Living kidney donation is the selfless act of a healthy person giving one of their two functioning kidneys to an individual suffering from end-stage renal disease. Receiving a kidney from a living donor provides the recipient with a shorter wait time, a scheduled surgery date, and generally better long-term outcomes for the transplanted organ. The process begins with a formal inquiry to a transplant center, which initiates a comprehensive evaluation to ensure the donation can be performed safely.
Initial Screening and Basic Health Requirements
The first step for any interested individual is to contact an accredited transplant center to begin a preliminary screening process. A potential donor must be an adult, with most centers requiring a minimum age of 18. General health status is assessed to confirm the donor is fit for major surgery and can live a healthy life with only one kidney. Contraindications include active or recently treated cancer, severe heart disease, or uncontrolled high blood pressure or diabetes. Potential donors are also assessed for a body mass index (BMI) often below 35, as higher levels can increase surgical risk.
The Full Medical and Psychological Assessment
The comprehensive evaluation is a multi-disciplinary process designed to protect the donor’s long-term health and confirm the donation is a voluntary choice. Blood testing, including a complete metabolic panel and liver function tests, assesses overall organ health and screens for infectious diseases like HIV and Hepatitis. Specific kidney function is measured using a 24-hour urine collection to calculate the glomerular filtration rate, confirming the remaining kidney will be able to perform its function adequately after the donation.
Detailed anatomical imaging, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI), visualizes the kidneys and their associated blood vessels. These scans help the surgical team determine the size and structure of both kidneys and decide which kidney can be safely removed. Cardiac health is also reviewed, often including an electrocardiogram (EKG) and potentially a stress test, to ensure the heart can withstand the demands of surgery.
A psychosocial evaluation is a mandatory component, generally conducted by a social worker or psychologist, focusing on the donor’s emotional well-being and motivation. This assessment confirms the decision to donate is informed, voluntary, and free from any form of financial coercion or undue pressure. Many transplant centers also provide an Independent Donor Advocate (IDA) who is separate from the recipient’s medical team and whose sole responsibility is to represent the donor’s interests.
Understanding Recipient Matching Options
The logistical path of the donation depends on the relationship between the donor and the intended recipient, which falls into three main categories.
Directed Donation
This is the most straightforward option, where the donor names a specific recipient, such as a family member or friend. This is possible even if the donor and recipient have incompatible blood types, due to medical advancements like desensitization protocols.
Non-Directed or Altruistic Donation
If a potential donor does not have a specific recipient, they can choose this option, where the kidney is given to a stranger on the national waiting list. This type of donation often initiates a chain in a paired exchange program, maximizing the number of transplants that occur.
Paired Kidney Exchange
This option is utilized when a willing donor and their intended recipient are incompatible, usually due to blood type or tissue cross-match issues. In a paired exchange, the incompatible donor-recipient pair is matched with another incompatible pair. The donors then swap recipients, allowing both people in need to receive a compatible kidney. These exchanges can involve a simple swap or grow into a complex chain involving multiple pairs.
The Surgical Procedure and Post-Donation Recovery
The surgical procedure to remove the kidney is called a donor nephrectomy, and it is performed using a minimally invasive laparoscopic technique. This approach involves the surgeon making several small incisions in the abdomen to insert specialized instruments and a camera. A slightly larger incision is then made to safely remove the organ. Laparoscopic surgery is preferred because it reduces pain, minimizes scarring, and accelerates the recovery timeline compared to older, open surgical methods. The operation generally takes between two and three hours under general anesthesia.
Following the procedure, the donor can expect a hospital stay of two to three days. Recovery continues at home, where donors are advised to avoid lifting anything heavier than ten to twenty pounds for four to six weeks to allow the internal incision sites to heal properly. While most donors can return to light, non-physical work within two to three weeks, a full return to all normal activities usually takes six to eight weeks. Follow-up appointments are scheduled for at least two years post-donation to monitor the function of the remaining kidney.