Living kidney donation offers a life-saving option for individuals with end-stage renal disease, providing an organ that typically functions longer than one from a deceased donor. The process involves a comprehensive and deliberately rigorous series of evaluations. The primary objective of this extensive testing is to ensure the long-term health and safety of the donor, which takes precedence over the recipient’s need. This multi-phase assessment ensures the donor remains healthy for the rest of their life with only one kidney.
Initial Screening and Eligibility Criteria
The first step for a person interested in donating is contacting a transplant center to begin a preliminary evaluation. This initial screening acts as a necessary filter, quickly identifying individuals who do not meet the baseline health requirements for major surgery. The process typically starts with a detailed health questionnaire or a phone interview conducted by a transplant coordinator. Potential donors must generally be between 18 and 65 years old and possess excellent overall health with no major systemic diseases. Absolute contraindications usually include uncontrolled diabetes, active or recent cancer, active infections, and significant heart or lung disease. Body Mass Index (BMI) is also considered, with many centers setting a limit, often a BMI of less than 35, to reduce surgical and long-term health risks. Individuals who smoke are typically required to quit for a specified period before being considered for donation. This early phase aims to prevent the expenditure of time and resources on deeper testing for those who are clearly medically ineligible. The information gathered includes a thorough review of past medical history, family history of kidney disease, and any history of substance abuse.
Comprehensive Health and Compatibility Testing
Once a person passes the initial health review, they move into the first major phase of medical testing to confirm general health and assess compatibility with the recipient. This phase involves extensive laboratory work, beginning with fundamental blood tests to check blood type compatibility. While a direct match is preferred, modern transplant programs can often facilitate donation through paired exchange programs even if blood types are incompatible.
Compatibility Testing
A Human Leukocyte Antigen (HLA) typing test analyzes genetic markers on white blood cells to assess tissue compatibility. A better HLA match can lead to a more successful transplant, though a perfect match is not mandatory. A cross-match test is also performed, mixing the donor’s and recipient’s blood samples to see if the recipient has pre-formed antibodies that would attack the donor kidney. A positive cross-match rules out the donation.
General Health Screening
Screening for infectious diseases is required, involving blood tests for viruses such as HIV, Hepatitis B, and Hepatitis C. These checks ensure no transmissible diseases are passed to the recipient, who will be taking immunosuppressant medication. A complete metabolic panel, complete blood count, and liver function tests are conducted to confirm the donor’s baseline systemic health is robust enough for major surgery.
Detailed Organ Function and Specialist Review
This phase focuses specifically on the health and capacity of the donor’s two kidneys and related vascular structures.
Kidney Function Assessment
A primary test is the calculation of the Glomerular Filtration Rate (GFR), which measures how well the kidneys are filtering waste from the blood. The GFR must be within an acceptable range to confirm the remaining kidney will function optimally for the donor’s entire life. To obtain a precise measure of kidney function, a 24-hour urine collection is often required to calculate creatinine clearance and check for excessive protein excretion, which could indicate underlying kidney disease.
Imaging and Specialist Clearance
The transplant team will order various imaging studies, such as a CT angiogram or an MRI, to map the kidney’s anatomy and blood supply. These images help the surgeon determine the best kidney to remove, ensuring the donor is left with the healthier organ, and identifying any complex vascular structures that might complicate the surgery. A specialist review is mandatory, often including cardiology clearance to assess heart health, sometimes involving an electrocardiogram (EKG) or stress test. Female donors may require age-appropriate cancer screenings, such as a mammogram and Pap smear. These consultations ensure that all organ systems are thoroughly evaluated and cleared for the physiological stress of the donation procedure.
Psychosocial Assessment and Final Approval
The non-medical component of the evaluation centers on the donor’s mental and emotional well-being. A required psychological evaluation ensures the potential donor understands the risks and benefits of the procedure and is making an informed decision. This process confirms that the donation is altruistic and free from coercion or undue pressure, such as financial incentive.
Financial and Social Support
Financial counseling clarifies which costs are covered, typically by the recipient’s insurance, and which are not. While medical expenses directly related to the donation are covered, donors are generally responsible for non-medical expenses like lost wages, travel, and childcare. The social worker assesses the donor’s support system, coping strategies, and potential psychosocial impact of the donation and recovery period.
Final Clearance
The final decision to approve a donor is holistic, made by the transplant center’s multidisciplinary team, often with the input of an Independent Living Donor Advocate (ILDA). The ILDA’s role is to safeguard the donor’s interests throughout the entire process, ensuring they are protected and have an independent voice. Once all medical, surgical, and psychosocial clearances are complete, the donor is officially approved, and the surgery can be scheduled.