"Fifty plus percent of the people that start the live donor workup get turned down because we find something that's wrong," says Dr. Charles Shield of St. Francis Hospital, Kansas.*

Making the choice to be a Living Donor is not a simple one, especially if the would-be recipient is a relative or close friend.

The first thing to consider is WHY you want to be a Living Donor.

- Are you feeling pressured?

- Did the recipient ask you to donate?

- Are you worried about disappointing friends or family members?

- Are you afraid that if you decide not to donate people will think you're selfish?

- Do you feel you are the 'only' person who can save the would-be recipient's life?

In one study, 13% of living donors experienced emotional pressure to donate the kidney, from the recipient, other family members and from the medical team.(4)

Most recipients are the living donors' loved one, making the decision a very emotional one. Often referred to as the 'rule of rescue', it is the impulse of human beings to save an identified life (a trapped miner, child in a burning building) despite risk to oneself, and it is also a reason why the transplant community and government have failed to increase living donor protection or oversight. A theoretical miner or child or living donor (a statistical life) is not nearly as immediate.

While the psychological portion of the living donor evaluation is supposed to look for signs of 'coercion', many transplant centers are rather lax on the matter if the donor is a relative of the recipient. However, if you are having doubts of any kind, please disclose these to the social worker or living donor coordinator assigned to you by the transplant center. (If a living donor coordinator is not assigned, ask for one - it's legally required by OPTN and CMS). They will offer no judgment and your statements will be kept confidential.

According to one study, 27% of prospective living donors 'voluntarily withdrew' from the process (75). Their reasons:

28% cited work commitments

28% had a ‘change of mind’ (often after consulting with their partners)

19% feared the risks of operation

10% were planning a pregnancy

and 15% did not wish to give a reason.

Pride, hubris, guilt and desperation are not healthy reasons for donating. Nor is futile to hope to 'get something out of it', or 'make up' for a past mistake. 

The choice not to donate is NOT a death sentence for the recipient.

They have other options: the national transplant list, another living donor. People live for many years on dialysis.

You are not responsible for a would-be recipient's kidney failure; therefore, you are not obligated to treat their disease.

A transplant is NOT a cure.

Many transplant recipients enjoy years of quality life after surgery, but some do not. Regardless of statistics, no one can guarantee how much life a recipient will have after a transplant, or how healthy they will be.

Most recipients will require at least one additional transplant in their lifetime.

Meanwhile, a donor's lost kidney will never grow back and complete pre-op function will never be regained. In fact, in a study of 402 donors followed between 1964 and 1995, estimated GFR was reported at 72% of age-predicted value.(95)

Donating an organ does have risks and complications, both physical and psycho-social, both short and long-term. In fact, because living donors are not followed, many long-term issues are unknown.

It's imperative you Take Care of Yourself First.

*http://www.kwch.com/Global/story.asp?S=9365060

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