Living kidney donation occurs when a living person decides to donate one of their kidneys to someone in need of a transplant. Donating a kidney is the most frequent type of living organ donation and living kidney transplants have the highest success rate of all transplant procedures.
Living donor kidney transplants have several advantages over cadaveric transplants:
- Eliminates need for placement on wait list
- Better short and long term survival rates
- Recipient knows the donor and his/her lifestyle and medical history
- Shortens the wait time for others on the wait list
- Transplant surgery can be scheduled at donor’s and recipient’s convenience
- Fewer recipients require temporary dialysis after a living donor transplant compared to a deceased donor transplant
Living Related Donor Transplant
A living related donor is a healthy blood relative of the person receiving the transplant. Living related donors are commonly a parent, brother, sister, aunt, uncle, or an adult child, niece or nephew.
A kidney from a relative will be a better match for the recipient. There is less chance of rejection. A kidney from a relative also has an overall improved graft survival rate.
Living Unrelated Donor Transplant
A living unrelated donor is a healthy donor that is not a blood relative to the person receiving the transplant. Living unrelated donors are commonly friends, coworkers, or a spouse. They usually are emotionally connected to the transplant recipient.
Reducing Wait Time
The Swedish Organ Transplant program also offers two living donor programs that are decreasing wait list time for transplant recipients.
Over 80,000 persons in the United States are awaiting kidney transplantation, including about 1,400 in Washington State. Recipients who have the opportunity to receive a living donor kidney can be transplanted sooner and have better long term outcomes.
In response to an increasing interest in living organ donation in our community, the Organ Transplant Program at Swedish created the Swedish Benevolent Community Donor Program. This Program opens up a whole new avenue for the life-saving work of transplant medicine.
A benevolent donor is an altruistic individual from the community who volunteers to anonymously give a kidney to a patient on the national waiting list in need of a life saving kidney transplant The BCD program allows altruistic individuals to donate a kidney without having a specific recipient in mind.
The transplant team at Swedish spent more than two years actively developing the BCD program which opened in July 2002. Since then almost 30 people in need of a kidney transplant have received this incredible gift through the Swedish Organ Transplant Benevolent Community Donor Program.
The Swedish Benevolent Community Donor Program is the first of its type on the West Coast and one of the few organized programs in the country. Although more than 50 national transplant centers claim to have experience with or are prepared to perform this type of donation, only a few have recognized the need to formalize the process into an active program.
The Swedish’s Benevolent Community Donor Program does not solicit organ donors. Instead, it provides a potential means for accepting the gift of organ donation offered by people who simply want to help. Many of these potential donors share similarities – they are long-time and regular blood donors or have been on the bone-marrow donor list for many years. Many have known someone who died waiting for a transplant. Not surprisingly, persons who wish to be considered as Benevolent Community Donors universally want to do something extraordinary to help those in need. They want to make a difference.
Because of the program’s emphasis on safety (for both the donor and the recipient), potential donors undergo a stringent screening process, including personal interviews, and extensive review of their medical and psychological records. Donors who pass the screening process then meet with transplant physicians and undergo a very thorough medical and psychological evaluation prior to being reviewed for acceptance by the Living Donor Medical Review Board of the Swedish Organ Transplant Program.
For a variety of reasons, only one of 10 prospective donors meets all of the requirements to become a donor. However, there remains a huge need for assistance in every aspect of organ donor services from public education to volunteer services. Every person who asks to be considered as a Benevolent Community Donor is provided with information on how they can continue to help support organ donation in a variety of ways.
For More Information
To learn more about Swedish’s Benevolent Community Donor Program, call 1-800-99ORGAN (1-800-996-7426).
Kidney desensitization is a process that improves the chances that a donated kidney will not be rejected by the recipient’s body.
White blood cells produce proteins called antibodies that help the body fight infection. The production of antibodies is the body’s first line of defense in the immune response. Antibodies work hard to protect us and keep us healthy.
These same antibodies that protect us from infection may affect how well a kidney transplant functions after the surgery In some cases, a transplant recipient’s body will react to the donated kidney as a foreign tissue and despite the usual immunosuppressive medications,reject the new kidney. Not all recipients produce these types of antibodies. People who produce these antibodies typically develop them through a previous exposure to foreign tissue, such as a prior transplant, blood transfusion, or pregnancy.
