What If Me And My Donor Are Not A Match
If blood types are not compatible, the donor will not be able to donate directly to you. However, the donor may consider donating through a paired exchange program. Paired exchange programs allow you to get a kidney from another donor who is not a match for their intended recipient. Paired exchange involves two living donors and two recipients. If the recipient from one pair is compatible with the donor from the other pair, and vice versa the transplant center may arrange for a “swap”for two simultaneous transplants to take place. This allows two transplant candidates to receive organs and two donors to give organs though the original recipient/donor pairs were unable to do so with each other.
Figure 1:In paired exchange, an incompatible donor/ recipient pair are matched with another incompatible donor/recipient pair for a “swap”. Each donor gives a kidney to the other person’s intended recipient.
Both donors and candidates are carefully evaluated and tested medically and psychologically to assure that the benefits outweigh the risks. It is important for both surgeries to be scheduled for the same time in case either donor changes their mind at the time of surgery. Surgeries can take place at the same or different hospitals. It can be advantageous if the surgeries take place at the same hospital though this may mean extra costs of travel and housing for one couple.
Why Compatible Pairs Can Benefit From Using The Nkr
Paired exchangewhen a donor donates their kidney to another recipient in exchange for a compatible, or better-matched, kidney for their loved onewas originally created to overcome cases of donor-recipient incompatibility, when the donor could not give directly to the intended recipient.
However, compatible pairsdonor-recipient pairs where the donor can donate directly to the patientcan also greatly benefit from entering paired exchange.
Through paired exchange and the Kidney for Life initiativewhich utilizes the latest generation in DNA sequencing technology to assess the histologic match between patients and donorscompatible pairs can find excellent matches, and the recipient can potentially reduce their immuno-suppression dosage and have a transplanted kidney that lasts longer.
What Will Be Expected Of The Donor
The donor will be assigned a nurse coordinator who will be responsible for educating them through the donation process.; The coordinator will work only with the donor and cannot disclose any health information to their family or the recipient.; It is very important for donors to keep the recipient informed of the process as it moves along.;;
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How Are Donor/recipient Pairs Matched
For many years, matching potential donor/recipient pairs was managed through the local hospital, or through partnering with area hospitals. Recently, The Organ Procurement and Transplantation Network started a Kidney Paired Donation program that will find matching donor/recipient pairs throughout the United States.; Johns Hopkins experts anticipate that, each year, an additional 1,000 2,000 donations can be performed through this national program.
Recovering From The Transplant Surgery
- After the transplant surgery, you will recover in the hospital where you will be watched closely. You will usually spend several days recovering in the hospital.
- In some cases, you may start making your own urine right away. Sometimes, especially with deceased donor kidneys, this will take a bit of time. If your new kidney is not producing urine right away, you will need to stay on dialysis until this starts happening.
- Your transplant team will adjust your immunosuppressant medicines, and watch you closely for signs that your body is accepting the new kidney.
- Usually the transplant team will recommend that you get up and start slowly moving around one day after your surgery.
- Once you have recovered enough to safely go home, you will be released from the hospital and continue recovering at home.
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Questions And Answers About Antibodies And Sensitization With Kidney Transplantation
Q. What does sensitized mean?A. Approximately30 percent of patients who are waiting for a donor kidney are considered sensitized, which means they have exceptionally high antibody levels that react to foreign tissue. High antibody levels are harder to match for donor kidneys. People develop this type of antibody through a previous exposure to foreign tissue, such as a prior transplant, blood transfusion or pregnancy. In fact, each year only 6.5 percent of highly sensitized patients receive a transplant. Sensitized patients wait three to four times longer than unsensitized patients for a compatible deceased donor.
Q. How do I know that I am sensitized?A. Panel reactive antibody measures antihuman antibodies in the blood. The PRA score is expressed as a percentage, which can range from 0 to 99 percent, that represents the likelihood of your blood having an antibody against a particular donor. A PRA of 20 percent means you have antibodies to approximately 20 percent of the population. Having antibodies against foreign tissues makes it difficult to find a compatible living or deceased donor kidney.
Q. What are the options if my cross-match is positive?A. There are three options if you have a positive cross-match: wait for another donor who has a negative cross-match, participate in a donor exchange program or undergo the desensitization process.
How Does The Operation Work
If the surgery is a simple exchange between two donor/recipient pairs, the Johns Hopkins Comprehensive Transplant Center will typically remove the kidneys from the donors in the morning and transplant to the recipients in the afternoon. There may be times, however, when one transplant surgery may be scheduled a few weeks after the other. If multiple donor/recipient pairs are involved, the process may take several weeks.If other hospitals are involved, there is a chance that a donor may be asked to travel to their location. If this is the case, the donor will be assigned a coordinator, surgeon and nephrologist at this hospital. Most hospitals will accept a donors kidney that has been shipped. Research has shown the living donor kidneys can be stored in preservation fluid for up to eight hours and still work effectively.
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What Is The Criteria For Kidney Donor Matching
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.
Secondly, what disqualifies a kidney donor? These include having uncontrolled high blood pressure, diabetes, cancer, HIV, hepatitis, or acute infections. Having a serious mental health condition that requires treatment may also prevent you from being a donor.
Similarly, how is a kidney donor match determined?
There are three main blood tests that will determine if a patient and a potential donor are a kidney match. They are blood typing, tissue typing and cross-matching. What is Blood typing ? If the donor’s blood type works with your blood type, the donor will take the next blood test .
Are parents always a match for kidney donation?
