OPTN: Organ Procurement and Transplantation Network

In addition to deceased (person declared brain dead) donor transplants, patients may also receive organs from living donors. Living donation offers an alternative for individuals awaiting transplantation and increases the existing organ supply. Create a data report to compare living and deceased donor data

Facts
Organ Types
Qualifications for Living Donors
Informed Consent
About the Surgical Procedure of Living Kidney Donation
Risks
Positive Aspects
Costs

Facts About Living Donation

History

The first successful living donor transplant was performed between 23-year-old identical twins in 1954. Doctor Joseph E. Murray at Peter Bent Brigham Hospital in Boston, MA, transplanted a healthy kidney from Ronald Herrick into his twin brother, Richard, who had chronic kidney failure. Richard Herrick went on to live an active, normal life, dying eight years later from causes unrelated to the transplant.

Since that time, thousands of patients have received successful transplants from living donors, which are handled by the center or hospital doing the transplant. For more information, contact your local organ procurement organization (OPO) or transplant program. To find your region's OPO or a local transplant program, use the Member Directory.

Organ Types for Living Donation

Living donor transplants are a viable alternative for patients in need of new organs. Many different types of organs can be delivered by living donors, including:

kidney
This is the most frequent type of living organ donation. For the donor, there is little risk in living with one kidney because the remaining kidney compensates to do the work of both kidneys.
liver
Individuals can donate segments of the liver, which has the ability to regenerate the segment that was donated and regain full function.
lung
Although lung lobes do not regenerate, individuals can donate a lobe of one lung.
pancreas
Individuals can also donate a portion of the pancreas. Like the lung, the pancreas does not regenerate, but donors usually have no problems with reduced function.
intestine
Although very rare, it is possible to donate a portion of your intestine.
heart
A domino transplant makes some heart-lung recipients living heart donors. When a patient receives a heart-lung "bloc" from a deceased donor, his or her healthy heart may be given to an individual waiting for a heart transplant. This procedure is used when physicians determine that the deceased donor lungs will function best if they are used in conjunction with the deceased donor heart.

Qualifications for Living Donors

In order to qualify as a living donor, an individual must be physically fit, in good general health, and free from high blood pressure, diabetes, cancer, kidney disease, and heart disease. Individuals considered for living donation are usually between 18-60 years of age. Gender and race are not factors in determining a successful match.

The living donor must first undergo a blood test to determine blood type compatibility with the recipient.

Blood Type Compatibility Chart

Recipient's Blood Type Donor's Blood Type
O O
A A or O
B B or O
AB A,B, AB or O

If the donor and recipient have compatible blood types, the donor undergoes a medical history review and a complete physical examination. The following tests may be performed:

Tissue Typing: the donor's blood is drawn for tissue typing of the white blood cells.
Crossmatching: a blood test is done before the transplant to see if the potential recipient will react to the donor organ. If the crossmatch is "positive," then the donor and patient are incompatible. If the crossmatch is "negative," then the transplant may proceed. Crossmatching is routinely performed for kidney and pancreas transplants.
Antibody Screen: an antibody is a protein substance made by the body's immune system in response to an antigen (a foreign substance; for example, a transplanted organ, blood transfusion, virus, or pregnancy). Because the antibodies attack the transplanted organ, the antibody screen tests for panel reactive antibody (PRA). The white blood cells of the donor and the serum of the recipient are mixed to see if there are antibodies in the recipient that react with the antigens of the donor.
Urine Tests: In the case of a kidney donation, urine samples are collected for 24 hours to assess the donor's kidney function.
X-rays: A chest X-ray and an electrocardiogram (EKG) are performed to screen the donor for heart and lung disease.
Arteriogram: This final set of tests involves injecting a liquid that is visible under X-ray into the blood vessels to view the organ to be donated. This procedure is usually done on an outpatient basis, but in some cases it may require an overnight hospital stay.
Psychiatric and/or psychological evaluation: The donor and the recipient may undergo a psychiatric and/or psychological evaluation.

