A guide to living donor kidney transplantation
An Incredible Gift. An Incredible Opportunity.
There is one thing almost all living donor recipients say about transplantation: "It was a life-changing experience." After years on dialysis, to be finally free of it is like a rebirth. The freedom to do what they want, when they want, is something many dialysis patients have long since forgotten. Living organ donation can change that.
And recipients aren't the only ones who are rewarded. Donors, too, tell of the satisfaction of giving an organ. Fortunately, nature has given us two kidneys, and we only need one to live normally. This gives donors the ability to enrich, and sometimes save, the life of a loved one-which is truly unique to living donation. But there are some concerns and questions that most donors and patients have about transplantation. Read on to learn more about this amazing procedure.
When should living donation be considered?
As is the case with many health questions, there is no single right answer. But there are some important things to consider and questions to ask.
Unfortunately, today there is a serious shortage of organs available for transplantation. This means that the wait for a kidney can be many years. Because of this, you should begin exploring the option of transplantation-and, more specifically, living donation-as early as possible. So, if you're currently on dialysis and are unhappy about the toll it takes on your life, talk to your doctor and loved ones about living donor transplantation and the opportunities it offers.
Why not just go on the waiting list?
For some people, waiting for a kidney may be the only option. The United Network for Organ Sharing (UNOS) administers a list of people waiting for organs. As kidneys become available, a name from the list is chosen according to certain criteria: quality of match, time on the waiting list, and the patient's medical status. However, there is a shortage of donors in the United States, which means that the wait for a kidney can be many years. In addition, according to the National Institutes of Health, success rates for living donation are 10% higher after 5 years than those for cadaveric transplantation (when the organ comes from a person who has recently died). Finally, with living donation, you schedule your surgery, giving yourself time to prepare both mentally and physically.
Who is a good living donor candidate?
Donor candidates vary greatly. Sometimes they are spouses, cousins, siblings, or even friends. They need to pass some screening exams and be willing to donate their kidney.
The screening process includes a blood-type matching test, a health exam to ensure that the donor is fit for the surgery, and counseling on what the surgery entails. In addition to the screening, the donor must also be aware of the time commitment involved. Depending on the type of surgery, the donor will not be able to return to work until about 4 to 8 weeks after the procedure.
What do you have to do to become a donor?
The first step any interested donor should take is to talk to the transplant team. The doctors can help answer any questions and concerns about the procedure and start tests on potential donors to see if they are a good match.
The potential donors' blood will be taken and tested to see if it is a good match. In addition, all donors receive thorough health exams and counseling to ensure that they are physically, emotionally, and mentally prepared to be a donor.
What does the surgery involve for the donor?
Although living donor kidney transplantation is a major surgery, recent advances have made the process far less demanding on the donor. Today, many kidney donors have their organ removed with only a few small incisions and a tube-like device called a laparoscope. This greatly limits the time in surgery and the recovery period. The donor may be in the operating room for only about 3 to 4 hours and usually returns home in a couple of days.
However, some facilities still perform the surgery using a more conventional method. In this type of surgery, there is a larger incision and sometimes more pain after the operation. The length of the surgery is still about 3 to 4 hours, but the hospital stay will usually be a little longer. However, both procedures have their advantages, and the options should be discussed with the donor's surgeon.
Will the donor be at risk?
There's no question about it: Donating an organ is a major procedure and carries the risk of any major surgery. However, modern techniques and medicines make the risk of complications very small. Fewer than 2% of donors experience major complications during the surgery, and long-term studies have shown that having only one kidney does not have a significant impact on health. In fact, the main risk for donors is if they have an accident in which their remaining kidney is injured or if they develop a kidney disease-both of which occur very rarely.
Will life for the donor be different with only one kidney?
The human body is amazing in its ability to heal itself. This couldn't be more true than in the case of kidney donation. After many years of living donation kidney transplantation, donors have shown very few side effects. The fact is that donors almost always go on to live happy, healthy, and normal lives-no different from when they had both their kidneys. Living kidney donors will have to visit their doctor on a regular basis so their blood pressure and general health can be monitored. And if a donor experiences kidney failure later in life, he or she is immediately placed at the top of the waiting list. But the most noticeable change in kidney donors is the great sense of satisfaction they feel in knowing they helped improve the quality of life of someone in need.
