Living Donor Kidney Transplant Donations

A kidney donation from a living donor has several advantages for the recipient versus a deceased kidney donation:

• Better Long-Term Outcomes. Living donor kidneys often last longer in the recipient’s body than deceased donor kidneys. Kidney recipients also live longer when they receive a living donor kidney rather than a deceased donor kidney. A living kidney is usually a better match and in better condition than a deceased donor kidney.
• Shorter Wait-Time. The recipient usually receives the living donor’s transplanted kidney faster than a compatible deceased donor organ. There are more than 96,000 people on the United Network of Organ Sharing (UNOS) waiting list for a kidney. The average waiting time for a deceased donor kidney at Baylor is just over 2 years.
• Scheduled Surgery. A living donation is a pre-planned surgery, not a sudden procedure; allowing the patient to be better prepared both mentally and physically.
• Quicker Kidney Function. Living kidney donations begin working in the recipient’s body sooner than an organ that has been kept on ice and transported to the hospital. A living donor kidney usually begins working immediately, whereas a deceased donor kidney may take several days or weeks to function properly.
• Lower Rejection Rate. Living donor kidney transplants offer a lower rejection rate than one from a deceased donor.

To be considered for a living kidney donation, you must first meet certain basic criteria:

• Healthy individual between the ages of 18 and 65, with two normal kidneys (Donors older than 65 are considered on a case-by-case basis)
• Blood type compatible with the recipient

It is important to note that the kidney donor and recipient do not need to be the same race or gender or be related. A potential donor can be someone who has emotional ties to the recipient, such as a close friend, co-worker or spouse.

A complete physical evaluation will be required to determine the full scope of the potential donor’s health and compatibility with the recipient. The cost of that evaluation is not the responsibility of the potential donor.

There are medical and other issues that might prevent someone from becoming a living kidney donor. These include but are not limited to:

• Obese, as to jeopardize their own health
• Hypertension or high blood pressure
• Diabetes
• Certain cancers (undergoing active treatment or a history of certain cancers)
• Pregnancy
• Kidney stones, recurrent kidney infections or history of surgery on the urinary system
Severe liver disease
• HIV positive
• Systemic Lupus Erythematosus
• Severe heart, lung or vascular problems
• Psychosocial issues that do not meet criteria guidelines

These conditions are screened for during the evaluation process to promote the health of the donor and recipient.

The paired kidney donor program allows you to donate your kidney to another recipient who was not compatible to their donor, but is compatible with you. Their donor would then donate to your recipient. Baylor Dallas performed North Texas’ first paired kidney donor transplant in 2010.

If you are interested in this option, please discuss it with your Living Donor Coordinator or visit the Alliance for Paired Donation.

People who have been evaluated and deemed an appropriate living kidney donor usually face few, if any, long-term lifestyle changes, lifespan issues or side effects from the surgery. However, with all major surgeries and anesthesia, there are risks that need to be considered. Nationally, the risk of having a life-threatening problem after donating a kidney is 1 in 3,000. The risk of minor complications such as a minor wound infection is about 2 to 4 percent. Potential risks will be explained to the donor by the transplant physicians and other team members over the course of the evaluation.

There are two categories of expenses that relate to living donors:

1) Medical expenses are the cost of hospital and physician services for the donor evaluation, donation surgery and routine follow up visits. These medical expenses are typically covered by the recipient’s medical benefits, which means a donor should not have costs associated with these services.

2) Non-medical expenses are the out of pocket cost of things like travel & lodging, parking, meals, lost wages from work, child care costs and caregiver expenses.  Donors are able to apply for employer based short-term disability should they have short-term disability benefits, but many times the donor receives less than 100% of their normal pay.

There are organizations such as the National Living Donor Assistance Center & the American Transplant Foundation that may be able to assist a donor with their non-medical expenses.

Our financial coordinators and social workers are available to discuss your specific circumstances in more detail.

Donors are usually off work one to four days for their evaluation and on average four weeks after surgery. Because the kidney donor operation is a major surgical procedure, donors find they have less energy and need about three to six weeks to return to their full pre-surgical activity level.

The potential donor will have a thorough medical and social evaluation to determine that he or she is healthy and that there is not anything that puts them at additional risks for future health problems related to the surgery, anesthesia and donation.

The first step is for the donor to complete our confidential online health history questionnaire.  If you are considering being a donor for a patient at Baylor Dallas, see our Dallas information card (English) or Dallas information card (Spanish). If you are considering being a donor for a patient at Baylor Scott & White – Fort Worth, see our Fort Worth information card (English) or Fort Worth information card (Spanish). If you are considering being a donor for a patient at Baylor Scott & White – Temple, see our Temple information card (English).

Once the questionnaire is completed, your information will be reviewed by a living donor coordinator.  If you are a possible candidate, the coordinator will contact you to review your health history questionnaire and answer any questions you may have. 

This step is followed by financial approval through the recipient insurance for testing.  If approved, then the donor is scheduled for medical tests including blood work, urine tests, EKG, chest X-ray, CT scan. In addition, a multidisciplinary team evaluation including consult with a nephrologist (kidney specialist), surgeon, social worker and donor advocate. The length of the testing process depends on availability of the potential donor, but can often be completed within one week. We make every effort to accommodate the donor’s schedule.

Donors are required to have routine cancer screenings such as pap smears, mammograms and colonoscopies through their own physician depending on their age and gender.

The evaluation results are presented to the transplant team to determine if the donor is suitable for donation.  Once approval is obtained by the transplant team for the donor and recipient, the transplant can be scheduled.

Once a donor has been evaluated and approved to donate, the kidney transplant is scheduled. The donor and recipient are usually in side-by-side operating rooms. The kidney is removed from the donor in a procedure called a nephrectomy and transplanted into the recipient. The most common ways to perform a nephrectomy include:

• Laparoscopic nephrectomy – a minimally invasive procedure that usually takes three to four hours. Surgeons on the medical staff at Baylor will make small incisions and insert a laparoscope to remove the kidney. Usually donors recover for two to three days in the hospital before returning home or local transplant housing.  
• Robotic laparoscopic nephrectomy – a minimally invasive procedure used by surgeons on the medical staff at Baylor that utilize a specialized robot to precisely control the insertion of the laparoscopic instrument to remove the kidney. Donors who have this procedure usually recover in the hospital for two to three days and then are able to return home.

In most cases, recovery for a donor is not difficult. Complications from the procedure for the donor are typically low and lifestyle changes are minimal and short term. This may include staying well hydrated, resting and taking pain medication as needed during recovery. Routine restrictions such as refraining from certain activities such as weight lifting for a few weeks during recovery may also be recommended. Because the kidney donor surgery is a major surgical procedure, donors will experience less energy but should return to their normal activity in four to six weeks.

To promote the donors ongoing health and wellness they are required to have follow-up visits at one week, six months, one year and two years. The donor should continue regular appointments with their primary care provider.