally, any medical treatment needed following the donation, such as annual physical exams, are your responsibility. However, complications directly related to the donation should be covered by the transplant center. Note that some living donors have found themselves charged for these expenses. It is the position of LDO that donors should not pay for the treatment of complications from living donor surgery. Please contact us if you find you are being charged for these expenses.

A7: What are the odds my donated kidney will work...that it won't be rejected?
Excellent. In fact, living kidney donation has the best track record of all forms of donation. Statistics from the Organ Procurement and Transplant Network show that the kidney donated from living donors is still functioning in 96% cases after one year, 81% of cases after five years, and 58% of cases after 10 years. Even so, you should be prepared mentally for the possibility of rejection.

A8: I've got lots of questions about donating. Who should I talk to?
The first place to go is the transplant team. Talk to the transplant coordinator, the surgeon, the social worker, or whomever you are most comfortable with. You should also consider talking with friends, family, religious leaders, and others you trust. You can also ask questions here on the LDO! Message Board.

A9: I'm a female considering donation but I'd also like to have children after donation. What effect does donation have on pregnancy?
The United Kingdom Guidelines for Living Donor Kidney Transplantation, published in January 2000, reviews two research reports and draws this conclusion: "The presence of a solitary kidney does not appear to pose a significant risk during the course of a normal pregnancy." Check the Links page for a link to the UK site with the complete text of the guidelines for more information and citations of the research papers.

Also, LDO! received this message from a female living kidney donor about the special steps taken during the donation process and her actual post-donation experience with pregnancy:

"Pregnancy was my big concern with planning the transplant. They removed the right kidney because they told me that that was the one that was the most stressed by pregnancy. They also took it from the front and didn't use staples on my scar. They used steri-strips.

As far as when I was actually pregnant the only thing my doctor did was do a 24-hour urine catch to check output. Everything was just fine. She told me there wasn't any reason to be concerned about just the one kidney. I didn't have any problems at all."

An abstract of research on this subject appeared in Transplantation 62 (12) 1934-1936, Dec 1996, regarding the risks of pregnancy after a living kidney donation: "Potential female donors frequently ask whether unilateral nephrectomy will impair future childbearing capabilities. To address this question, we surveyed 220 women who underwent donor nephrectomy between 1985 and 1992. Of the 144 women who responded, 33 became pregnant after donation for a total of 45 pregnancies. Seventy-five percent of the pregnancies were carried to term without difficulty. Complications incurred during gestation included miscarriage (13.3%), preeclampsia (4.4%), gestational hypertension(4.4%), proteinuria (4.4%), and tubal pregnancy (2.2%). Four of the 45 pregnancies (excluding miscarriages) required preterm hospitalization, resulting in an overall morbidity of 8.8%. There were no pregnancy-related deaths, and no fetal abnormalities were reported. Problems with persistent hypertension, proteinuria, or changes in renal function were not noted. None of the above complications exceeded what has been noted for the general population. Infertility was a problem in 8.3% (3/36) of our respondents, compared with a worldwide incidence of 16.7%. Based on these results, we conclude that donor nephrectomy is not detrimental to the prenatal course or outcome of future pregnancies (emphasis added)."

Finally, a study in Norway linking data from their living donor registry to birth records found living donor women with a higher incidence of preeclampsia (5.7%, versus 3.5% for a randomly selected group).

Be sure to talk with your obstetrician or gynecologist about your interest in donation and the effect it could have on future pregnancies.

A10: HLA (Human Leukocyte Antigen) matching is used for kidney donation. It is a means for determining how well your tissues match the recipient and, therefore, reduce the chance of rejection. Generally, HLA matching looks at six primary antigens. A perfect match is sometimes referred to as a "six out of six." A zero match is "zero out of six."

Improvements in anti-rejection drugs have made HLA matching less important. (You must still match blood type and pass the crosstest, among other screens.) That's good news because the potential donor pool increases to include people who are not strong HLA matches.

However, data from the Organ Procurement and Transplant Network (OPTN) indicate there is a positive relationship between the level of HLA matching and the historical survival rates of the patient and the donated organ (called a "graft"). The data indicate, given a choice, a transplant recipient would prefer a living donor kidney to a deceased donor kidney regardless of the HLA matching level. Also, to the extent possible, the patient should seek the best HLA match possible.

Even so, a patient and his or her transplant team need to weigh the health impact of taking a poorly matched organ against alternative forms of treatment such as dialysis.

More on this subject can be found here.

A11. You should ask your doctor for guidance. Other living kidney donors report that they are advised to avoid or at least minimize use of medications that can be toxic to kidneys. A common example is ibuprofen, which is the main ingredient in pain relievers like Advil. Other examples and explanations can be found here.

A12. One of the first tests for living donors is determining whether the donor and recipient have compatible blood types. If they are not compatible, because of ABO incompatibility or a positive crossmatch, there are a couple of alternative ways to donate.

One option is a new procedure called plasmapheresis. In general, this procedure involves a process similar to dialysis to remove the plasma, where the antibodies reside, from the recipient's blood. The recipient's spleen, where antibodies are produced, is also removed. This procedure is considered experimental by some insurance companies, so insurance coverage may be limited. Check with the medical insurer to confirm that plasmapheresis is a covered procedure. You can learn more about this process at there web sites (these links may expire):


http://www.hopkinsmedicine.org/transplant/programs/kidney/incompatible/plasmapheresis.html

http://www.ucsfhealth.org/treatments/living_kidney_donor_transplant/index.html

http://www.nmh.org/nm/kidney-desensitization


Another option is "paired exchange." In this situation, you find another pair of people--a potential donor and recipient--where the donor is compatible with your recipient and you are compatible with their recipient. You can learn about paired exchange here: paired exchange.


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