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Living Donors - National Kidney Registry - Facilitating Living Donor Transplants
You can make a difference. Join the ranks of over 50,000 living donors
who have donated their kidneys to people facing kidney failure. Since 1959,
when the first successful living donor transplant took place in Boston,
living donors have been giving the gift of life and making a difference. This
tradition has allowed thousands of people to live longer, healthier lives, free
from the challenging routine of dialysis therapy. Donating a kidney not only
helps the person who receives the kidney but also shortens the deceased donor
wait list, helping another person get a deceased donor kidney sooner. Also,
all living donors are awarded list points for their donation so if they every
need a kidney later in life, they will be at or near the top of the deceased
donor list, shortening the wait time for a deceased donor kidney.
Types of Donation
There are three types of living kidney donation:
Direct donation
Paired exchanges
Non-directed donation
Direct Donation
With direct donation, the donor knows the recipient and wants to donate
directly to that person. If the donor is compatible with the intended recipient,
the donor’s kidney can be transplanted directly into the recipient. The
problem with direct donation is that, in the majority of the cases, direct donors
are incompatible with their intended recipients. Below is an illustration of
the three hurdles that direct donors must clear before they can donate their
kidney to a specific recipient. If the direct donor is not blood compatible
with the recipient or does not pass the cross match tests, the direct donor
can still help the recipient through a paired kidney exchange.
Healthy
Blood Compatible
Pass Cross Match
Hurdle #1
Hurdle #2
Hurdle #3
Paired Kidney Exchanges
In a kidney exchange, a donor will donate their kidney to another recipient
that also has an incompatible donor. In the example to the right, a mother and
her son enter into an exchange. The son needs a kidney and his mother wants to
donate hers, but they are incompatible. A husband and his wife also enter the
Registry in a similar situation; the husband wants to donate to his wife but is
incompatible. In this kidney exchange, the mother in the first pair would donate
her kidney to the wife of the second pair. The husband in the second pair would
donate to the son in the first pair. The transplant operations would take place
at the same time with the donors traveling to the recipient’s hospital.
The first recorded paired exchange was performed in 2000, and since then, this
process has been growing in popularity driven by the significant benefits of
better matching between donors and recipients. In 2007 the first donor chain
(a new form of paired exchange) was started which significantly increases the
benefits of paired exchanges.
Non-directed Donation & Donor Chains
In a non-directed donation, the donor does not have a specific recipient identified and donates to a recipient that is a good medical match. The first, non-directed donation occurred in 1999 at Fairview-University Medical Center in Minneapolis, Minnesota, and since this first heroic act, hundreds of people have become non-directed donors and providing life-saving organs for people in need. Most recently, non-directed donors have begun initiating donor chains which have the potential to facilitate thousands of additional living donor transplants at much higher compatibility levels. Donor Chains are a way for one non-directed donor to help dozens of people get transplants instead of just one person. Donor chains are a major breakthrough in living donations and are revolutionizing living donor transplants by eliminating incompatibility as a barrier to donation and providing a way for recipients to find very well matched kidneys much faster than with traditional paired exchange.
Donor chains are initiated by a non-directed donor and fundamentally change the math of paired exchanges, allowing for better donor-recipient matches, providing a way for poorly compatible donors and recipients to improve donor match compatibility. Donor chains have the potential to facilitate highly compatible transplants, in some cases six antigen matches, allowing the transplanted kidney to function longer in the recipient, creating fewer antibodies and allowing the recipient to potentially take lower doses of medications. The first six antigen match between strangers was found in a donor chain by the National Kidney Registry in January of 2008. Many non-directed donors choose to start donor chains because it is a way to help more than one person suffering from kidney failure. One donor chain has the potential to facilitate up to 36 transplants per year. The National Kidney Registry attempts to start donor chains with all non-directed donors that enter the Registry, maximizing the gift-of-life provided by non-directed donors.
