Kidney Donation

Kidney donations may come from a recently deceased or living donor. There are two kinds of living kidney donations:

• Living related. A living related kidney donation comes from a biological (blood-related) relative, such as a parent or sibling.
• Living unrelated. A living unrelated kidney donation comes from a friend or another person who doesn’t share a blood relation with the recipient.

Other types of kidney donation include:

• Directed kidney donation. In a directed kidney donation, you choose (direct) who receives your kidney.
• Paired kidney exchange. A paired kidney exchange requires two living donors and two recipients. All organ transplants work best when the donor and recipient have the same blood and tissue types. But if the donor and recipient don’t share the same blood and tissue types (aren’t compatible), the donor can give their kidney to someone else who is a match. In return, a family member or friend of the recipient donates a kidney to a family member or friend of the donor. A paired kidney exchange helps noncompatible donors find and pair with compatible donors using a nationwide kidney registry database (National Kidney Registry).
• Nondirected or altruistic kidney donation. In a nondirected or altruistic kidney donation, the donor doesn’t know the recipient. They unselfishly donate a kidney because they know it’ll help another person.

You must meet several conditions to be a living kidney donor, including:

• Age. You must be at least 18 years old to donate a kidney. People under 18 aren’t adults and can’t give informed consent to donate a kidney. There isn’t an age limit for donating a kidney. People in their 90s have successfully donated a kidney.
• Physical examination. A healthcare provider will evaluate your physical health to ensure you’re capable of donating a kidney. A physical exam may include checking your overall health, medical history, biological family health history (including whether you have any biological family history of kidney disease), which prescription and nonprescription medications you’re taking, an assessment of your kidneys and other organ systems and various tests. Pregnant women can’t donate a kidney. You should have a body mass index (BMI) less than 35 and you shouldn’t smoke, vape or use other forms of tobacco. The goal of this health evaluation is to ensure you’re fit to donate.
• Psychological evaluation. A group of healthcare providers will evaluate you to ensure you’re physically and mentally able to donate a kidney. They’ll discuss potential causes of stress that may arise for you and your support system after a kidney donation, including recovery setbacks. Your evaluation usually includes psychiatrists and social workers. It may also include living donor advocates and bioethics professionals. A living donor advocate helps you understand what the procedure and recovery entails and ensures no one’s pressuring you to consent to the donation. A bioethics professional makes sure your personal beliefs and freedoms with regard to your health are respected.

In the United States, you can register to be a kidney donor through Donate Life America. In many states, you can also register through your local motor vehicle department.

A healthcare team may order the following tests before you can donate a kidney:

• Blood tests.
• Antibody tests.
• Age-appropriate cancer screenings, including a colonoscopy. Females may get a mammogram and Pap smear.
• Imaging tests, including X-rays and CT scans (computed tomography scans).
• Tests to determine your heart’s health, including an electrocardiogram (EKG), exercise stress test and echocardiogram.
• A urinalysis (urine test) to make sure your kidneys are healthy.
• A 24-hour blood pressure monitor.
• A pregnancy test. Pregnant women can’t donate a kidney.

How hard is it to find a kidney donor match?

Most people wait an average of three to five years on a kidney transplant list. But you may wait longer. A kidney donor match is most likely to occur between biological relatives. A match between a parent and child is at least a 50% chance. Biological siblings have a range of compatibility. Some are a perfect match, while others aren’t compatible at all.

A kidney donation care team typically consists of:

• A urologist or a transplant surgeon.
• An anesthesiologist.

The anesthesiologist will sedate you with general anesthesia. You’ll be asleep, won’t move and won’t feel any pain during the procedure. The anesthesiologist will usually review your health records before surgery to ensure you won’t have any problems with anesthesia. After you’re asleep, a provider will insert a Foley catheter to drain any pee from your urinary bladder. The catheter will remain in place during surgery and for 24 hours after surgery to monitor your urine output.

A radical nephrectomy is the name of the procedure to remove your entire kidney. The urologist typically removes a kidney. They usually use a minimally invasive laparoscopic approach. A laparoscope is a thin, metal surgical tool with a light and camera at the end. During a laparoscopic radical nephrectomy, the surgeon will:

1. Use a sharp surgical knife (scalpel) to make three to five small cuts (incisions) in your side. The incisions are usually less than an inch (2.5 cm) each.
2. Insert a laparoscope into an incision. The laparoscope shows video on a monitor near the operating table.
3. Using the monitor as a guide, insert tiny instruments through an incision and remove the kidney.
4. Close the incisions with dissolvable stitches or staples.

In some cases, the urologist may need to use an open approach to perform a radical nephrectomy. During an open radical nephrectomy, the surgeon will make one single incision of about 8 to 12 inches (20 to 30 cm) in your side. With a larger incision, the surgeon has a better view and more access to the surrounding access. Less than 5% of all nephrectomies use an open approach.

After removing your kidney, your care team will transport it to the kidney recipient. The kidney recipient is usually in a nearby operating room in the same hospital. Another surgical team will operate on the recipient and complete the transplant.

A kidney donation surgery usually takes two to three hours.

A kidney donation surgery usually takes two to three hours.

After kidney donation surgery, the care team will:

• Cover your surgery site with bandages to reduce bleeding.
• Stop putting anesthesia into your body. You’ll wake up after a few minutes, but you’ll likely feel groggy.
• Move you to a recovery room and monitor your overall health and recovery from surgery.
• Manage your pain and ensure you’re getting IV fluids until you’re fully awake and can drink safely. They’ll slowly introduce you to food as you can tolerate it. They’ll also ask you to walk as early as possible. Walking helps your body recover faster after surgery.

Most people stay in the hospital for two to three days. You may feel pain, tenderness or itching in your incision site(s) for a few days. It’s also common to feel fatigue the first few weeks after a kidney donation.

Once the care team determines that you no longer require monitoring, they’ll let you go home (discharge you). You’ll need a family member or friend to drive you home. It’s a good idea to have someone help take care of you for at least a week after donating a kidney.

Schedule an appointment with the transplant surgeon and a doctor who specializes in treating kidney conditions (nephrologist) in the first week after discharge. You must schedule appointments with your transplant team for the first two years after your donation. Your appointments occur at six-month, 12-month and 24-month intervals. You must also schedule follow-up appointments with your primary care physician (PCP).