A living kidney donation involves removing one healthy kidney from a volunteer for transplant into a recipient. This process requires a rigorous, multi-phased evaluation to ensure the safety of the donor and the success of the transplant. The testing is comprehensive, confirming the donor is physically and psychologically capable of living a full life with only one kidney. This assessment minimizes risks for the donor while maximizing the long-term benefit for the recipient.
Starting the Evaluation Process
The first step for a potential donor is to contact a transplant center, often a dedicated hospital program. If the donation is directed towards a specific person, the donor should contact the center where the recipient is receiving care. For non-directed or altruistic donation, any transplant center can be chosen.
After initial contact, often by phone, the potential donor interacts with a living donor coordinator. This coordinator manages the entire evaluation and guides the donor through the first formal step: completing a detailed health and psychosocial screening questionnaire. This questionnaire is usually submitted online or over the phone and gathers information about the donor’s medical history, lifestyle, and motivation.
Initial Medical Screening and Basic Eligibility
The initial screening uses simple, non-invasive criteria to quickly identify major health conditions that would immediately prevent donation. One of the first compatibility checks involves blood samples for ABO blood typing to determine if the donor and recipient’s blood types are compatible. While incompatible pairs can still donate through paired exchange programs, this initial test determines the direct match potential.
General health requirements dictate that donors must be at least 18 years old, though some centers require a minimum age of 21. Potential donors are screened for major chronic illnesses, such as uncontrolled high blood pressure, active cancer, or diabetes. A Body Mass Index (BMI) above 35 may also be a disqualifying factor, as it can increase surgical risk and future health complications. These initial checks act as a basic eligibility filter.
Comprehensive Medical Testing and Diagnostic Imaging
Once initial eligibility is confirmed, the potential donor moves into extensive medical testing designed to confirm long-term health with a single kidney. Advanced blood tests are performed, including tissue typing, also known as Human Leukocyte Antigen (HLA) matching. HLA typing identifies genetic markers on white blood cells to assess immune system compatibility between the donor and the recipient, which directly impacts the likelihood of organ rejection.
The evaluation includes a 24-hour urine collection to measure creatinine clearance and total protein, providing a detailed assessment of baseline kidney function. Blood work also screens for infectious diseases that could be transmitted to the recipient, such as HIV and various forms of Hepatitis. Cardiovascular health is thoroughly assessed with an electrocardiogram (EKG) and, depending on age or health history, may include a stress test or echocardiogram.
Specialized diagnostic imaging is performed to visualize the donor’s kidneys and vascular structures. This often involves a Computed Tomography (CT) angiography or Magnetic Resonance Angiography (MRA). These scans provide surgeons with a detailed map of the renal arteries and veins, helping them plan the safest surgical approach and confirm the anatomy is suitable for donation. Additional health screenings, such as a mammogram and Pap smear for women, or a colonoscopy for older donors, may be required to ensure all preventative care is current.
Review, Approval, and Final Steps
After all medical and diagnostic information is collected, the potential donor’s case is presented for a comprehensive review by a multidisciplinary team. This team includes transplant surgeons, nephrologists, social workers, and an independent donor advocate whose role is to protect the donor’s interests. The team reviews the data to confirm the donor is in excellent health and that the donation will not pose an unacceptable long-term risk.
A psychosocial evaluation is also conducted by a social worker or psychologist to ensure the decision to donate is voluntary, fully informed, and that the donor has adequate emotional support. The donor advocate ensures the potential donor understands the risks and benefits without coercion or pressure. This group collectively determines if the donor is medically and psychologically suitable for the procedure.
If the donor is approved, the transplant team will inform them confidentially before notifying the recipient. The final steps involve a detailed education session and scheduling the surgery at a time that works for both parties. The donor is also required to provide a final blood sample close to the surgery date to confirm compatibility and screen for any last-minute changes.