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61 Live kidney donor information


This article is from the Organ Transplant FAQ, by mike_holloway@hotmail.com (Michael Holloway) with numerous contributions by others.

61 Live kidney donor information

The following is a summary of "Donating a kidney to a family member- How
primary care physicians can help prepare potential donors"

Authors: Michael L. O'Dell, MD
Kristi J. O'Dell, ACSW
Thomas T. Crouch, MD

VOL 89/NO 3/February 15, 1991/Postgraduate Medicine . Kidney

Summarized by Katherine Eberle, eberle@gdls.com for the


When a relative needs a kidney to survive, family members often
impulsively offer to donate one without stopping to consider the
physical, emotional, and financial ramifications, which can be
considerable. The family's primary care physician can be very
helpful in guiding and educating potential donors and, by arranging
for screening to be done in the community, can ease the financial
strain. The authors discuss the things a potential kidney donor
should consider.

The desirability of transplantation is increasing and the supply of
cadaveric kidneys falls far short of the demand. So searching for a
possible living related donor is becoming more and more common.
Much of the preliminary testing required to identify a donor can be
easily performed in the potential donor's community, under the
direction of the primary care physician in communication with the
transplant team. Additionally, the donor's care is aided when the
evaluating physician serves as an advocate.

Evaluation for Immunologic Match

Usually, the first test performed is determination of ABO blood type
compatibility. Many physicians follow ABO compatibility testing
with HLA typing.

Tests required by most centers and a description of results that may
prohibit transplantation:

TESTS                         Potential Disqualifying
History and Physical          Age under 18 or over 55 yr
Examination                   Obesity
                              Systemic disorder with
                              potential to impair health
                              Psychiatric disorder
                              Deep vein thrombosis
                              Family history of polycystic
                              kidney disease,
                              diabetes in both parents,
                              hereditary nephritis,
                              systemic lupus erythematosus
Laboratory Studies
Blood typing                  Poor match with recipient
Complete blood cell count     Anemia or blood dyscrasia
Automated biochemical         Abnormalities indicating
analysis                      significant disease state
Screening for diabetes        Evidence of diabetes
Serologic tests for syphilis  Evidence of current
Hepatitis B surface antigen,  Evidence of current
antibodies, core antigen      infection
Human immunodeficiency virus  Evidence of current
testing                       infection
24-hr urine collection for
     Creatinine               Diminished clearance
     Protein                  Significant proteinuria
     Calcium                  Hypercalciuria
     Oxalate                  Hyperoxaluria
     Urate                    Hyperuricemia
Urine osmolality after        Inability to concentrate to
overnight thirst              >700 mOsm/L
Urinalysis                    Unexplained hematuria and/or
                              other abnormality
                                 (eg, proteinuria)
Urine culture                 Evidence of urinary tract
Pregnancy test (where         Positive for pregnancy
HLA typing                    Poor immunologic match with
Radiographic Studies
Chest x-ray film              Evidence of significant
Intravenous urography         Anatomic abnormality
Renal arteriography           Anatomic abnormality

Other Studies

                              other significant
Tuberculin and Candida skin   Evidence of active
tests                         tuberculosis or anergy
Multiple gated acquisition    Evidence of ischemic heart
stress test (in men over age  disease
45 yr and women over 50 yr)
Pulmonary function testing    Significant abnormality in
(in smokers)                  lung function

If the potential recipient is a reasonable match, renal angiography
is performed to determine which of the donor's kidneys is the more
accessible and the better anatomic match and to screen for
abnormalities that might preclude uninephrectomy. In general, the
left kidney, with its longer renal vein, is selected.

Potential donors should also be screened for psychosocial risk
factors. An evaluation of the stability of the individual and the
family and the financial impact of donation should be undertaken.
This is often performed by social workers. An important
consideration is psychosocial evaluation is whether the potential
donor is being coerced into the donation. Purchase of a kidney is
illegal in the United States. Occasionally, evaluators discover
potential donors who are unwilling to donate and yet are being
significantly pressured to do so by family members. Such persons
should be skillfully assisted in resisting such coercion, perhaps by
honestly describing them as "not an appropriate match."

Potential Disqualifying Psychosocial Factors in Kidney
Evidence of significant coercion to donate
Evidence that donation would cause extreme financial
Evidence that spouse is strongly opposed to donation
Evidence of significant psychiatric disturbance

Often, family members spontaneously decide to donate a kidney before
they have had an opportunity to consult medical personnel. They
make their decision on moral rather than technical grounds, often
describing it as "the right thing to do" or their "calling."

Effects on the Donor

PHYSICAL EFFECTS - The actual risks to the donor from uninephrectomy
may be divided into short- and long-term. Short-term risks are those
typically seen with this major surgical procedure (ie, pulmonary
embolus, severe infection or sepsis, renal failure, hepatitis,
myocardial infarction, splenic laceration, pneumothorax). Estimates
of the mortality rate are generally less than 0.1% and of
significant complications less than 5%. Less than 1% of donors have
any permanent disability. Long term risks are controversial and
largely unknown. In one third of all donors, nonprogressive
proteinuria develops. This finding has led to a recommendation that
donors restrict their protein intake after uninephrectomy. In
addition, donors experience a slight rise in the serum creatinine
level, which is also nonprogressive.

PSYCHOSOCIAL EFFECTS - These risks to potential and actual donors
may also be short- or long-term. Potential donors who choose not to
donate may experience guilt about their decision or be ostracized by
the family, although detailed studies of potential donors who choose
not to donate are few.

About one fourth of those who choose to donate experience moderate
to severe financial difficulties. Even though the cost of the
evaluation and procedure is borne by the federal End Stage Renal
Disease Program, unreimbursed financial losses resulting from job
absence and travel can be significant. Most authorities cite a
return to work 4 weeks after uncomplicated uninephrectomy. Some
centers use donor- specific blood transfusions as a means of
enhancing graft survival. This requires blood donation from the
potential donor several days before the actual procedure, which may
extend the time away from home and work.

Troubled marriages may fail when the added stress of a kidney
donation is introduced. According to one study, one third of the
couples whose marriage failed cited the kidney donation as a major
factor in the failure.

Although much attention may be lavished on the donor in the
perioperative period, it may be short-lived and tends to quickly
refocus on the recipient. The recipient may, paradoxically,
criticize the donor's decision or become distant or angry toward the

However, the increase in self-esteem gained from the altruistic
action of donating a kidney may counterbalance such losses.
Donation of a kidney has provided many donors with a sense of deep

In view of the potential risks to donors, some centers refuse to
perform transplantation from a living related donor. With effective
immunosuppressive therapy, cadaveric transplantation is quite
successful, and these centers argue that the benefit to the
recipient is not greatly enhanced by transplantation from a living
related donor. However, cadaveric organs are scarce. In contrast,
proponents of transplantation from a living related donor argue that
thwarting legitimate altruistic behavior by denying the procedure is
paternalistic, particularly since enhanced graft survival is noted
in such recipients compared with recipients of a cadaveric


Although the use of living related donors will remain controversial,
everyone involved should be struck by the courage of those willing
to donate a kidney to a relative. For physicians providing care to
these families, an exceptional opportunity for guidance exists.


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