Understanding a Kidney Match
Becoming a kidney donor involves a biological evaluation to ensure compatibility between the donor and recipient, which is important for transplant success. Key factors include blood type compatibility, tissue typing, and crossmatching to minimize the risk of organ rejection. These assessments help determine if the recipient’s immune system will accept the donated kidney rather than attack it as a foreign body.
Blood type, or ABO compatibility, is the first consideration. Donors with O blood are universal donors, able to donate to recipients with any blood type, while AB blood type recipients can receive a kidney from any donor. If blood types are incompatible, specialized procedures like ABO-incompatible transplants or paired kidney exchange programs can facilitate donation. Paired kidney exchange programs involve incompatible donor-recipient pairs swapping kidneys with other incompatible pairs to find compatible matches.
Tissue typing, also known as HLA (Human Leukocyte Antigen) matching, assesses genetic markers on white blood cells. While a perfect HLA match is not always necessary, a closer match is associated with better long-term transplant outcomes. A crossmatch test further evaluates compatibility by mixing samples of donor and recipient blood to check for antibodies in the recipient that could attack the donor’s kidney. A positive crossmatch indicates incompatibility and would lead to immediate rejection of the organ.
Starting the Donor Evaluation Process
Individuals considering living kidney donation contact a transplant center for evaluation. This process begins with preliminary screening, through questionnaires on medical history, lifestyle, and motivations. These initial inquiries help determine if a prospective donor meets basic health criteria and understands the commitment involved.
An independent donor advocate (IDA) plays an important role early in this process, providing objective support and protecting the donor’s rights. The IDA functions separately from the recipient’s medical team, offering confidential guidance and information about the evaluation process, surgical procedure, and necessary follow-up care. This assessment confirms the decision to donate is voluntary and free from coercion.
Comprehensive Medical Assessment
Following initial screening, prospective kidney donors undergo a comprehensive medical assessment to ensure suitability for surgery and long-term health. This evaluation includes a range of blood tests to assess overall health, kidney function, and detect any underlying conditions. Tests cover metabolic panels, liver function, lipid levels, blood sugar (Hemoglobin A1c), and screen for infectious diseases like HIV, hepatitis, and CMV. Blood samples also determine clotting mechanisms and baseline glomerular filtration rate (GFR).
Urine tests screen for kidney disease, urinary tract infections, and protein excretion. Imaging studies provide detailed views of the kidneys and surrounding structures. Imaging includes chest X-rays for lung and heart health, and CT or MRI scans of the kidneys for abnormalities like cysts or tumors. A renal scan may be performed to assess the function of each kidney individually.
Cardiac evaluations, such as an electrocardiogram (EKG), a stress test, or echocardiogram, are performed to ensure the donor’s heart is healthy enough for surgery. A psychosocial evaluation is a required component, assessing the donor’s mental health, motivation, and ability to make an informed decision, and identifying potential pressures. This assessment confirms the donor’s physical and psychological well-being before donation.
The Kidney Donation Surgery
The kidney donation surgery, known as a nephrectomy, is performed using a minimally invasive laparoscopic approach. Small incisions allow insertion of a camera and specialized instruments to remove the kidney. Carbon dioxide gas is used to inflate the abdominal cavity, providing the surgeon with a clearer view and working space.
Once the kidney is detached, it is placed in a protective bag and removed through a slightly larger incision below the navel. This laparoscopic method results in less post-operative pain, a shorter hospital stay, and quicker recovery than traditional open surgery. Most living kidney donors remain in the hospital for one to two days after the procedure.
The recipient’s transplant surgery occurs concurrently with the donor’s nephrectomy. Immediately following the donation surgery, donors may experience tenderness, itching, or pain at the incision sites, and fatigue or gastrointestinal upset. Donors are advised to avoid heavy lifting for several weeks for healing.