Living Donor Evaluation Stage

INITIAL DONOR ASSESSMENT AND INFORMATION SESSION

The following is a summary of what happens, at the beginning of the journey towards becoming a living kidney donor:

• The potential donor contacts the transplant co-ordinators’ office for general discussion of living kidney donation.
• Transplant coordinators complete an initial telephone triage screening with the donor.  
• If previous or current medical/surgical/psychosocial issues are identified these may require further discussion with team members prior to initial OPD scheduling.  
• Potential donor(s) will then be invited to attend Beaumont Hospital for initial consultation and assessment of blood group and antibody compatibility (form of blood testing)
• Once results are given, one compatible donor who wishes to proceed is invited to book into the next stage: medical evaluation.  

DETAILED POTENTIAL DONOR ASSESSMENT

After the initial assessment and information session, the following stages are usually followed as part of the detailed evaluation of potential living donors.

• A transplant nephrologist (kidney doctor) evaluates the donor with a full history and physical assessment where a detailed discussion of the risks and benefits of living donor kidney transplantation are explored in depth.
• A transplant co-ordinator arranges for the following tests to be performed: Multiple blood and urine tests, including a 24 hour urine collection (completed the day prior to assessment). Blood testing for viruses including hepatitis and HIV (AIDS) test and syphilis test. At this stage a second tissue type test will be taken.  
• ECG  
• Technesium GFR screening  
• Radiological imaging: Chest x-ray, abdominal ultrasound and CT abdomen/pelvis are completed.  
• Clinical psychology assessment with our transplant psychologist

Once all of the above testing results are available and clinical reviews have been completed the donors case is then formally discussed at our Living donor multidisciplinary team – prior to clearance.  

Following this the donor and recipient are both reviewed by their assigned surgeons

Date for surgery are discussed.  

Who Makes The Final Decision?

Before the living kidney donation surgery, both donor and recipient have to agree that they want the surgery to proceed. All test results will then be reviewed by the multidisciplinary team. This team consist of the consultant transplant surgeons, transplant nephrologists, transplant immunologists, transplant co-ordinators, psychiatrist and psychologist. It is only when the results of all the testing are formally discussed and approved by this group that the donor and recipient pairing will progress to surgical review and potential dates for surgery explored.  

THERE ARE MANY DIFFERENT PEOPLE IN THE TRANSPLANT TEAM AND EACH HAS A SPECIFIC ROLE:

TRANSPLANT CO-ORDINATORS

The Co-ordinator is responsible for ensuring that the individual aspects of the donor’s care, including pre-donation assessments and the surgery itself, run as smoothly as possible. The co-ordinator is aware of what stage each donor is currently at in their assessment, and whom is responsible for each part of the process. In addition to ensuring the donor feels supported, informed and central to the decision making process.  

CONSULTANT NEPHROLOGIST

The consultant Nephrologist is the responsible person for overseeing the donor’s medical workup, following additional testing required, and deciding on the overall medical suitability of the donor.  

TRANSPLANT SURGEON

A team of senior transplant surgeons, one for the donor and one for the recipient, with another surgeon to assist, will perform the operation. The transplant surgeons must ensure that all the results of tests point to a successful and safe donation and transplant. They must also be sure that the donor and recipient are fit to undergo surgery with the minimum risk. The surgeon who removes the kidney carries overall responsibility for ensuring the safety of the donor.  

PSYCHOLOGIST

Many important emotional relationship issues need to be considered in a living kidney donation. The psychologist is there to discuss them with the potential donor and offer support to donors at any stage in the process. The psychologist also has responsibility for considering whether a potential donor is under undue pressure or stress in relation to donation. The psychologist also examines whether potential donors are currently emotionally stable and how they are likely to cope with major surgery. They also liaise with the donors nominated person for collateral to support the decision making process.  

CONSULTANT ANAESTHETIST

It is the responsibility of the anaesthetist to administer the general anaesthetic and to ensure the health of both patients during the surgical procedure.

CONSULTANT IMMUNOLOGIST AND MEDICAL SCIENTISTS

It is unlikely that you will meet the consultant immunologist and medical scientists, but there is a large group of people, in the laboratory, that are members of the transplant team. These scientists analyse your blood in detail to maximise the chances of transplantation success.