ERROR:   Our system requires that you have cookies enable in order to work correctly. It appears that you have cookies disabled in your browser. Check your browser's help manual to find out how to enable cookies.
Living Donors - National Kidney Registry - Facilitating Living Donor Transplants   Skip navigation

Living Donors

Overview

You can make a difference by joining the ranks of over 50,000 living donors who have donated their kidneys to people facing kidney failure. Since 1954, 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. 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 points for their donation so if they every need a kidney later in life, they will be given priority on the deceased donor list.

Types of Donation

There are three types of living kidney donation:

  • Direct donation
  • Paired Exchange donation
  • Good Samaritan 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 or poorly compatible 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, does not pass the cross match test or is poorly compatible (i.e. age, HLA, size); the direct donor can still help the recipient through a paired exchange.

Healthy

Direct Kidney Donation - Hurdle #1: Healthy
Hurdle #1

Blood Compatible

Direct Kidney Donation - Hurdle #1: Healthy
Hurdle #2

Pass Cross Match

Direct Kidney Donation - Hurdle #1: Healthy
Hurdle #3

Paired Exchange Donation

Paired Kidney Exchange

In a kidney exchange, a donor will donate their kidney to another recipient that also has an incompatible or poorly compatible donor. In the example below, 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 generally take place at the same time.

Donor Chain Graph

Good Samaritan Donation

With Good Samaritan donation, the donor is giving to a stranger. Most recently, Good Samaritan donors have begun initiating chains which are facilitating hundreds of additional living donor transplants at much higher compatibility levels. Chains are a way for one Good Samaritan donor to help many patients get transplants instead of just one person. Chains are a major breakthrough in transplantation and are revolutionizing the process by eliminating incompatibility as a barrier to donation and providing a way for all recipients to find very well matched donors.

Chains are initiated by a Good Samaritan 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 match compatibility. 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. To date the Registry has facilitated two six antigen match transplants (approximately 1% of transplants) utilizing chain matching. As the Registry pool size increases, the number of six antigen matches will increase), Many Good Samaritan donors choose to start donor chains because it is a way to help more than one person suffering from kidney failure. One chain typically facilitates 6 transplants but in some cased can facilitate over 20 transplants.

 

Back to Top of Page

 

Why the National Kidney Registry

If you want to donate to someone in need of a kidney, the National Kidney Registry will give you the best chance of helping the most patients with your donation. The National Kidney Registry works with most of the top transplant hospitals in the United States and has facilitated more exchange transplants than any other exchange program in the world. Additionally, the patient outcomes from transplants facilitated by the National Kidney Registry are superior to the average U.S. living donor transplant outcome (see below). We believe this is driven by the improved donor - recipient matches available through the National Kidney Registry.

Graft Survival - NKR Transplants vs. U.S. Living Donor Transplants as of 3/19/2014

Paired Exchange donors participating in the Registry will be assured that:

  • You will be provided a "Swap Expert Patient Advisory" that will describe your pair's key matching variables
  • You will be matched as quickly as possible so you and your recipient can minimize your wait time
  • You will not be required to travel in order to participate in a swap
  • Your recipient will get the best matched donor possible through utilization of donor age, donor size and HLA match preferences
  • We will work hard to create the longest chain which will help others get transplanted

Good Samaritan donors participating in the Registry will be assured that:

  • You will be supported by an experienced Registry advocate who intimately understands the process
  • You will be matched in accordance with your donation timeframe so that your surgery fits into your schedule
  • The patients that you help will get the best matched donor possible through utilization of donor age, donor size and HLA match preferences
  • We will work hard to create the longest chain which maximize your gift by facilitating as many transplants as possible
  • You will not be required to travel in order to start a chain
  • You will be provided with a donor insurance policy at no cost

Single center exchange programs

There are some transplant centers in the United States that attempt to provide paired exchange services from a "single center". Although this approach will make the logistics easier (no need to ship kidneys or coordinate surgery dates with other centers) this "single center" approach is likely to delay or even prevent a successful paired exchange transplant. Paired Exchange is inherently a numbers game and the larger the exchange program the higher the probability that the patient will quickly get a great match. A great match will increase graft survival and provide a kidney that lasts longer. The NKR is the largest paired exchange program in the world and provides the best chance for patients to rapidly find a great match. The top NKR Member Centers have a 90%+ match / transplant success rate and have an average wait time of less than 6 months for the completion of NKR paired exchange transplants. For more information on NKR Member Center performance CLICK HERE.

