Living kidney donation - Questions & Answers

Who can donate?

Donors are often a close relative such as a parent, brother or sister, son or daughter but may also be individuals who are not related but have an established emotional relationship with the recipient such as a partner or close friend. Sometimes a donor and a recipient may be incompatible with each other because of blood group or tissue-type and in this case it may be possible for them to be paired with another donor and recipient in the same situation. This means that each recipient will benefit from a transplant that they would otherwise not have had (this is called paired donation). Where more than two pairs are involved in the swap it is called pooled donation. Donors may also offer to give a kidney to someone who is on the waiting list for a transplant but whom they have never met before (this is called non-directed altruistic donation).

What is the age range for being a donor?

In England, Wales and Northern Ireland, there is no minimum age limit specified within the Human Tissue Act 2004 for a person to be considered as a living kidney donor. However, the majority of donors will be over the age of 18 years and children would only be considered in very exceptional circumstances. In Scotland, only people over 16 years of age can be legally considered as living kidney donors.

How will I know if I am suitable to donate?

You will have a thorough medical and surgical and psychological assessment to establish that you are fit and healthy to donate. A number of people who wish to donate find that they are not able to do so because health problems are discovered through the assessment process. Members of the healthcare team involved in your assessment include counsellors, co-ordinators and social workers.

Are there any risks to me?

All operations carry some risk and this is no different for living donation. Donors are at risk of infections (eg chest, wound or urine) and, more rarely, bleeding or blood clots. There is a very small risk of death for the donor: this is estimated at 1 in 3,000 for this operation.

Are there any long-term risks?

There is a small possibility of a slight rise in blood pressure and excess protein in your urine. However studies have shown that there is no long-term effect on the health of the donor or your remaining kidney.

Am I at greater risk of developing kidney failure?

You are at no greater risk of developing kidney failure after donating than anyone in the general population.

Will it shorten my lifespan?

Studies have shown that donors live longer than the average population. This is because donors are selected on the basis of good health and are thoroughly screened prior to donation.

Will I have to change my lifestyle after donating?

No. You should lead a normal healthy life as before.

Will donating my kidney affect a future pregnancy or fathering a child?

The small amount of data available shows that, having donated one kidney, there is no evidence to suggest an increased risk of complications during pregnancy. A man’s fertility will not be affected.

Will I be covered by my health insurance?

You should check with your insurance company.

What if I live in a different part of the UK from the person I am donating to?

You can still donate. The transplant team can arrange for your donor assessment to take place at a hospital near you if that is more convenient for you. Usually the donation will take place in the hospital where the person you are donating to is cared for. However, different arrangements can be made depending upon individual circumstances for both the donor and recipient.

What if I live overseas?

You can still donate. Some preliminary tests can be arranged in your own country to see if you will be a suitable donor.

What are the religious views on living donation?

Most religions support living donation as they view it as a gift to a loved one. If you have any doubt, you should contact your religious leader.

How long does the donor assessment process take?

In general, this will take at least three months. There is variation depending upon where you live and what tests you may require. Wherever possible, the assessment is tailored to your needs and commitments.

How much time will I need to take off work?

Most transplant centres will try to arrange the tests and investigations before the operation around your work schedule to minimise disruption to your job. It is sometimes possible to arrange for some of this to be done locally if the donor lives a long way from the transplant centre. The operation and recovery period varies from 2 - 12 weeks depending on surgery, your individual recovery and the type of work you will be resuming.

How will I be able to afford time off work?

You should discuss this with your employer and find out what is available under your (their) terms of employment around Statutory Sick Pay. You may be eligible for reimbursement of loss of earnings and costs. However, reimbursement is at the discretion of the recipient’s health care providers. You will need to discuss this with your transplant team.

What if I am in receipt of a benefit such as job seeker’s allowance?

You should take advice about this by contacting your local Citizens Advice Bureau.

How is the kidney removed?

You will be given a general anaesthetic which means that you will be asleep during the operation. Traditionally in the UK, the kidney is removed by making an incision in the side or abdomen (tummy) which is known as the "open" technique. Increasingly, keyhole surgery is used to remove the kidney and this is also available in a number of transplant centres in the UK.

How long will the operation take?

The operation takes approximately two hours and you will have a urinary catheter and a drip when you return from theatre.

How long will I be in hospital?

This varies depending on your individual recovery. The average stay is four to ten days.

Will I experience a lot of pain?

Strong pain relief will be provided to help alleviate pain and discomfort after the operation.

Will I need to take any medication after donating?

You will need to take some painkillers immediately after the operation and during the recovery period. You may also be prescribed antibiotics for a short period if you need them. However, you will not need any long-term medication as a result of kidney donation.

What about follow-up?

You would usually be seen by the transplant team between two and six weeks after donation. We recommend that you attend an annual follow-up appointment, if you wanted this, for the rest of your life.

Do some donors have trouble making the decision?

Some people make the decision easily. Others go through some soul searching before deciding. Being afraid of donating a kidney or feeling guilty about not wanting to donate is quite normal. The only “right” decision is the one that makes you, the potential donor, feel comfortable. Finding out more information about living donation and what it involves may help you with this decision.

Can I speak to somebody who has donated?

Your co-ordinator at your local transplant centre should be able to arrange this for you.

Suppose I decide against being a donor?

You have the right to withdraw your offer at any time and you would be supported in your decision by the transplant team.

Who makes the final decision?

Once all the tests have been completed and found satisfactory by the transplant team, a date is set for the operation. The transplant will only take place if both the donor and recipient are willing to proceed.

Will the transplant be successful?

There is no guarantee that any kidney transplant will work. However, living kidney transplantation is overwhelmingly successful with 90-95% of live donated kidneys working well at one year. This compares with a success rate of 85-90% for kidneys from deceased donors.

What is the first thing I should do if I am thinking about being a donor?

If you know the person who you are considering donating to, you will need to contact the hospital/transplant centre where the intended recipient is cared for. The first piece of information we would need to know is your blood group to see if it is compatible with your recipient. After this an appointment will be arranged for more detailed discussion and initial blood tests. If you do not know who the intended recipient might be, the best thing to do is to contact your local transplant centre for further advice.

What governs living organ donation in the UK?

In England, Wales and Northern Ireland the Human Tissue Act 2004, and in Scotland the Human Tissue (Scotland) Act 2006, provide the legal framework for organ and tissue donation in the UK. The Human Tissue Authority is the regulatory body that is established under the Acts to ensure that there is no coercion, pressure or payment involved in the donation of organs, which is illegal in the UK. The Authority must approve all donations from living donors and all donors will be assessed by an Independent Assessor as a routine part of the evaluation process to ensure that all the legal requirements are met.

Sources:

UK Living Donor Kidney Transplantation, BTS & Renal Association, 2nd Edition, April 2005.

Living Donor Kidney Transplantation: Your Questions Answered, Gift of Life, 2005

Information about living donor transplants, Human Tissue Authority, 2006

Waiting Time on Dialysis as the Strongest Modifiable Risk Factor for Renal Transplant Outcomes, Meier-Kreische, H-U, Kaplan, B. Transplantation, vol. 74, 1377-1381, no.10, November 27, 2002

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