How Do I Know If My Kidney Is A Match For The Recipient
The transplant team will check your blood type as well as the recipient blood type to see if they are compatible. A unique blood test also needs to be done which is called crossmatch.
It is possible that the recipient of the kidney has an allergy to the donated kidney so the recipient’s body may reject the donated kidney. Such allergy is due to some substances called antibodies which are present in the recipient’s blood. In order to make sure that the recipient does NOT have those antibodies against your kidney tissue, the crossmatch test is performed. Briefly, a sample of your blood is combined with a sample of the recipient’s blood. If the recipient has antibodies to the donor, this will cause a “positive” reactivity during the crossmatch test. This may mean your recipient is incompatible to you. In the case that you and your recipient are not compatible, you may participate in UCLA’s Kidney Exchange Program. This program allows the recipient and donor to enter a paired exchange registry, where the donor will donate to another recipient that is matched, and the recipient will recieve a matched kidney from a compatible donor in return.
Living Donor Kidney Transplants
Incompatible Living Donor Transplant | Paired Donor Exchange | Next Steps
The first successful live donor kidney transplant was performed in 1954. The donor and recipient were identical twins. Since then, our understanding of donor compatibility and the development of immunosuppressant medications have greatly advanced living donor procedures. Today, approximately 75% of people who receive a kidney transplant from a living donor maintain their kidney function for 10 to 20 years.
Living donor programs allow a relative or a compatible unrelated donor to donate a kidney. Siblings have a 25% chance of being an “exact match” for a living donor and a 50% chance of being a “half-match.” Donor compatibility is established through blood tests that look for matching blood types and antigens. The overall health of the potential donor is also of critical importance.
Kidneys from perfectly matched sibling donors on average can function for over 35 years. Live donor procedures of all types, however, offer better outcomes than deceased donor procedures:
- Live donor recipients spend less time waiting for a donor organ. The wait for a deceased donor kidney in New York averages five to seven years.
- Immediately upon transplantation, 97% of live donor kidneys are fully functional, versus 50-60% of deceased donor kidneys.
- Live donor recipients face less risk of organ rejection.
Transplant Procedure
Hendrik: I Felt Grateful I Could Have An Impact
Hendrik Gerrits remembers sobbing on the subway when he learned about living organ donation.
It was late fall in 2016, and he was on his regular commute from the Museum of Arts and Design in Manhattan, where he is the deputy director of exhibitions and operations, to his home in Ridgewood, Queens.
As he sat on the L train listening to the podcast Risk!, he found himself struck by the story of a woman who became a nondirected kidney donor to help one stranger. She ended up jump-starting a transplant chain that saved the lives of 28 recipients.
I just remember bawling, recalls Hendrik. I was overwhelmed by the power of the story and I immediately thought, I could do that.
Hendrik Gerrits
As a long-distance runner and avid rock climber, Hendrik was a prime candidate to be a living kidney donor. Im fortunate to say Im healthy, he says. And I immediately felt grateful that there was something I could do in the world that would have such a huge impact.
The need for kidney donors far outpaces the demand for any other organ in the U.S. Currently, almost 109,000 people are on the national organ transplant list of those, roughly 92,000 are waiting for a kidney, according to the Organ Procurement and Transplantation Network. In 2019, about 29% of kidney transplants performed in the U.S. stemmed from a living donor, and less than 2% of kidney transplants came from altruistic donors .
Hendrik only sees how his life will change for the better.
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Blood Type Compatibility For Kidney Donation
There are four basic blood typesO, A, B and ABand the blood types of the donor and recipient must be compatible in order for a transplant to be successful. The compatible blood types for kidney donation follow the same rules as blood type compatibility for blood transfusions:
| Donors with blood type: | Are blood type compatible with recipients with blood type: |
|---|---|
| O | |
| AB |
Who Is The Best Match
The UNOS computer system considers these things about the donor and the person who gets the kidney :
- The age of the recipient
- Blood type of the donor and recipient
- The size of the donor kidney compared to the size of the recipient’s body
- How urgent it is for the recipient to get a kidney
- How long the recipient has been waiting for a kidney
- The distance of the recipient from the donor kidney
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Testing For A Match For Kidney Donation
Making sure that the kidney will be compatible with the recipients body is essential. There are many steps for screening between the donor and recipient to ensure a successful transplant. An experienced transplant care team will assist you and your recipient through this process.
Dont let concerns about incompatibility stop these conversations. You may not be compatible with your intended recipient, but you may be a fit for a paired match through which you can donate to a stranger, and that strangers intended donors kidney would be a match for your intended recipient. Your healthcare team will help you explore this.
