Living Kidney Donation: Your Questions Answered
Some years ago, a man living in Florida needed a kidney. He posted his story on Facebook, and numerous people stepped forward to help. He ended up receiving a kidney from a donor in Indiana—a total stranger. “That happens now with much greater frequency,” says Dr. Joseph Del Pizzo, the E. Darracott Vaughan Distinguished Professor of Urology and Surgery and Director of the Advanced Minimally Invasive Kidney Donor Program at Weill Cornell Medicine.
The stranger from Indiana was a so-called altruistic donor, a person who is motivated by a strong desire to help another human being through the life-saving act of donating a kidney.
The kidney is the most commonly transplanted human organ. Other organs that may be transplanted include:
- a segment of the liver
- a egment of the pancreas
- a segment of the lung
- a segment of the small intestine
In what follows, Dr. Del Pizzo answers your FAQs and provides additional information for anyone considering donating a kidney, as well as for those in need of one.
Who is eligible to become a living kidney donor?
A living kidney donor must be at least 21 years old, in good overall health, and possess an altruistic reason for organ donation. A donor should also have a blood type that’s compatible with the recipient’s blood type.
Which blood types are compatible?
- A donor with type A blood can donate a kidney to a recipient with type A or AB.
- A donor with type B can donate to a recipient with type B or AB.
- A donor with type AB can only donate to a recipient with type AB.
- A donor with type O is able to donate an organ to any recipient.
Are there other compatibility criteria?
In the past, compatibility depended on antigen matching. Antigens are signals on the surface of our cells. Antigen matching is no longer decisive to the success of a transplant.
However, there’s one additional criterion affecting compatibility: cross-matching—a blood test that mixes the donor’s and recipient’s blood to detect any signs of potential organ rejection.
What percentage of donors and recipients are incompatible?
About one-third of donors and their intended recipients will be incompatible, says Dr. Del Pizzo. “That’s why our paired donation program has been developed. If you want to donate a kidney to a spouse, friend or co-worker but you turn out to be incompatible, you can donate to another recipient, and your intended recipient can receive a kidney from another, compatible donor.
“These paired donations can be as few as 2 or 3 pairs and as many as 50 or even 60 pairs forming a long chain,” he continues. “A transplant won’t happen until your intended but incompatible recipient is scheduled to receive a kidney from another donor. Everything has to be scheduled for the program to work.”
What are the advantages of receiving a kidney from a living donor compared to a deceased donor?
There are approximately half a million people with end-stage kidney disease in this country. The volume of deceased donor kidneys hasn’t increased at the same rate as the need for kidney transplantation, he explains.
- A patient in need of a kidney may need to wait from 4 to 6 years for an organ from a deceased donor, or even longer.
- Living donor kidneys result in higher rates of transplant success. Long-term, the kidney will last an average of 20 years, compared to 10 to 12 years for an organ from a deceased donor.
- Generally, patients who have received a living donor kidney tend to live longer.
- A living donor kidney can also spare a patient with end-stage kidney disease from the ordeal of dialysis. Dialysis works by removing waste and extra fluid from the blood, but it’s tough on the body, plus it’s disruptive to a patient’s ability to work or travel. With extended time on dialysis, patients can experience higher rates of malnutrition and cardiovascular disease.
How has transplant surgery improved over the years?
The first kidney transplant took place between identical twin brothers in Boston in 1954. The feasible use of prednisone had not yet been developed. Today, the pool of recipients has expanded to include other relatives as well as genetically unrelated people; someone you know or don’t know.
“Even as recently as the early 1990s, surgical removal of a kidney involved a large open incision and scar and a prolonged recovery,” Dr. Del Pizzo says. “Then, in the late 1990s, laparoscopic surgery was pioneered and quickly became the gold standard for kidney donation. Patients recovered in 2 to 3 weeks instead of 2 to 3 months.”
About 15 years ago, Dr. Del Pizzo helped pioneer an innovative method called laparo-endoscopic single-site (LESS) surgery, which allows for the removal of a kidney through a single small incision. The resulting scar is well hidden in the patient’s belly button, he says, making it barely discernible to the naked eye.
If I want to donate a kidney, where do I begin? What steps are involved?
First, a prospective donor needs to meet with the donor nurse coordinator at Weill Cornell Medicine. That’s the start of an extensive process.
“Our first directive is to protect the living donor. Are you healthy enough? Do you know the short- and long-term risks? Then, you’ll undergo the most extensive physical and psycho-social evaluation of your life.”
After that, you’ll meet with an independent donor advocate team (IDA). Independent of the recipient’s medical care, the IDA team has no conflict of interest, especially where potential financial gain is concerned. The team is there to advocate for the rights of the donor and to oversee the donor’s education and consent.
The recipient’s insurance pays for the donor’s evaluation, laboratory work-up and radiology scans, as well as surgery and hospitalization.
Weill Cornell Medicine’s donor medical team includes mental health professionals, who will evaluate the prospective donor’s intentions and provide emotional support. A financial specialist is also on hand to help patients deal with any challenges that may arise during the pre- and post-surgical period.
Then, “we do a CT scan, which provides the surgical team with a ‘road map’ to the kidney’s blood vessels that need to be dissected and isolated for successful transplantation,” he says.
One week before surgery, the kidney donor meets with the final member of the medical team: the surgeon. The donor and the recipient have separate surgeons and separate teams.
The procedure takes about 1 to 2 hours, and the donor will spend 1 to 2 nights in the hospital. Office workers can go back to work in roughly 10 days, while those performing heavier labor can return to work in about 4 weeks.
What are the risks?
The vast majority—roughly 99 percent—come through the surgery without incident, and they tend to resume all of their normal activities in a month.
However, any surgery has risks. For instance, there’s a small possibility (less than one in 250 cases) of significant bleeding during the surgery, necessitating a blood transfusion.
What may disqualify me from becoming a donor?
During a prospective donor’s medical evaluation, a health issue may emerge, such as high blood pressure or cardiovascular disease. These may disqualify you as a donor, but you’ll benefit from the testing process during which something was found that can be treated.
What can I expect after donation?
Some donors report that they feel emotional in the aftermath of surgery. Among hospital staff, attention tends to be focused on the recipient after a transplant, and the donor may feel neglected.
It’s also possible that their kidney may not work in the recipient, but the great majority will work, says Dr. Del Pizzo.
“The opportunity to give the gift of life is extremely rewarding,” he says. “Most donors tend to feel good about themselves afterwards, with higher quality-of-life scores compared to the general population.”
To learn more about Weill Cornell Medicine’s Kidney and Pancreas Transplant Program or to consult with a surgeon, please visit the program’s website or call 212-746-3099.