People facing kidney failure who are medically qualified for transplant surgery have
two basic options: stay on dialysis or get a transplant. For saving/extending lives,
transplantation is superior to long-term dialysis
(Reference: New England Journal of Medicine, Volume 341: 1725-1730, December 2, 1999, No. 23).
Transplant recipients, on average, live twice as long as patients who stay on dialysis and are not restricted
by the challenging routine of dialysis therapy. These and other benefits lead many
people to seek transplants.
Deceased Donor vs. Living Donor Transplants
If one chooses to pursue a transplant, he or she will have two options: a deceased
donor transplant or a living donor transplant. Kidneys transplanted from living
donors are superior because they last nearly twice as long as kidneys transplanted
from deceased donors.
The reason that kidneys from living donors last longer has to do with several
complex medical issues, including the death process and the amount of time the kidney
is “cold” or out of the body, whereas living donor kidneys are removed
from a healthy person who is only a few feet away in the next operating room. This
provides the best conditions for the transplanted kidney to last as long as possible
in the recipient.
Time Matters
Once a person has made the decision to get a transplant, time matters. Studies
indicate that the less time the patient is on dialysis, the higher the survival rate
of the transplanted kidney (Reference: Effect of Waiting Time on Renal Transplant
Outcome, Kidney International. 58(3):1311-1317, September 2000).
In addition, it is now believed that receiving a preemptive transplant and never
going on dialysis leads to higher transplant success rates and is best for the patient
(see chart below).
Although more than 6,000 living donors in the United States donate their kidneys
every year, the procedure is not without risks. The donor surgery has a .03% mortality
rate (i.e., 3 in 10,000). As a point comparison, according to the U.S. Census Bureau,
the 2007 infant mortality rate in the United States is .64% (e.g., 64 in 10,000)
indicating that it is about 20 times riskier to be born in the United States than
to donate a kidney. Additional information on
mortality risks.
Life Expectancy
Donating a kidney is major surgery but does not appear to reduce a person’s
life expectancy. Interestingly, people who have donated a kidney outlive the average
person. (Reference: Fehrman-Ekholm, Ingela 2,3; Transplantation, 64(7): 976-978,
October 15, 1997.) This fact has fueled an ongoing debate over why kidney donors live
longer than expected. Some experts believe that it is simply a selection bias since only
healthy people can be selected to be living donors. Others argue that the altruistic
act of giving the gift of life and the happiness and satisfaction that follows has a
positive impact and leads to a healthier and longer life.
Complications
In addition to the mortality rate, living donors face the possibility of post-operative
complications such as bleeding, wound infection, fever, etc. Most of the post-operative
complications are generally short-term and can be addressed with quality medical care.
Recovery Time
The two types of kidney removal procedures, laparoscopic and non-laparoscopic, have
very different recovery times. Laparoscopic kidney removal is less invasive and allows
the donor to be discharged one or two days after surgery and to return to work in one
to four weeks depending on the donor’s occupation. Non-laparoscopic surgery
has a longer recovery time. When donors register with us they can set a preference
as to what type of kidney removal procedure they are willing to undergo. However,
the ultimate decision is still up to you in consultation with your healthcare provider.
Becoming a donor through the National Kidney Registry depends on what type of donor you are.
If you want to be a direct donor, contact your recipient’s
transplant center so you can be tested to see if you are compatible with your
recipient and to see if you are medically qualified to donate.
If you are incompatible or poorly matched to your recipient,
and want to enter into a kidney exchange with the Registry
click here.
If you want to become a non-directed donor click here
and follow the 10 step registration process.
Regardless of what type of donor you become, there are costs associated
with donating a kidney you need to be aware of. In some cases the recipient will
reimburse the donor for these expenses. For non-directed donors, the Registry will
cover some of these costs. Below is an overview of two donor expense scenarios:
Typical Donor Expenses
Example 1: 2 weeks off, medium size city, car trip