- How do I know if I can donate a kidney?
To be a donor, you must be at least 18 years old, in overall good health, and with a body mass index under 30. The following criteria will exclude you from donation:
- Uncontrolled, elevated blood pressure
- History of pulmonary embolism or blood clots
- Bleeding disorders
Living Kidney Donation Surgery & Recovery
The donor surgery will be conducted under general anesthesia. The surgeon will place three small holes in the donorâs abdomen for a camera and surgical instruments, and one incision will be made to remove the kidney. Once the kidney is removed, the abdomen will be closed.
A small IV tube and a urinary tube will be in place for 1-2 days after surgery, and most donors remain in the hospital for 2-3 days. The care team works closely with the donor to manage and minimize post-operative pain.
Feeling more tired than usual for a few months after the surgery is common. Depending on any physical requirements of the job, most donors are able to return to work in 2-6 weeks. Donors must avoid any heavy lifting or strenuous activities for 8 weeks. For these reasons, support from family or friends is necessary for a successful recovery after living kidney donation.
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Live Donor Kidney Transplant Requirements
The specialists at Lahey Hospital & Medical Center can help you understand the requirements for live donor kidney transplantation.
To become a live donor, you must:
- Be over age 18
- Be willing to commit to the pre-donation evaluation process, surgery and the burden of recovery
- Be in good health and psychological condition
- Have a compatible blood type
- Have normal kidney function
In certain situations, you must meet additional requirements to become a live donor. You may have to do this if you:
- Are an incompatible cross-match
- Have a body mass index greater than 30
- Have high blood pressure
- Have a history of kidney stones
- Have an incompatible blood type
You cannot be a live donor if you:
- Are under age 18
- Have heart disease, diabetes or cancer
- Have chronic kidney problems
Living Donor Kidney Transplantation
Living donor kidney transplants are the best option for many patients for several reasons:
- Better long-term results
- No need to wait on the transplant waiting list for a kidney from a deceased donor
- Surgery can be planned at a time convenient for both the donor and recipient
- Lower risks of complications or rejection, and better early function of the transplanted kidney
Any healthy person can donate a kidney. When a living person donates a kidney the remaining kidney will enlarge slightly as it takes over the work of two kidneys. Donors do not need medication or special diets once they recover from surgery. As with any major operation, there is a chance of complications, but kidney donors have the same life expectancy, general health, and kidney function as most other people. The kidney loss does not interfere with a woman’s ability to have children.
Potential Barriers to Living Donation
- Age < 18 years unless an emancipated minor
- Uncontrollable hypertension
- Bilateral or recurrent nephrolithiasis
- Chronic Kidney Disease stage 3 or less
- Proteinuria > 300 mg/d excluding postural proteinuria
- HIV infection
- Shorter recovery time in the hospital
- Quicker return to normal activities
- Very low complication rate
The operation takes 2-3 hours. Recovery time in the hospital is typically 1-3 days. Donors often are able to return to work as soon as 2-3 weeks after the procedure.
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What Is The National Transplant Waiting List
The national transplant waiting list is a list of all the people in the United States who need an organ transplant and want to be matched with an organ from a deceased donor . The list is managed by the United Network for Organ Sharing , a private, nonprofit agency that works under contract with the federal government.
There are more than 106,000 people on the national transplant waiting list with 92,000 waiting for a kidney.
Hepatitis B Core Antibody Positive Donors
UF Health allows donations from patients who have had hepatitis B in the past but have tested negative for more serious hepatitis B surface antigen and viral proteins . These organs are only used in recipients who have antibody against hepatitis B.
Testing will be done to check if the donor has hepatitis virus in the blood, which is rare. If the recipient were to test positive for the virus, the anti-viral treatment would continue for a longer period of time.
Many factors used to match organs with patients in need are the same for all organs:
The first step
Before an organ is allocated, all transplant candidates on the waiting list that are incompatible with the donor because of blood type, height, weight and other medical factors are automatically screened from any potential matches. Then, UNOS computer system determines the order that the other candidates will receive offers.
Geography plays a part
Organ transplants are most successful when preservation and transport time are short. The matching system considers the distance between donor and transplant hospitals. In general, local candidates get organ offers before those listed at more distant hospitals.
The right-sized organ
Proper organ size is critical to a successful transplant, which means that children often respond better to child-sized organs. Although pediatric candidates have their own unique scoring system, children essentially are first in line for other childrens organs.