The decision to become a living donor is a voluntary one, and the donor may change his or her mind at any time during the process. The donor's decision and reasons are kept confidential.

Informed Consent

The OPTN/UNOS Living Donor Committee developed this information to help transplant professionals obtain the informed consent of all living donors.

Education is important in the consent process for any potential living donor. The potential donor must understand all aspects of the donation process and understand the risk and benefit associated with being a living donor as well as center-specific risk factors. Above all else, the potential donor must understand that the donor can stop the evaluation or donation process at any time.

The consent process for any potential living donor should include, but is not limited to:

The assurance that the potential donor is willing to donate, free from inducement and coercion, and understands that he or she may decline to donate at any time.
A psychosocial evaluation of the potential donor completed by someone with mental health training which could include, for example, a licensed clinical social worker, nurse specialist, psychologist, or psychiatrist.
Disclosure of alternate procedures or courses of treatment for the potential donor and recipient, including deceased donation. All potential donors should be informed if the intended recipient has or has not been listed for deceased donation. Pre-existing, life threatening conditions of the potential recipient should be disclosed to the potential donor prior to obtaining consent.
An evaluation of the potential donor’s ability to comprehend the donation process, including procedures employed for both donor and recipient and possible outcomes.
Providing printed materials that explain all phases of the living donation process. Materials should be written at an appropriate reading level and provided in the potential donor’s native language. When necessary, independent interpreters should be provided to make certain the potential donor comprehends all phases of living donation and its associated risks and benefits.
Ensure that the potential donor has time to reflect after consenting to donate.
Offer any potential donor a general, nonspecific statement of unsuitability for donation should they wish not to proceed with donation.
Explain that a decision by the potential donor not to proceed with the donation will only be disclosed after obtaining the consent of the potential donor.
An understanding that the donor undertakes risk and receives no medical benefit from the operative procedure of donation.
A specification of the medical, psychological, and financial risks associated with being a living donor, to include, but not be limited to the following:

Potential Medical Risks

potential for surgical complications including risk of donor death
potential for organ failure and the need for a future organ transplant for the donor
potential for other medical complications including long- term complications currently unforeseen
scars
pain
fatigue
abdominal or bowel symptoms such as bloating and nausea
increased risk with the use of over the counter medications and supplements

Potential Psychosocial Risks

potential for problems with body image
possibility of post surgery adjustment problems
possibility of transplant recipient rejection and need for re-transplantation
possibility that the transplant recipient will have a recurrence of disease
possibility of transplant recipient death
potential impact of donation on the donor’s lifestyle

Potential Financial Risks

personal expenses of travel, housing, and lost wages related to live donation might not be reimbursed; however, the potential donor should be informed that resources may be available to defray some donation-related costs
child care costs
possible loss of employment
potential impact on the ability to obtain future employment
potential impact on the ability to obtain or afford health, disability, and life insurance
health problems experienced by living donors following donation may not be covered by the recipient's insurance

Disclose that transplant centers are required to report living donor follow-up information for at least two years
Centers will specify who is responsible for the cost of follow-up care
The agreement of the potential donor to commit to postoperative follow-up testing coordinated by the recipient transplant center for a minimum of two years
Disclosure that donors may not receive valuable consideration (including without limitation monetary or material gain) for agreeing to be a donor. In certain cases, donors may be reimbursed for limited travel expenses and may receive subsistence assistance.
Disclosure that living donor follow-up is the only method for the collections of information on the long-term health implications of living donation.
The stipulation that transplant centers will provide potential donors with both national and their center-specific outcomes from the most recent SRTR center-specific report. This information should include, but not be limited to. 1-year patient and graft survival, National 1-year patient and graft survival, and notification about all Medicare outcome requirements not being met by the transplant center.

