Comprehensive Evaluation and Testing for Living Kidney Donors
Weighing the possibility of donating a kidney is a large decision, and we want to be sure that you are truly ready to donate. Discuss what you are feeling with your care team, family, friends, counselor or clergy.
There are various requirements to become a living kidney donor, starting with a questionnaire about your health. If there are no conditions that would prevent you from safely donating, you will have the option to move forward with initial blood tests.
If you are found to be a possible candidate for donation, you will proceed to a comprehensive medical evaluation. Your doctor will take a detailed personal and medical history and conduct a physical exam. You will be instructed on the transplant process and undergo testing, which may include:
- Blood tests
- Chest X-ray
- CT scan
- Psychosocial evaluation
- Urine test
As part of your evaluation, you will meet with a psychologist for an examination to ensure that you are completely prepared for making such an important decision. There are several factors you should consider prior to making a living kidney donation, such as how this will this affect your:
- Current and future health
- Emotional health
- Life insurance status
- Physical health
It is important to know that you have the right to delay or stop the process at any time. Your care team is completely separate from the recipient’s team. Nothing you discuss with your living donor advocate or anything related to your medical condition is ever discussed with the recipient’s team. You are free to change your mind about donation at any time. The only two categories for a living donor are eligible or ineligible. You can tell your living donor advocate in complete confidence that you no longer want to donate; and the only thing ever told to the recipient and the recipient’s team is that you are not eligible to donate.
What to Expect with Living Kidney Donation
Once you have been approved as a donor, your care team will work with you and your kidney recipient to arrange the surgeries. This is usually scheduled four to six weeks in advance.
In the operating room, you will receive general anesthesia and be set up for an IV. In the recovery room, your nurses will give you pain medication to ease any discomfort you may experience.
After surgery, you may be discharged from the hospital the next day. You will have lifting restrictions for about six weeks, and you should be able to return to most other activities four to six weeks after surgery. You likely will be given clearance to drive in about two weeks.
Living donors have post-surgery follow-up care for at least two years. Your medical team will help you with a smooth transition to your primary care doctor, who will be updated on your care every step of the way.
Who pays for the operation? Insurance, whether private, Medicare or Medicaid, will pay for the recipient’s evaluation and surgery. The recipient’s insurance also pays for the evaluation and surgery for a living donor. Please contact your insurance company for specific levels of coverage.
What do the kidneys do? You have two bean-shaped kidneys in the lower back on either side of the spine. They help the body remove waste material and extra fluid from the blood and body in the form of urine. The kidneys also help to control blood pressure, stimulate production of red blood cells and regulate fluids and chemicals in the body.
What is kidney failure? Kidney failure, also known as chronic kidney disease (CKD), is when your kidneys can no longer clean toxins and other chemicals from your blood, regulate blood pressure or produce red blood cells.
Does the donor have to be hospitalized for evaluation? All tests to evaluate a potential donor are done as an outpatient.
What does the donor’s pre-evaluation entail? The kidney donor evaluation is an extensive physical exam that includes laboratory tests to check not only kidney function, but also the health of all the other organs. This includes diagnostic tests to check the function of the potential donor’s heart and general overall health. A psychosocial evaluation is also performed to ensure that the donor can manage the emotional stress of donating a kidney and to make certain that the donation is being made without any pressure from others.
Is there an age limit for living donors? Kidney donors have to be a minimum age of 18 and of sound mind and judgment to make such an important decision.
Are there any restrictions resulting from kidney donation for living donors? After your full recovery, there are no lifestyle or work restrictions.
How are kidneys selected when a kidney patient has several donors? If a recipient has more than one willing donor and assuming they are all appropriate to donate, siblings are chosen first because they usually are the best match from an immune-system perspective. After siblings, a parent is next, depending on age and health. Then any other blood relative is considered. After blood relatives, donors usually can be anyone who has a close personal relationship with the recipient such as a spouse or a best friend. Altruistic donation, generous, selfless donors who would like to give a kidney to someone like Maddie.
Are living donors at greater risk for developing kidney disease later in life? Research has shown that people who were healthy and donated a kidney are at no greater risk for developing kidney failure than the same population in the general public.
What is recovery like for donors? It is different for every person. The nurses caring for you will encourage you to tell them about any pain you are having so they can ease your discomfort. Your doctors will monitor you closely for the first 24 hours after surgery, and you will begin to feel better within the first day. You will be encouraged to get up, walk around and do some deep breathing and coughing to prevent complications from the anesthesia.
As a donor, how long will my hospital stay be, and when can I go back to work? Most people go home the day after surgery. If you experience more pain than normal, you may be required to stay an extra day until your pain is under control. Our medical staff will send you home with pain medicine. Going back to work depends on the type of work you do; most people regardless of occupation can resume normal activities within a few days. The time needed for a complete recovery in order to return to all prior activity is approximately four to six weeks.
What should donors expect on an emotional level? This differs from person to person. Some people will feel very happy they were able to help someone in need of a life-saving organ. Other people might feel slightly depressed even though they helped someone in an incredible way. Some will feel completely the same afterward. The important point is that all of these emotions are completely normal feelings after donation. Everyone is unique in how they respond. Most organ donors report an overall positive response and experience.
Do living donors have to pay more for insurance after kidney donation? In the past, there were occasions when some had to pay more for life insurance after donating a kidney—but not necessarily health insurance. There also has been evidence that some health insurance companies attempted to charge patients higher premiums after donating a kidney; but under current healthcare laws, pre-existing conditions are no longer an issue.
How Do Paired and Chain Donations Work?
In a “pay-it-forward” kidney transplant, an altruistic donor gives a kidney to a compatible transplant candidate who has a willing but incompatible donor. The incompatible donor could be a friend, acquaintance or family member who agrees to give a kidney to a third person with an incompatible donor, and a chain reaction begins. A kidney transplant chain can potentially go on forever, but a chain typically ends with a kidney patient who is extremely difficult to match.
Traditionally, transplant recipients would have to wait about three to five years for a suitable deceased-donor kidney in our region. Now with paired kidney exchanges and chain transplant surgery, our goal is to help every recipient with a healthy donor undergo transplant surgery within a year.
Our approach sets us apart. While many hospitals only look for kidney matches within their own campus, we use this landmark approach to conduct a nationwide search. Not only are these faster matches, but they are better matches. When you have a better match, it reduces the need to suppress the immune system and you are at less risk of rejection. With a more precise match, your kidney will remain healthy for a much longer period of time. The process starts with a transplant evaluation.
Loyola’s innovative pay-it-forward program began when four people offered to donate kidneys to four complete strangers across the country—with no strings attached. The program was the first of its kind in the Midwest. We were honored to take part in the longest kidney transplant chain in United States history.
Loyola has helped numerous kidney patients across the country end dialysis treatment with the pay-it-forward program. Our patients have gotten their lives back and removed their names from the waiting list, which means that others will find a match sooner.
The largest kidney transplant chain touched 60 lives as 30 kidneys were donated. Click hear to read more about the amazing story.