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Where Does Unos Look For A Match
The United States is divided into 11 regions and 58 local Organ Procurement Organizations , which are areas that UNOS uses to find matches for a transplant. For example, when a donor kidney becomes available:
How Do I Get On The Waiting List For A Kidney Transplant
To get on the national waiting list for a kidney transplant:
If you pass the evaluation and the transplant team decides you are healthy enough to have transplant surgery, you will be added to the national waiting list.
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What Processes Do You Have To Go Through To Be A Living Kidney Donor
The decision to donate a kidney is just the first step on a journey that may eventually lead to a kidney transplant operation.
Everyone who wants to donate is asked to go through a number of tests and examinations. These checks are designed to ensure that you are healthy enough to give a kidney, that your kidneys are currently working well and that you are physically and emotionally prepared for the donation. Your safety and well-being is always the priority for the medical teams and you should be aware from the beginning that there may be a number of reasons why you might not be suitable to donate. The tests and checks can take several months , which include medical, surgical and psychological assessments.
In England, Wales and Northern Ireland, no minimum age limit is specified under the Human Tissue Act 2004, but most donors will be over the age of 18 years. In Scotland, the law specifies that the donor has to be over 16. There is no upper age limit, and there have been donors in their 70s and 80s.
Throughout the process, anonymity and confidentiality are necessary, and most altruistic donors never meet the person who receives their donated kidney. It is, however, possible for both parties to contact each other after the transplantation, but only if both parties are willing.
Tests and examinations before the operation
General physical health
Psychological health
Urine tests
Blood tests
Glucose tolerance test
Blood pressure monitoring
Kidney tests
ECG
Chest X-ray
Why Become A Living Donor
Living donors help save the lives of patients experiencing kidney failure. Living donors reduce or eliminate the need for patients with kidney failure to start dialysis or spend years waiting for a deceased donor transplant.
A kidney from a living donor can function better and last longer because the donor is healthy. It also functions better because the kidney is transplanted into the recipient shortly after being removed from the donor. Because of these factors, patients receiving a kidney from a living donor often have better outcomes than patients receiving a kidney from a deceased donor. This advantage continues long term.
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All Of Us Are Combined For The Rest Of Our Lives
Kidney swaps allow recipients to receive better-matched kidneys and help other kidney transplant recipients who otherwise would continue to wait for a matched donor.
In November 2018, Luis Villalobos was prepared to give his father, Pedro, a kidney but they werent a match.
They gave us hope when they said, We got Option B, which is we could swap, said Luis Villalobos.
At the same time, Tom Sweet was set to donate a kidney to his old high school buddy, Chris Moore. It turned, Luis was a match for Chris, and Tom was a match for Pedro. Dr. Enrico Benedetti, head of the Department of Surgery at UI Health, asked the pairs about a kidney swap.
I said, As long as gets a kidney I dont care how many people we do it with! Tom said.
The pairs all had successful transplants and were home for Thanksgiving!
We got all of us are combined for the rest of our lives, said Chris.
What Blood Types Match
Blood typing is the first blood test that will determine if your blood is compatible with the potential donors blood. If the donors blood type works with your blood type, the donor will take the next blood test .
Kidney donors must have a compatible blood type with the recipient. The Rh factor of blood does not matter in a transplant.
The following blood types are compatible:
- Donors with blood type A can donate to recipients with blood types A and AB
- Donors with blood type B can donate to recipients with blood types B and AB
- Donors with blood type AB can donate to recipients with blood type AB only
- Donors with blood type O can donate to recipients with blood types A, B, AB and O
- Recipients with blood type O can receive a kidney from blood type O only
- Recipients with blood type A can receive a kidney from blood types A and O
- Recipients with blood type B can receive a kidney from blood types B and O
- Recipients with blood type AB can receive a kidney from blood types A, B, AB and O
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Positive Crossmatch And Sensitized Patients
About 30% of transplant patients are sensitized. This means that they have harmful antibodies which will attack foreign tissue, such as the transplanted organ from a living donor. These antibodies develop through a previous exposure to foreign tissue, such as through pregnancy, previous transplants, or blood transfusions. Sensitized patients may wait three to four times longer than unsensitized patients for a compatible deceased donor kidney.To test a recipient for these antibodies, a sample of their blood is mixed with a sample of the potential donors blood. This test is called a crossmatch, and shows how a recipients antibodies react with the potential donors. Test results can be either positive or negative. It may seem confusing at first, but a positive crossmatch means that a donor and recipient are not compatible.
A positive crossmatch results in the recipients antibodies attacking the donors which means the kidney is not suitable for transplant.
A negative crossmatch means that the recipients antibodies do not attack the donors which means the kidney is suitable for transplant.