The following is a general overview of the living donor evaluation process. The details will differ slightly for a non-directed, solicited or chain donation.
**Important** A living donor does NOT have to have their evaluation or procedure done at the same hospital as the transplant recipient. A living donor has the right to choose their surgeon and their facility. Donated organs are transported across the country every day from both deceased and living donors (see here for more).
1. Contact the transplant center (Contact info can generally be found on the hospital’s website). This usually results in a series of ‘eligibility’ questions concerning age, weight, and health history and status.
See Also: Choosing a Transplant Center
2. If the transplant center indicates the potential living donor falls within their guidelines*, instructions will given regarding the initial blood draw for tissue matching and sensitivity testing.
*Transplant centers have great latitude in deciding what is or isn’t an acceptable living donor. What one center might deem high risk, another might find acceptable.
See Also: Living Donor Bills and Health Insurance
3. A number of vials of blood are taken from the potential living donor to determine blood type and HLA/tissue type**, which are then compared to the would-be recipient.
If the results aren’t volunteered by the Transplant Coordinator or other transplant professional, ask about the tissue match with the intended recipient.
4. If the transplant center determines the potential living donor and the would-be recipient to ‘match’, the potential LD will be given instructions on the next step of the evaluation. If there is a blood type conflict and/or large HLA mismatch, the transplant center may ask the potential living kidney donor if s/he would be willing to participate in a Swap, Pair or Chain.
Final Rule 2007 requires an Independent Donor Advocate be available to all potential living donors. A Living Donor Coordinator is not an IDA; nor is a Donor Buddy/Mentor. (see Questions below). As of 2013, OPTN now also requires an IDA.
5. The potential living donor will undergo myriad diagnostic tests to ensure good health and adequate kidney function. S/he will also meet with a nephrologist, surgeon, and transplant coordinator. The potential living donor will also have a psychological evaluation.
Once again: a prospective living donor has the right to choose her/his surgeon and not simply accept the surgeon assigned by the transplant center. Please take the time to research the transplant center and the surgeon before undergoing surgery. No exaggeration – your life could depend on it.
See Also: Questions To Ask
OPTN now has checklists for living kidney donor medical evaluation, psychosocial evaluation and informed consent. Use them to ensure your transplant center is doing everything they should be doing!
**There is growing concern that the BK virus is living kidney donors is being transmitted to recipients. BKV can cause the transplanted organ to be rejected (231). Find out your BKV status prior to donation; it should be part of the living donor evaluation lab results.**
6. The results of the potential living donor’s assessments will be evaluated by the transplant committee. At this point, the potential living donor will either be cleared or denied for the living donation surgery.
|Before agreeing to the donation – GET YOUR LAB RESULTS. Compare them to age and gender-appropriate norms. Consult with an independent (not employed by a transplant hospital) nephrologist if you’d like.Make sure you feel comfortable with inevitable blood pressure and creatinine levels increases post-nephrectomy, as well as a significant decrease in GFR (kidney function) and loss of renal reserve. Due to lack of data and individual variables, the amount of these changes cannot be accurately predicted.|
If you are uncertain, DO NOT DONATE. Putting your own life and health in jeopardy helps no one.
See here for more details on acceptable GFR, proteinuria, and hypertension pre-donation.
7. At the living donor’s convenience, the surgery will be scheduled. Do not allow the transplant center to dictate the terms or dates of the surgery. (Again, see Choosing a Transplant Center)