About the Surgical Procedure of Living Kidney Donation

While procedures may differ for the living donation of organs such as liver or lung, the most common living donor procedure involves the kidney. Traditionally for living kidney donation, the donor is admitted to the transplant hospital the day before the operation. The anesthesiologist and the transplant team meet with the donor to explain the surgical procedure. Laboratory tests, blood work, a chest X-ray, and an EKG may be performed again to verify the donor's health status. If the operation is to be performed the next morning, the donor is asked not to eat or drink anything after midnight.

Shortly before the operation, an intravenous line is connected to a vein in the donor's arm so that medications and fluid can be given during the operation. A catheter will also be inserted to drain urine from the bladder. The recipient's transplant operation follows the donor's operation.

The donor may spend several hours in the recovery room after the operation. Immediately after the operation, a nurse will ask the donor to turn, cough and breathe deeply to help clear the lungs of secretions. This will be repeated every two hours to prevent pneumonia or other respiratory difficulties associated with the use of anesthesia during the operation. Several hours after the operation, the donor is encouraged to get out of bed and walk around. The I.V. and catheter may remain in place for a few days. The donor may begin eating and drinking again after recovery of bowel function. After five to eight days, the donor may return home. A post-operative check-up follows in two to four weeks. The donor is encouraged not to attempt any heavy lifting or rough contact sports until at least six weeks after the operation. If no complications arise, the donor may return to work four weeks after surgery.

There is an alternate procedure used to recover a kidney from a living donor. The more traditional procedure (described above) involves a surgical incision around the donor's lower back and side. In recent years, laparoscopy has been used in some cases to recover kidneys from the donor's abdomen. (In laparoscopy, surgical instruments are inserted into the body through a series of small incisions.) While laparoscopy involves a smaller incision and a potentially shorter recovery time for the donor, the transplant team must decide which procedure will offer the fewest potential risks and the greatest likelihood for success for the individual operation.

Risks Involved in Living Donation

All patients experience some pain and discomfort after an operation. And as with any major operation, there are risks involved. It is possible for kidney donors to develop infections or bleeding and when a portion of the liver or pancreas is donated, the liver or spleen may be injured.

Living donation may also have long-term risks that may not be apparent in the short term. It is therefore important that the benefits to both donor and recipient outweigh the risks associated with the donation and transplantation of the living donor organ. In addition to potential individual health concerns, it is possible for negative psychological consequences to result from living donation. Living donors may feel pressured by their families into donating an organ and guilty if they are reluctant to go through with the procedure. Feelings of resentment may also occur if the recipient rejects the donated organ. Living donors must be made aware of the physical and psychological risks involved before they consent to donate an organ. They should discuss their feelings, questions and concerns with a transplant professional and/or social worker.

Positive Aspects of Living Donation

Living donation has several advantages:

Living donation eliminates the recipient's need for placement on the national waiting list. Transplant surgery can be scheduled at a mutually-agreed upon time rather than performed as an emergency operation. Because the operation can be scheduled in advance, the recipient may begin taking immunosuppressant drugs two days before the operation. This decreases the risk of organ rejection.
Transplants from living donors are often more successful, because there is a better tissue match between the living donor and the recipient. This higher rate of compatibility also decreases the risk of organ rejection.
Perhaps the most important aspect of living donation is the psychological benefit. The recipient can experience positive feelings knowing that the gift came from a loved one or a caring stranger. The donor experiences the satisfaction of knowing that he or she has contributed to the improved health of the recipient.

Costs Related to Living Donation

Health insurance coverage varies for living donation. If the recipient is covered by a private insurance plan, most insurance companies pay 100 percent of the donor's expenses. If the recipient is covered by Medicare's end-stage renal disease program, Medicare Part A pays all of the donor's medical expenses, including preliminary testing, the transplant operation, and post-operative recovery costs. Medicare Part B pays for physician services during the hospital stay. Medicare covers follow-up care if complications arise following the donation.

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