A cross-match test is performed between all donors and recipients to ensure that the recipient does not have antibodies in their blood against the donor tissue. These antibodies can cause rejection of the kidney being donated.
A negative result from a cross-match test indicates that the recipient does not have antibodies that would reject the donated kidney the transplant can proceed safely.
A positive result from a cross-match test indicates that the recipient has antibodies that would reject the donated kidney almost immediately and the transplant cannot proceed.
A recipient with a positive cross-match to their intended donor can either wait for or find another donor who has a negative cross-match, participate in the paired kidney exchange program, or undergo the desensitization process.
Your Swedish transplant team will help you weigh your options and help you determine the choice that best fits your situation.
Sometimes in carefully selected recipients, the antibodies that cause a recipient to have a positive cross match with their intended donor can be successfully removed. This is called desensitization. The desensitization process involves a plasma exchange that removes the antibodies against the donor tissue. The number of treatments depends on the amount and type of antibodies a recipient has in their blood. Several treatments are typically required prior to a transplant. Patients are also given anti-rejection medications during the desensitization process to help prevent reformation of the harmful antibodies. These are the same anti-rejection medications used after the transplant.
Currently, only patients with a living donor take part in the desensitization process. The desensitization of the recipient only lasts for a limited amount of time. The time to transplant has to be controlled very closely and this can only be done if a recipient has a living donor already identified. There is no way to anticipate when a deceased donor will become available for a patient on the deceased donor waiting list. Therefore this type of desensitization is not available to patients waiting for a deceased donor kidney.
The transplant team and your transplant coordinator can give you more information on this process and determine whether it is an option for you.
A deceased donor transplant is a transplant where the donated kidney comes from a person who has died.
For various reasons, many people do not have the opportunity for a living donor. Organs donated from deceased donors are used for about 40 percent of our kidney transplant recipients. Results for these recipients are excellent, but the waiting time to receive a deceased donor transplant may be months to many years.
There are several classifications of kidneys that come from deceased donors:
- Standard criteria donor (SCD)
- Extended criteria donor kidneys (ECD)
- Donation after cardiac death donors (DCD)
- High social risk donors
Standard Deceased Donor Transplant
A standard criteria donor kidney is a kidney that comes from a deceased donor under the age of 60 who is on life support and is declared brain dead. Brain death is defined as the irreversible loss of function of the brain while the heart is still beating keeping vital organs alive and available for transplantation.
Extended Deceased Donor Transplant
An extended criteria deceased donor kidney is a kidney that comes from a deceased donor who has the following risk factors:
- Age: the deceased donor is over age 60
- Age plus risk factors: the deceased donor is over 50 with 2 or more of the following risk factors:
- Donor has history of high blood pressure
- Donor died from stroke
- Donor has some kidney damage. Donor’s serum creatinine level is higher than normal
- Donation after Cardiac Death
Donation after Cardiac Death refers to a donor whose heart has stopped beating. These donors are not brain dead, but the severity of their brain injury has led physicians and families to decide to remove life support and donate organs after their heart has stopped beating. After the patient’s heart stops and he or she is declared dead, the donor is taken to the operating room and the organs are removed.
High Social Risk Donors
A high social risk donors refers to a donor whose personal behaviors before death have been identified by the Centers for Disease Control (CDC) to place them at higher risk for transmission of infectious disease. Such behaviors include current use of recreational drugs, prostitution, or recent incarceration. These high-risk behaviors increase the possibility of transmitting hepatitis, HIV and other infections to the recipient. Because the elapsed time between the risky behavior and death is very short, conventional testing may not detect the presence of an infection.
Using the latest technology, called NAT testing, we can now make this detection process much faster, allowing use of kidneys from high-risk behaviour donors in a much safer way.