What does the surgery involve for the recipient?
The surgery for the recipient is more complicated than for the donor. However, in recent years, doctors have developed techniques that have made the procedure much quicker and less prone to complications.
The procedure usually involves the following steps:
The recipient is usually up and about in the hospital within a day or two.
What can the recipients do to help with the success of their surgery?
Life on dialysis can be very difficult. The time commitment and number of medications that need to be taken are extensive. For this reason, the recipient's dedication to a post-transplant medication routine is very important. The body naturally rejects foreign organs, but special anti-rejection medications allow the donated kidney to operate normally in the recipient's body. Immunosuppressive medication is necessary, and taking it properly, as instructed by the transplant team, is critical. It is very important that patients take their medications to keep them from rejecting the donated organ. Managing your anti-rejection medication should be no more difficult than managing the medications you take while on dialysis. In fact, most patients take many fewer medications to control their immune system after their transplant than they do to treat renal failure while on dialysis.
Also important in helping with the success of a kidney transplant is proper diet and exercise. Decreasing fat intake and exercising at least three times a week are important steps recipients can take on their own.
What are the success rates for kidney transplantation?
In recent years, success rates for kidney transplant recipients have significantly increased. Most recipients and donors go on to live long, healthy, active lives with few complications.
Patient survival when remaining on dialysis:
1 year (1997-1998): 79.7%
5 year (1993-1998): 29.0%
Patient survival following cadaveric kidney transplant:
1 year (1997-1998): 94.4%
5 year (1993-1998): 79.5%
Patient survival following living donor kidney transplant:
1 year (1997-1998): 97.5%
5 year (1993-1998): 89.1%
(Statistics from the National Institutes of Health. 1993-1998.)
Talking to family and friends about living donation.
How in the world can you ask anyone to give you their kidney? Well, most dialysis patients are surprised by the eagerness of both friends and family to donate. Although kidney donation is a huge sacrifice, seeing a loved one go off dialysis makes it worthwhile.
Perhaps the most important thing anyone can do when talking to a loved one about donation is to help educate them. Thanks to improvements in the surgical procedure and medications, living donor transplant recipients have the chance to live normal lives and usually feel better than they did before the transplant. Because of these improvements, many potential donors who were once hesitant may reconsider donation. So give them the information and get your transplant team involved, and most importantly, remember that most people would happily do for you what you would do for them.
Addressing the finances of transplantation.
Each patient is unique in almost every way-and that includes their financial and insurance situation. For some, insurance or Medicare will cover all or most of the procedure and medications needed post-transplantation. A new law was passed in December 2000 that provides some Medicare recipients complete coverage of anti-rejection medications for the life of their organ. Call the Medicare Hotline (1-800-633-4227) to see if you're covered. For others, it's necessary to seek out other sources of financial support. In almost all cases, the donor's surgery is covered by the recipient's insurance. So whatever your situation, it's important to begin looking at your options right away. Below are some groups that can help you evaluate where you stand and assist you in finding the necessary funds for transplantation.
American Kidney Fund
www.akfinc.org
1-800-638-8299
National Transplant Assistance Fund
1-800-642-8399
Medicare Hotline
1-800-633-4227
National Insurance Consumer Hotline
1-800-942-4242
National Foundation for
Transplants
1-800-489-3863
Prescription Drug Patient Assistance Programs
1-800-762-4636
Additional Resources:
American Association of Kidney Patients
www.aakp.org
1-800-749-2257
National Kidney Foundation
www.kidney.org
1-800-622-9010
TransplantLife
www.transplantlife.com
United Network for Organ Sharing
www.unos.org
1-888-894-6361
To receive additional transplant education materials, call 1-800-575-6573.
Astellas Pharma US, Inc.
©2005 Astellas Pharma US, Inc. FK167 10/01 Printed in USA