mamassage

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
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

  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.

• 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

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.

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.

Bibliography

   

BIOCOM (Producer). The Living Donor [Videotape]. Richmond, VA: Southeastern Organ Procurement Foundation, 1987.

Callender, Clive O. "Legal and Ethical Issues Surrounding
Transplantation: The Transplant Team Perspective." In D. H. Cowan,
M.D., J.D., J. A. Kantorowitz, J.D., J. Moskowitz, Ph.D. and P. H.
Rheinstein, M.D, J.D., eds., Human Organ Transplantation: Societal,
Medical-Legal, Regulatory and Reimbursement Issues (pp. 42-52). Ann
Arbor, MI: Health Administration Press, 1987.

Craven, J., and Rodin, G. M., eds. Psychiatric Aspects of Organ Transplantation. New York, NY: Oxford University Press, 1992.

Durrett, Deanne. Organ Transplants. San Diego, CA: Lucent Books, 1993.

Garella, S., M.D., and Mattern, W. D., M.D. Kidney Disease: A Guide
for Patients and their Families. Rockville, MD: The American Kidney
Fund Public Information Series, 1987.

Kidney Transplant Services Manual. Richmond, VA: Virginia Transplant Center at Henrico Doctor’s Hospital, 1985.

Living-Related Donor Transplantation Manual. Wichita, KS: St. Francis Regional Medical Center, 1983.

Living-Related Kidney Donation Manual. Los Angeles, CA: Cedars-Sinai Medical Center, 1987.

Moriss, P. J. Kidney Transplantation: Principles and Practice. Philadelphia, PA: W. B. Saunders Co., 1984.

Russell, S., and Jacob, R. G. (1993). "Living-Related Organ
Donation: The Donor’s Dilemma." Patient Education and Counseling, 21
(1-2), 89-99.

Sankari, B. R.,Wyner, L. M., and Streem, S. B. (1994).
"Living-Unrelated Donor Renal Transplantation." Urologic Clinics of
North America, 21 (2), 293-8.

Terasaki, P. I., and Cecka, J. M., eds. Clinical Transplants 1997. Los Angeles, CA: UCLA Tissue Typing Laboratory, 1998.

Tokunaga, Y., Tanaka, K., Fujita, S., et. al. (1993).
"Living-Related Liver Transplantation across ABO Blood Groups with
FK506 and OKT3." Transplant International, 6 (6), 313-8.