Acceptance of kidneys from high social risk donors is the decision of the recipient. We will ask early in your evaluation if you want to be considered for one of these kidneys, which may shorten your waiting list time. If you are offered a kidney from a high social risk donor, the transplant team will explain the risks to you so that you can make a decision on whether to accept the kidney offer. If you choose not to accept a high social risk donor, this will not affect your care with the Transplant Program nor will it change your position on the national wait list.
Helping you Weigh Options and Risks
Non-standard criteria donor kidneys carry increased risks of early and late loss of the kidney. However, data shows that your survival rate is better with a non-standard criteria kidney than waiting on dialysis. For some patients a non-standard criteria kidney is a good option.
If a non-standard criteria donor kidney becomes available and is a match for you, your Swedish physicians, surgeons, and support staff will review with you specific aspects of your medical situation, the donor and the donor kidney to help you make a decision about whether or not this kidney is for you.
Learn more about extended criteria donor kidney from the American Society of Transplantation: Facts About Kidney Transplantation: Deceased Donor Kidney Selection and "Expanded" Criteria Donor Kidneys.
You may have a friend or blood relative willing to donate a kidney to you, but they are blood type or tissue type incompatible with you. Another transplant recipient may be in a similar situation with someone willing to donate a kidney to them but the kidney is incompatible.
In these situations a paired kidney exchange allows incompatible donors to help their loved ones or friends receive a live donor kidney by matching one incompatible donor/recipient pair with another incompatible pair. The donors then exchange a kidney with a recipient of the other pair with whom they are compatible.
The Paired Kidney Exchange Program allows living donors and their intended recipient to proceed with kidney transplantation. The Swedish Organ Transplant Program performed its first paired exchange in 2006. On average at least one paired exchange is performed every year at Swedish. To increase the chance that compatible recipient/donor pairs will be found, the Swedish Transplant Program has partners with other transplant centers in the state, joined the Ohio-based Alliance for Paired Donation, and participates in the UNOS Paired Donation Pilot.
Expanding the Opportunities for Living Donation for our Patients
Both the Paired Kidney Donation Program and the Benevolent Community Donor Program are very active at the Swedish Organ Transplant Program. In June 2010, two living, unrelated kidney transplants took place completing a three way kidney transplant donor chain. The first transplant was initiated through the Benevolent Community Donor Program. An altruistic donor gave their kidney to a recipient in the Paired Kidney Donation Program. That recipient’s incompatible donor then gave their kidney to a recipient on the deceased donor waiting list.
If you would like more information about the Paired Kidney Donation opportunities as Swedish, please call 1-800-99ORGAN (1-800-996-7426).
Swedish’s kidney transplant program is the only transplant center in Seattle that does not have a body mass index (BMI) cutoff for kidney transplant recipients. The BMI is calculated using an individual’s height and weight measurements.
Concern that obese (BMI of 30-40) and morbidly obese (BMI greater than 40) kidney transplant recipients have worse outcomes than non- obese recipients leads many transplant centers to deny them the benefit of kidney transplantation. It is our practice to evaluate obese and morbidly obese transplant candidates for transplantation under the same criteria used for non-obese candidates.
Potential kidney transplant recipients at Swedish are evaluated on a case by case basis and selection is the result of a coordinated process which looks at the whole patient. In the case of obese and morbidly obese persons, the kidney transplant team works with physicians and bariatric surgeons from Swedish’s Weight Loss Services team to arrive at solutions that best fit our patient’s needs and ensure the best possible outcome.
Swedish Transplant surgeons compared kidney transplant results of morbidly obese and non obese patients between 1995 and 2000 and published their findings in the American Journal of Surgery in 2004 (American Journal of Surgery – Volume 187, Issue 5, May 2004). They found that morbidly obese transplant recipients had similar survival rates as non obese recipients. While morbidly obese transplant recipients did have more complications and longer hospital stays, Swedish Transplant surgeons concluded that those reasons are not sufficient to deny morbidly obese persons the survival and quality-of-live advantages of kidney transplantation.
Obese and morbidly obese kidney transplant recipients are more likely to experience the following compared to non obese kidney transplant recipients:
- Longer post-transplant hospital stay (6-8 days vs. 5-6 days)
- Greater occurrence of hospital readmissions within first six months after transplant
- Increase risk of incisional wound infection