Working with a transplant center that participated with the NKR will:
  • Increase the chance of a "clean cross-match" eliminating the need for desensitization
  • Reduce the chance of not getting a match or waiting a long time for a match
  • Increase the chance of finding a great HLA match (5 NKR patients have received 6 antigen matched kidneys)
  • Increase the chance of finding an age compatible donor match

 

Back to Top of Page

 

Recipient Benefits

Dialysis vs. Transplant

People facing kidney failure who are medically qualified for transplant surgery have two basic options: stay on dialysis or get a transplant. Transplantation is far superior to long-term dialysis on all fronts. Transplant recipients generally live twice as long as those who stay on dialysis and transplant recipients are not restricted by the challenging routine of dialysis therapy. These and the quality of life improvements 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 (see chart below).

Living Donor Kidneys Last Longer

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. Receiving a preemptive transplant and never going on dialysis leads to higher transplant success rates (see chart below).

Ten year overall adjusted graft survival - Pre-emptive Living Donor Transplant vs. Dialysis

The Match Matters

Not only does time matter but the donor - recipient match matters too. Below are charts that show the impact of donor age and antigen matching on transplant outcomes.

Donor Age Matters Antigen Match Between Donor and Recipient Matters


Donor Risks

Life Expectancy

Donating a kidney is major surgery but does not 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

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 two days after surgery, allowing the donor to return to work in one to four weeks depending on the donor's occupation. Non-laparoscopic surgery has a longer recovery time. Registry member centers generally utilize the laparoscopic procedure.

Mortality Rate

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.

Long Term Outcomes

For more details on the long term outcomes of kidney donation, read the article published in the New England Journal of Medicine.

 

Back to Top of Page

 

Myths about Living Donation for Kidney Transplantation

By Ilana Silver Levine, LMSW and Marian Charlton, RN, CCTC

The purpose of kidney transplantation is to give a healthy kidney to a person who has kidney disease. A successful kidney transplant may prevent the need for dialysis and the complications associated with kidney failure. For many years, the kidney that was transplanted had to come from a person who had died, from a "deceased donor." But there are not enough deceased donors for the number of people who need kidney transplants. Although living donor kidney transplantation is more common, there are still many myths associated with living donor kidney transplantation.

Myth #1: A kidney donor will have to take medications for the rest of their life

Fact #1: A kidney donor will be given prescriptions for pain medication and stool softeners at discharge from the hospital. These are only for the immediate post-operative period, after that time, a donor does not have to take medication.

Myth #2: A kidney donor will have debilitating pain for an extended period of time.

Fact #2: A kidney donor will have some pain after surgery from both the incisions and related to gas and bloating. This pain will diminish in the days following surgery and can be controlled with pain medication if necessary.

Myth #3: A kidney donor will be on bed rest following surgery.

Fact #3: A kidney donor will be out of bed and walking independently before discharge from the hospital.

Myth #4: A kidney donor will be in the hospital for an extended period of time after surgery.

Fact #4: A kidney donor will be hospitalized for two nights (i.e. if surgery is on a Tuesday, the donor will typically be discharged on Thursday).

Myth #5: A kidney donor can no longer participate in sports or exercise.

Fact #5: A kidney donor should be able to return to regular activities and exercise at approximately 4-6 weeks following surgery.

Myth #6: A kidney donor will have to follow a new diet plan following donation.

Fact #6: A kidney donor should eat a healthy, well balanced diet. There are no dietary restrictions following donation.

Myth #7: A kidney donor can no longer consume alcohol following donation.

Fact #7: While excessive alcohol use is always dangerous, a kidney donor can consume alcohol in moderation.

Myth #8: A female kidney donor should not get pregnant after donation.

Fact #8: A female kidney donor should wait 3-6 months' time after donation to become pregnant. The body requires time to recover from the surgery and to adjust to living with one kidney prior to pregnancy.

Myth #9: A kidney donor's sex life will be negatively affected by donation.

Fact #9: A kidney donor may engage in sexual activity when they feel well enough to do so.

 

Back to Top of Page

 

 

Back to Top of Page

 

Related Sites

The list of top kidney transplant centers in the United States
www.kidneytransplantcenters.org/

Donate Life America
www.shareyourlife.org/UnderstandingDonation/LivingDonation.php

Living Donors Online
www.livingdonorsonline.org/general.htm

National Donor Memorial
www.donormemorial.org

National Kidney Foundation
www.kidney.org/transplantation/livingDonors/about.cfm

Transplant Living
www.transplantliving.org/livingdonation/default.aspx

Detailed information on becoming a living donor
www.ucsfhealth.org/childrens/edu/living_donor.pdf

Health Guidelines for Living Donation
Health Guidelines

http://ihatedialysis.com/

American Kidney Fund
www.kidneyfund.org

Renal Support Network
www.rsnhope.org

 

Back to Top of Page