A mother who has a biological child as a donor should always consider paired exchange because the mother may have donor specific antibodies against the child’s paternal antigens. A parent giving to a biological child is always a good HLA match but is sometimes a poor age match depending on the age of the parent.
During The Transplant Surgery
You will be placed on your back on the surgery table. You will be given anesthesia, a medicine to make you sleep only while the surgery is being done. The surgeon will make a cut on your abdomen, or belly area. Your new kidney will be put into your body in this area, and the donors ureter will be sewn to your bladder. Usually your own kidneys will not be removed. The surgeon will close the skin cut and you will be taken to the recovery room. This operation takes 2 to 4 hours.
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What Blood Types Match
Blood typing is the first blood test that will determine if your blood is compatible with the potential donor’s blood. If the donor’s 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
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.
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Prioritizing Patients For Transplantation
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.
How Long Does The Process Take
The donation process depends on how many tests are required of the donor and how quickly he or she is able to complete them.; The average donor work up may take six months or more for completion and may depend on test results, which may indicate additional evaluation is required.; A transplant date cannot be set until the donor has completed the entire work up and has been evaluated by the surgeon.; The transplant center does its best to accommodate the needs of the donor and recipient, but appointment times may be limited.;
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Does It Matter If Hla Numbers Are A Good Match Or Not
We prefer a good match, although this is;more important for deceased donor kidneys.;When a deceased donor kidney becomes;available, UK Transplant matches the six;numbers that the donor has with the best;match for all the potential recipients on the;on-call register.One way of thinking of this is that it is very;much like the National Lottery. That is, we all;have our own six numbers and if the donor;had the same six numbers as one of the;recipients on the list, they would be offered;that kidney.
This is called a 6-antigen match;or a full house match. Just like winning the;lottery jackpot, this does not happen very;often. Five numbers matching is a bit more;common, and four numbers matching is a bit;more common again. However, we do not like;to take less than four numbers matching as far;as possible, unless the child has numbers that;are extremely uncommon in the population;and very unlikely, therefore, to be matched.
If the child is lucky enough to receive a full;house 6-antigen matched kidney from a;deceased donor, then this is the only match;that does as well as a kidney from a parent,;even though the parent may only have three;numbers in common with their child.;This is because the parent may have other;things in common that we do not match for;or even understand. It is also because the;kidney is taken from the parent and very;rapidly transferred into the child, with very;little wait in between.
Your Blood And Tissue Type Must Be Compatible With Your Recipients
Besides being healthy, living donors must have compatible blood and tissue types with the kidney recipient. The transplant team will perform tests to see if your blood and tissues are compatible with the kidney recipient. If they arent, our living donor program can also educate you about the;paired donation program.
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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.
Kidney Offering And Matching
When an organ donor is notified to NHS Blood and Transplant the following details are recorded: their renal function, blood group, and tissue type. The donor information is then added to the national database which identifies the most suitable recipient for the kidney.
Suitability is determined by a complex mathematical process which gives priority based on the following factors, each of which are given points:
- The compatibility of the blood group
- Length of time on the waiting list one point for every day waiting
- The similarity of the donor and recipients tissue types the better the match the more the points
- Whether the recipients tissue type is unusual such that it would be particularly hard to find a transplant for that person. Difficult to match patients are awarded more points in order not to miss the rare chance of a transplant
- Whether the recipient has developed antibodies that reduce the likelihood of a match. This is called sensitisation – highly sensitised patients get more points.
- The age of the recipient children get more priority
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How Organ Matching Works
When a transplant hospital accepts a person as a transplant candidate, it enters medical datainformation such as the persons blood type and medical urgency and the location of the transplant hospitalabout that candidate into UNOS computerized network. When an organ procurement organization gets consent for an organ donor, it also enters medical datainformation such as the donors blood type and body size and the location of the donor hospitalinto UNOS network.
Using the combination of donor and candidate information, the UNOS computer system generates a match run, a rank-order list of candidates to be offered each organ. This match is unique to each donor and each organ. The candidates who will appear highest in the ranking are those who are in most urgent need of the transplant, and/or those most likely to have the best chance of survival if transplanted.
The UNOS Organ Center helps place donated organs for transplantation 24 hours a day, 365 days a year.
What If The Donor Is Not A Match
When compatibility testing shows that the donor is not a match to the recipient there are other options to consider so that the recipient might not have to wait for a deceased donor organ to become available.
- In some cases, the donor may still be able to donate directly to the recipient as part of our Blood Type Incompatible Transplant Program.; More testing must be done to decide if this is an option.
- If the donor cannot donate to the intended recipient, the donor-recipient pair might be able to participate in our;Kidney Exchange;Program.; In this program, incompatible donor-recipient pairs exchange kidneys so that each recipient receives a compatible organ.
For more information visit our website;
For additional living donor information refer to:
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Blood Type Compatibility Chart
|AB||A,B, AB or O|
If the donor and recipient have compatible blood types, the next step for the donor is a medical history review and a complete physical examination.
In the examination, doctors may commonly perform the following tests:
Tissue typing: the donors blood is drawn for tissue typing of the white blood cells. This test checks the tissue match between six codes on the donor and recipient cells. While still required as part of the transplant process, tissue typing is rarely a consideration for living organ donation.
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 because antibodies will immediately react against the donors cells and consequently cause immediate loss of the transplant. 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 bodys immune system in response to an antigen . Because the antibodies attack the transplanted organ, the antibody screen tests for panel reactive antibody . 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.
X-Rays: A chest X-Ray and an electrocardiogram are performed to screen the donor for heart and lung disease.