Why Become A Living Donor?

Individuals volunteer to donate a kidney for a variety of reasons. Oftentimes donors are motivated by watching someone close to them wait a long time for a transplant or seeing a loved one suffer in some way as a result of kidney problems.

Other reasons for wanting to donate a kidney include feeling a duty to do something for a loved one who is unwell or feeling that it will benefit the donors’ life to have their loved one free of dialysis. Research has shown the reasons for donating can vary, such as:

• Desire to help.
• Feeling of moral duty.
• Pressure.
• Increased self-esteem.
• Identification with recipient.
• Self-benefit from recipient’s improved health.
• Logic.

While all these motives might be acceptable reasons to be a donor, more complex reasons can also be involved, such as:

• Offering to donate a kidney because of feeling pressure from others (e.g., family members), perhaps because the situation seems urgent, or it appears that the ill person has no other options.
• Offering to donate because of feelings of guilt, or feeling that it is your duty as a close relative/ friend.
• Offering to donate to “right” past wrongs, to feel good about yourself, or to feel closer to the person to whom you are donating.

Most people have a number of reasons for donating, and it is normal for different issues to come up when you are thinking about becoming a donor. It is important that these are discussed openly during your donor work-up, and this discussion forms part of your meeting with the team, particularly the psychologist.

HOW CAN I VOLUNTEER? 

Direct personal communication is the key to making sure the process of assessment for living kidney donation goes smoothly. This is true both for donors and for recipients. If you want to be considered as a potential kidney donor, for a friend or family member, you will need to make direct contact with the kidney Transplant Office at Beaumont Hospital and ask to speak with one of the kidney Transplant Co-ordinators. Phone number is 01-852 8397.

It is important to be aware that we will not commence the evaluation of a potential living donor until the recipient has been evaluated by the transplant team and active on the transplant list. This means that a potential recipient must be suitable for transplant for a deceased/living donor kidney. It is important to discuss your wish to donate a kidney with the potential recipient prior to contacting out office, since we cannot commence screening of a potential donor until we have the consent of the recipient to do so.

WHAT MAKES A SUITABLE LIVING DONOR?

Before the medical staff can agree to anyone becoming a living donor, they must be satisfied that the donated kidney is unlikely to be rejected by the recipient’s body. They also need to ensure that the person, willing to be a donor, is unlikely to suffer ill health as a result of making the donation.

BLOOD GROUPS

Most people are familiar with the fact that red blood cells have a specific type or group: A, B, AB, or O. In general , for successful transplantation, the blood group of the potential donor must be compatible with that of the proposed recipient. So, before anything else, the blood group compatibility of donor and recipient must be tested. The different pairs which can be considered are:

In general, a suitable match of blood groups, as shown, is necessary before any further assessment can be considered. Since family members have many different blood groups, it may not be possible for some family members to give a kidney. It is possible, under certain circumstances to overcome these blood group rules for recipients who do not have an alternative donor.

TISSUE MATCHING

Once blood group compatibility has been confirmed, the donor has to be tested for tissue compatibility. The tissue type of the donor and recipient will be determined in the transplant laboratory by way of a blood test. This process may take up to four weeks. In general, the better the match between the recipient and the donor the better the long-term success of kidney transplantation.

You are tested for HLA antigens on up to 12 different markers, which can have thousands of different combinations. A donor recipient pair that has matches on each of these 12 markers has a so-called ‘full house match’, sometimes called ‘zero mismatch’. Donor recipient matching is important because a better match often results in better success of this transplant, and because poor matching can make kidney transplantation, a second or third time, a lot more difficult.

A lot more goes into the success of kidney transplantation than just tissue matching. The long-term success of a kidney transplant can be excellent, even when the donor and recipient tissue-match is less than perfect.

OTHER BLOOD TESTS

Tests to check the donor for viruses are completed quite early in the assessment process. A potential donor’s blood is examined for the presence of previous exposure to certain viruses, such as Hepatitis B & C, HIV and Cytomegalovirus (CMV).

With the exception of CMV, if these viruses are detected, transplantation cannot normally take place due to the risk of disease transmission. CMV can be transmitted during transplantation. Recipients can be affected with — from mild flu-like symptoms to serious pneumonia — but usually modern anti-viral drugs can help combat it.

In summary, donors generally need to meet the following standards:

• Donors need to be fit enough to undergo the operation.
• They need to be capable of living normally with just one kidney.
• They must be in excellent physical health.
• Their medical history needs to be relatively “clear” or uneventful.
• They must be relatively free of pressure to donate as well as having a positive relationship with the potential recipient.
• They must have some positive coping skills and supportive relationships.
• They must be relatively free of current emotional distress or disturbance.
• They must demonstrate a clear and realistic understanding of what is involved in living kidney donation.

If tests show evidence of poor kidney function or, if investigations show the possibility of the donor being medically unsuitable, the offer of a donation may be declined. The team recognises that this can be difficult news for those who are motivated to donate a kidney.

Risks & Benefits

FOR THE RECIPIENTS

BENEFITS

The main benefit to the recipient of a successful kidney transplant is usually freedom from dialysis, energy levels returning to normal and feeling ‘well’ again.  

