Donation Information

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donation & transplantation - about donation -> living donation

For all of you who have expressed a desire to know what it would take to help out Kajsa, I offer the following.  It is a long post.  But I figured it would be better to get it all out of the way now.  If any one has any more specific questions, please just let me know.

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

Recipient’s Blood Type Donor’s Blood Type
       O
A        A or O
B        B or O
AB        A,B, AB or O

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 bibliography

I have completely stolen this information from the United Network for Organ Sharing (UNOS)
which is under contract with the U.S. Department of Health and Human Services
(HHS) and the Health Resources and Services Administration (HRSA).
They
are committed to meeting 508 standards
and making this site accessible to all users. If you are using an
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this page, please contact Patient Services at (888) 894-6361.
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