Living Related Donor
Giving a Kidney to a family member can be one of the life’s greatest experiences. For many families, this gift has meant restored health for the person receiving the transplant & closer ties among everyone involved. However, the decision to donate a kidney is an important one and it helps to know as much as possible about the potential benefits & problems.
The Organ most commonly given by a living Donor is the Kidney. The parts of Organs including Liver, Lungs & Pancreas are now being transplanted from Living Donors.
Does it make a difference in outcome when kidney comes from a living related donor & from a cadaver donor?
Generally, a relative’s kidney will match the recipient’s body tissue more closely than a cadaver kidney. A close match between the tissues of the donor & recipient increases the chances that the recipient’s body will accept the donated kidney. Thus, the results of transplant are better when the kidney comes from a living related donor. However, the success of both living related donor & cadaver donor transplants continue to improve with new drugs becoming available for prevention & treatment of rejection.
Most important, the donation of a kidney must be a voluntary act. When more than one family members wish to be donors, individual circumstances of each of the donors is evaluated. After the situations of each of the potential donors have been carefully considered, the specific person for donation is determined by a series of blood tests. These include ABO blood group testing and HLA typing. These tests will tell the transplant staff whether the donor and recipient have compatible blood group and how similar their body tissues are. The more similar the body tissues of donor and recipient, the lower the chances that the kidney will be rejected.
To determine the general health of the donor, as well as the condition of his or her kidneys, a detailed medical history is taken and physical examination is performed. In addition, urine examination and a series of blood tests are performed. A chest X-ray and an electrocardiogram is taken to assess the lung and the heart status. An IVP (intravenous pyelogram) and an angiogram are performed to determine if there are any abnormalities in the kidneys or blood vessels leading to them.
Some people make the decision instantly, with few worries or problems. Others go through some soul searching before deciding. It is quite normal for a potential donor to be afraid of giving a kidney or to feel guilty about his or her reluctance. It must be remembered that the only “right” decision is the one with which the person considering donation feels most comfortable.
In some families, everyone wants to be the donor, while in others there is a general unwillingness to consider donation. Sometimes the spouse, the children, siblings or the parents of a potential donor express reservations or even strongly oppose the whole idea. The donor’s friends, perhaps because they may not have a close relationship with the recipient, appear to discourage donation more often than the family members do.
Generally, the donor is admitted one or two days before the operation. At this time a physical examination and several routine tests are performed again. If it has not occurred before, the surgeon who will be removing the donor’s kidney will be introduced and will discuss any final question or concerns the donor may have.
At first a general anesthetic is administered in the operating room to put the donor to sleep during the surgery. They surgeon then makes an incision on the side from which the kidney is to be removed. Next, the kidney is removed and kept in ice and flushed with ice cold solution. The kidney is then taken to the recipient in the adjoining operating room and connected to the recipient’s blood vessels while the donor’s incision is being closed and stitched. In most cases the transplanted kidney begins to function immediately while in a few cases it takes several hours or days. In extremely rare cases, the transplanted kidney fails to the recovery room for observation until the anesthesia wears off. Thereafter the donor is returned to his or her room in the hospital.
The operation involves the same level of risk as any other major surgery. The risk of death in a major surgery in which a general anesthetic is used is 1 in 10,000 cases. Although the risk of death is low, donors may experience some complications following the surgery. These include infection, pain at surgical site etc. Most of these complications are treatable.
Following the operation the donor typically feels tired, a natural phenomenon after a major surgery with a general anesthetic. Certainly there is pain lasting for several days to several weeks as the muscles around the incision heal. The severity of pain felt varies from individual to individual depending upon the pain tolerance. The discomfort generally decreases, however, as the donor becomes more physically active.
The length of hospital stay for an uneventful surgery is about 8 to 10 days after surgery. After leaving the hospital and returning home, donors typically experience pain and itching at the site of surgery. After about a week’s rest they can resume their activity. Generally they are advised to avoid heavy lifting for 6 weeks following discharge from the hospital.
There is no evidence that donating a kidney has any effect on the ability of donors to have children. If any donor is unsuccessful in having a child it is usually due to reasons unrelated to having been a donor.
This question is being carefully examined by several research groups all over the world. At one stage it was felt that donors could have a higher chance of getting high blood pressure in future but when the group of healthy donors were compared to age matched healthy non-donors, the incidence of high blood pressure was the same in both donors and non-donors. Thus the evidence so far does not suggest that kidney donation places an individual at risk for future health problems.
This is a possibility because of lack of awareness in the insurance companies. If this happens, the donor should take help of his doctor who can provide all necessary information to the agent of the insurance company. It would be better to resolve this issue even before the donation so that donor faces no problem later on.
n a survey conducted at one center the donor were asked, “If you could reconsider donating your kidney, would you make the same decision?” Ninety-one percent said “yes” without any reservations while an additional 5% stated that they would probably make the same decision. Three percent of the donors were unsure of the decision they would make and 1% indicated that they would not give their kidney if they had it to do all over again. These donors were also questioned about their relationship with the recipient after transplant surgery. Fifty-seven percent stated that they had always been close to the recipient and that this close relationship had continued. Forty-two percent felt their relationship with the donor had improved since the operation, while 1% believed they were less close to the recipient then before.