• Although a transplant recipient will always have to take medications to prevent the rejection of the kidney, most aspects of their lives can return to normal. The majority of recipients return to their normal activities of daily living and even full-time work.
• Long-term kidney transplant survival rates are very good for kidneys from living donors, often lasting 10 – 20 years.
• In general, the only way a patient with severe kidney disease can avoid a long period of time on dialysis is if they have a willing and suitable living donor. The average waiting time for a deceased kidney transplant in Ireland is two and a half years. A living kidney transplant can sometimes be organised in 4 to 6 months and may be planned prior to the person actually starting dialysis.

RISKS

• As with any surgical procedure, there are risks for transplant recipients. This includes the risk of death, which is less than two to three cases per thousand living transplant recipients.
• Poor blood supply to the kidney or severe rejection can cause failure and great disappointment to everyone. It is estimated, however, that 95% of living kidney transplants are still functioning at one year and many patients are fit and well twenty years after surgery.
• Relationship and emotional problems can arise within the family for the potential recipient as well as the donor. Potential recipients may feel under pressure from other family members – even the donor – to go ahead with the procedure. It is a topic that needs to be discussed, at length, with all members of the family. The recipient might feel a tremendous sense of guilt about the donor and this needs to be recognised and spoken about.

FOR THE DONORS
 

Benefits

• A potential donor is likely to have experienced some changes that needed to be made to their own lifestyle due to a family member’s illness (e.g., as a sibling these could include greater domestic responsibilities). A successful kidney transplant may mean the balance of roles/ responsibilities change in a positive way in a family, when a formerly ill person may be able to contribute more to family life.
• Spousal transplantation offers the potential for considerable improvement in quality of life for both parties; if the transplant is a success spouses and families are free of the burden of dialysis.
• The main benefit of donating a kidney is purely an emotional or psychological one. The sense of satisfaction, at giving a loved one a kidney, can sometimes be thoroughly rewarding for the donor.

Risks

• Only one in eight donors that come forward to be tested will be considered suitable as an actual donor. Donors who have gone through testing and found to be unsuitable may be left feeling helpless and disappointed.
• Any patient who has a general anaesthetic or a major operation runs a slight risk of problems, though the tests that are done before the operation try to ensure that this risk is made as small as possible.
• The removal of a kidney involves a rather more difficult and uncomfortable operation than the transplant operation. It involves a degree of post-operative pain and discomfort which can be partly controlled by painkillers. The potential donor should keep in mind that they are likely to feel less well than the recipient in the first few weeks after the operation.
• The tests involved in the process could reveal an abnormality or health problem that the donor was unaware of before volunteering as a potential living donor.
• After the operation, the donor may experience a sense of anti-climax and may be at a slightly higher risk of depression, particularly if he or she or the recipient has post-operative problems.
• An emotional difficulty for the donor may be the worry around how they will face their future with one kidney; the donor may worry that they do not have the ‘assurance’ of the second, in case of serious accidents or illness.
• The risk of the surgery not working out needs to be seriously considered. As we know, no matter how many tests are undertaken beforehand, there is still a risk that the transplanted kidney will fail and the recipient will have to return to dialysis.
• There is a possibility that, as a result of tissue type testing, we will discover that one of your parents or other potential donors is not in fact your blood relative. You need to think about how you could cope with this news before you embark on becoming a living kidney donor.

One of the most common emotional challenges a recipient may face is fear – particularly fear that the transplant will not work out. This can be especially difficult for recipients as they are aware that the donor has made a sacrifice on their behalf. By discussing these issues as openly as possible, difficult situations such as the transplant not working out can be handled in a sensitive and supportive way by all involved.

IN SUMMARY, THE MAIN RISKS OF THE SURGERY FOR DONORS ARE AS FOLLOWS:

1. The risk of death (estimated to be approximately 1 in 3,000 cases).
2. Negative reaction to anaesthetic or other drugs.
3. The general complications of major abdominal surgery: 
   a) Venous blood clot 
   b) Intra-abdominal bleeding and infection 
   c) Wound complications 
   d) Chest complications 
   e) Urinary retention/urinary infection 
   f) The possible need for blood transfusions 
   g) Risk of adhesions and blockage of the bowel
4. The possibility of short and long-term wound pain.
5. The need for a recovery period of between 4-12 weeks. Potential donors should check their sick leave entitlement with their employers.
6. The possibility of increase in blood pressure and protein in the urine.
7. The possible emotional consequences of donation: the risk of the donor feeling pressure from family, feeling worried about the future with one kidney, or feeling upset after surgery.
8. The possible family and relationship consequences of donation: the risk that tensions can arise in families around the surgery or that the balance in a donor/recipient relationship can change after surgery (e.g., a recipient feeling like they “owe” something or are indebted to a donor).
9. The emotional and psychological impact on the donor of the recipient dying suddenly or the transplanted kidney failing.
10. The risk that surgery may impact on the current or future insurability of the donor. This has to be checked by the donor with their own insurance agency.