Living-Donor Transplant

Living-donor transplant is a surgical procedure to remove a portion or an entire organ from a living person and place it in another person whose organ is no longer working properly.

A person can donate one of their two kidneys so the remaining kidney will still be able to perform its function. Living kidney donation is the most common type of living-donor procedure.

Living donors can also donate a portion of their liver as the remaining liver grows back and regenerates and perform its function.

Liver and kidney are the most common types of living-donor organ procedures. A living person can also donate tissues for transplantation such as bone marrow, skin, and blood.

The two types of living - organ donation includes:

Directed donation - the donor is directing the organ to a specific recipient for transplant. The recipient can be a person who knows about the candidate’s need, a first-degree relative such as a sibling, and a biologically unrelated person such as a spouse.

Non-directed donation – the match will be based on compatibility and medical need of the person, and the recipient will not be named. Paired exchange or paired donation can be an option if the recipient and donor have incompatible blood types.

Two or more organ-recipient pairs trade donors so that each recipient will get an organ that is compatible with the blood type.

Here are the most common reasons to receive a living-donor transplant.

This procedure is another way to wait for a deceased donor organ.

This procedure has a longer survival of the donor organ and has less complication compared to a deceased donor transplant.

Along with undergoing a living-donor transplant procedure comes potential risks.

There are short and long-term complications associated with living donor transplant. If you are going to donate an organ, you may have risks of complications of having a major surgery.

If you are a recipient of an organ, the risks of complications are low.

The immediate major surgery risks of donating an organ include:

• infection
• pain
• bleeding and hernia
• wound complications
• blood clots
• mental health issues such as depression and anxiety
• sometimes death

For kidney donation risks:

The life expectancy for those who have donated a kidney is the same as for similarly matched people who have not donated a kidney.

There is a research suggest that a high risk of kidney failure in the future may occur in living kidney donors.

The long-term complications that are related to living kidney donation are elevated protein levels in urine and high blood pressure.

For liver donation risks:

• bleeding
• infection
• blood clots
• bile leakage
• intra-abdominal bleeding
• inadequate growth of the remaining part of the liver
• narrowing of the bile duct
• sometimes death

In order to prepare for the living-donor transplant, you should talk to your doctor the risks and benefits of donating an organ. Consult your family and friends if you are going to make that decision.

You should consider some of these questions:

• How do I feel about the organ donation?
• What are the medical risks?
• How will it affect me financially?
• How will it affect my work?
• Will it be covered by my insurance?
• Do I know enough to make this decision?
• Is there someone else who can donate?
• How will it affect my relationship with the recipient?
• So I have any medical or health history that I know should keep me from donating?
• Do I have a support group near my place to help me cope?

The transplant center will keep your information confidential.

Living donor transplant centers should provide an independent living donor advocate to protect the informed consent process according to the Organ Procurement and Transplantation Network (OPTN) and the Centers for Medicare and Medicaid Services.

This is mostly done by a counselor that will help you if you have any questions regarding the procedure.

To determine the right transplant center for you:

• ask the center about the survival rates of the organ donor and recipient
• learn about the types and umber of transplants that they perform each year
• check if the center is keeping up with the latest technology and techniques
• compare centers by going to the Scientific Registry of Transplant Recipients
• check if there are other services that will be provided to you such as support groups and transportation

Read on to learn more about what to expect before, during, and after your living-donor transplant.

Before the procedure: You should ask a family member or a close friend to accompany you to the hospital and to stay with you throughout the entire surgery.

Mostly the ages of living organ donors are 18 to 60 years old. You will first have an initial screening so the center can ask you several questions regarding your overall health and medical history.

Blood tests will be ordered after the screening to check if you and the recipient have compatible blood types.

Your doctor will now conduct a physical and psychological evaluation to make sure that donating an organ will have minimal risks to your mental and physical health.

You may be disqualified is you have conditions such as cancer, diabetes, heart diseases, infectious diseases, and other conditions. Your doctor will also check if the organ you are going to donate is healthy and working properly.

The center will inform you of all aspects and potential results of organ donation and receive your informed consent to the procedure if you are eligible as a living donor.

They will now discuss the risks and benefits of donating a liver or kidney.

For living kidney donation:

This is a minimally invasive surgery (laparoscopic nephrectomy) that will involve shorter recovery and less pain compared to open nephrectomy or open surgery.

Your surgeon will make small cuts near the bellybutton and uses a special camera called a laparoscope – an instrument used to view the internal organs and guide the surgeon through the procedure – in a laparoscopic nephrectomy.

Five to seven inches of incision will be made by your surgeon on the side of the chest and upper abdomen in an open nephrectomy. To spread the ribs to access the donor's kidney, a retractor will be used.

A general anesthesia will be used for both procedures and the surgery will last up about three hours.

For living liver donation:

Your surgeon will make an incision in your abdomen to remove a portion of your liver, either on the left or right lobe. There may be about 40 to 70 percent of the liver that will be removed.

This is performed with a general anesthesia and lasts up about four hours. After the procedure: You will stay at the hospital up to a week. You will still be monitored by the transplant team.

You will have follow-up visits with your doctor because transplant centers are required to submit follow-up data at six months, 12 months and 24 months after donation.

Your doctor will give your restrictions and advice on how to reduce the risk of complications during your recovery and how to take care of yourself such as managing pain and having a normal diet.

You can go back to your daily activities after two to four weeks after donating a kidney, while two to three months after donating a kidney.

Understanding the results of your living-donor transplant will be made possible by your doctor.

You should carefully think about donating an organ. It is a personal choice that can carry risks and benefits.

After the transplant join a group of organ donors so you can share your experience, educate yourself about the procedure even after it’s already done.