The most living donor procedures performed in the world

Living Donation--Questions to Consider

Why use a living organ donor?

In most situations, the greatest chance of success in transplantation is using an organ from a living donor.

What are the advantages of transplanting from living donors?

· The organ recipient experiences fewer rejection episodes and tends to keep the organ longer.

· The organ is transferred under the most desirable conditions—it is put directly into the recipient in an operating room next door to that of the donor, so the organ is only without a blood supply for a short period of time (An organ taken from a deceased donor has to be cooled and kept in preservation solution until it is transported to the transplanting hospital).

· The organ usually begins to work immediately. (For example, a deceased-donor kidney might not work right away and dialysis may be necessary for a few weeks following the transplant.)

· The transplant can be done when the donor and the recipient are in the best possible physical and emotional state for surgery.

· It is rare for complications, such as bleeding or infection, to occur, although they can happen.

· The recipient does not need to wait for a deceased-donor organ to become available, which often takes more than three years.

Who can donate an organ?

An exact match living donor is an identical twin, and generally the next most suitable donor is a sibling. The next most likely compatible donors are parents, other relatives (half-brothers, half-sisters, children, grandparents, nieces, nephews, cousins, aunts or uncles) and finally, unrelated donors. The minimum age for a donor is 18.

(Note: The National Organ Transplant Act Public Law 98—507 prohibits the sale of human organs. Violators will be fined a maximum of $50,000 and/or imprisoned for a maximum of five years.)

Why is a family member the most suitable?

An organ from a family member is closest to the recipient genetically, reducing the chance of rejection. Recipients still must take anti-rejection drugs for the rest of their lives following transplantation.

What if the family members cannot donate?

If no related living donor is readily available, a spouse, an in-law, friend, or a nondirected donor may be considered. Strict procedures are followed to evaluate these potential donors and they are asked why they want to donate a kidney. Evaluations and medical workups can be done at the University of Minnesota Medical Center. An acceptable donor will be in good physical and mental health, over 18 years of age, and free from the following:

• high blood pressure/hypertension
• HIV infections
• known viral infections (Hepatitis B or C, Lyme's disease, etc.)
• active alcoholism with frequent and heavy alcohol intake
• current psychiatric illness or treatment by a mental health professional
• history of malignancy/cancer (exception: skin cancer)
• heart and lung disease requiring medications
• diabetes mellitus
• obesity

What will happen if I decide to become a living donor?

A potential donor must call the transplant office to volunteer. This confidential initial phone interview begins the donation process. We then send out a pack of informational material. If you are still interested, preliminary blood work can be arranged. If you are compatible with the recipient and want to proceed, a thorough medical evaluation is arranged.

No person is ever locked into donating an organ – a potential donor may back out at any point in the process, for any reason.

How do I find out if I am a compatible donor?

Different organ transplants use different compatibility measures. Lung donation, however, compares the size of the donors to the recipients. Kidney and liver are the most common types of transplants. Your donor coordinator will send you a packet outlining your specific requirements.

Determine your blood type - Have a blood test completed by a blood bank or a hospital and send a copy of the report to The Transplant Center. To learn whether your blood type is compatible with the recipient’s blood type, refer to the following chart:

Call The Transplant Center - Tell us that you are considering being a donor. The staff will review your health status and answer any questions you may have. If you have a medical condition or are taking any medications, do not assume this will keep you from being a donor. Because different organ transplants use different compatibility measures, talk to The Transplant Center to find out if you need to do cross matching and/or tissue typing.

Have your blood crossmatched - If you have no disqualifying medical problems and are a compatible blood type, the next step is a cross match test. In this blood test, your blood cells and the recipient’s blood cells are mixed to see whether or not they react with each other. This will indicate whether or not the recipient's body will accept your organ. If the recipient's body can accept your organ, the result will be reported as “NEGATIVE,” meaning there was no reaction between your cells and the recipient’s cells. A “POSITIVE” result indicates that there was a reaction between your cells and the recipient’s cells, and it is likely that the recipient's body would reject your organ. You might not be given further consideration as a potential donor.

Have your tissue typed- (if you are a sibling of the recipient) - This blood test identifies the specific antigens (cell markers) you inherited from your parents. There is a 25 percent chance that siblings will inherit the same antigens, meaning that a brother or sister could be a “perfect match” to the recipient.

It is helpful to the recipient to get an organ from a “perfect match” donor, since those recipients have fewer problems with rejection. An organ from a living donor other than a sibling will NOT be a perfect match. It is still acceptable, no matter how many antigens match. The donor's tissue will be typed at the time of the transplant, if that test was not conducted previously.

The Transplant Center will give you instructions for the cross match and tissue typing tests. You may either: 1) have your blood drawn by your primary physician and then mailed to the Fairview-University Immunology Laboratory; or, 2) have it drawn at the University of Minnesota Medical Center. Your cross match results will be available three days after the Immunology Laboratory receives your blood sample. Tissue typing results will be available two weeks after they are received. Please call The Transplant Center for the results. Only you will be given these results.

What if there are two possible donors?

If there more than one possible donor matches and there is no advantage to using either one, potential donors should decide among themselves who will donate. The Transplant Center staff can help you make the decision, but we cannot make the decision. We are happy to provide information about the donor workup and follow-up care, and will make certain that potential donors consult with the most appropriate people to assist with the decision-making process.

The person who decides to donate should call The Transplant Center, so the workup can be arranged.

What happens once compatibility is determined?

To qualify as the donor, you must prove that you are in excellent health. You may be asked to provide your routine medical care records. An example of this would be the results of a woman’s routine Pap test, pelvic examination, and mammogram. You must have a workup, which will include many tests to assess your health. This can be done without being admitted as a patient at University of Minnesota Medical Center, and generally takes one and a half days. It involves providing your health history, a physical exam, blood and urine tests, a chest x-ray and an electrocardiogram (EKG). Your blood will be tested for hepatitis and the virus that causes AIDS. If you are unable to come to the University of Minnesota Medical Center for the workup, the workup instructions (protocol) will be mailed to you to take to your primary physician.

To ensure that you will be an acceptable donor, the transplant donor team will review all tests. If any results are unclear, we will ask that additional testing be done.

If there is any question that donating your organ would be a risk for you, you will not be considered for donation.

What is recovery like for the donor?

The surgery for each organ is very different, and so the recovery times and follow-up schedules are different as well. Depending upon the organ you donate, you may be permitted to return to work as soon as three weeks or as many as six months after the transplant.

For example, we highly recommend that a doctor in Fairview-University's Transplant Center examine kidney donors approximately six weeks after discharge from the hospital. Liver donors have a more intensive recovery schedule with check-ups every three months for the first year. You may have your doctor conduct a follow-up examination. We encourage you to be checked by your personal physician one year after your surgery, even if you experience no medical complications. It is extremely important that you maintain a healthy lifestyle after you donate, a part of which should be regular checkups.

Once your incision heals, you should experience no difference in energy level, ability to work, life expectancy, susceptibility to illness, sexual function, or feeling well. Donation should not prevent you from being able to have children. Psychologically, you may feel even better about yourself after the transplant.