FAQ: Living Kidney Donor

Most kidneys for transplant are from people who have died and whose families give permission for organ donation. But there aren't enough of these organs for everyone who needs one. Nationally, more than 70,000 patients are on the kidney transplant waiting list, and more are added each year.

Living donor kidney transplants are an important option. They're possible because we're born with two kidneys. When surgeons remove one of the donor's kidneys, the remaining kidney grows slightly to compensate for the loss of the other and the kidney can function normally.

Here are some questions and answers about living donor kidney transplants:

Evaluation

• What are the requirements to become a living donor?
• Must I be related to the recipient?
• Will the recipient be removed from the cadaver kidney waiting list while I'm evaluated?
• What are the first steps of the evaluation?
• What else does the evaluation involve?
• Is my evaluation covered by medical insurance?
• Is donor information confidential?
• When will I be told if I can be a donor?
• If I'm approved as a donor, when will the transplant take place?
• How should I prepare for the surgery?
• What should I bring with me to the hospital?
• How is my kidney removed?
• Will I require a blood transfusion?
• What are the possible complications?
• How long will I be in the hospital?
• Will I have a scar after the surgery?
• Will I have pain after the surgery?
• Will I have a normal life after surgery?
• How long is the recovery?
• Am I be entitled to disability pay?
• Will I have to return to the hospital for check-ups?
• Will I need medications or care at home after surgery?
• When will my sutures be removed?
• When can I resume normal activities?

What are the requirements to become a living donor?

Generally, donors should be between the ages of 18 and 65 years old. You should not have any major medical or psychiatric illness and you must not be pregnant. You should not be overweight, although you may still be a potential donor if you lose weight. If you smoke, you must quit for six weeks prior to surgery. You also must understand the risks of this surgery and comply with instructions for follow-up medical care.

Must I be related to the recipient?

No, it's not necessary to be related to the recipient. The relationship between donor and recipient also doesn't appear to affect the amount of anti-rejection medication the recipient needs after transplant.

Will the recipient be removed from the cadaver kidney waiting list while I'm evaluated?

No changes are made to the recipient's status on the waiting list while you're being evaluated.

What are the first steps of the evaluation?

Know your blood type. You must be either the same blood type as the recipient or blood type "O." Your Rh factor — positive (+) or negative (-) — does not affect your ability to donate.

Then, call the UCSF Transplant office at (415) 353-1551 and ask for the Living Donor Kidney Transplant Program coordinator. We will conduct a brief health screening over the phone. We will send you a medical questionnaire to complete and return and ask you to confirm your blood type. The questionnaire will identify any medical problems that could influence our decision to proceed with further testing. Please take your time to complete the questionnaire to ensure accuracy. Some questions, such as family history, may require the help of other family members. Other questions, such as smoking, alcohol or drug history, can be sensitive.

Please be truthful. Hiding information may be dangerous to you or the recipient. The questionnaire is confidential. Only the health professionals on the transplant team will use this information. It will not be shared with the recipient or others.

What else does the evaluation involve?

We will need blood and urine test results, a chest X-ray and an electrocardiogram (ECG or EKG). If these tests suggest that you could be a donor, an intravenous pyelogram and renal arteriogram will be performed to ensure you have two healthy kidneys.

A pyelogram is an image of the ureter and renal pelvis made by introducing a radioactive material intravenously. An X-ray image made while the material is excreted provides important information. An arteriogram is a similar image made of the renal arteries. Other tests may be necessary.

The purpose of the evaluation is to make sure your kidneys are normal and that you don't have any medical or psychiatric illness that would make this procedure risky or difficult. We want to make sure you don't have any medical conditions that could be transmitted to the recipient and to confirm that you're donating voluntarily, without pressure.

The work-up involves a full medical history and physical including cardiovascular and cancer screening. A medical evaluation is done by a doctor who serves as a "donor advocate," with only the donor's interests in mind. None of the tests, procedures or consultations will be scheduled until insurance authorization has been obtained for both the recipient's transplant surgery and the donor's work-up and surgery.

Generally, tests are performed at UCSF Medical Center. Some insurance companies want some tests performed elsewhere but we insist that the crucial tests are done here. If you live outside California, some of the initial evaluation can be done near your home. No matter where the initial testing is done, the evaluation will require visits to UCSF Medical Center.

Is my evaluation covered by medical insurance?

You shouldn't incur any medical expenses related to the evaluation, surgery, hospitalization or immediate post-operative care. These charges are billed to the recipient's insurance company. After you leave the hospital, some insurance carriers for recipients don't cover medical expenses for donors. We insist that donors have their own medical insurance or agreements with the recipients' insurance companies to cover expenses, related to transplant surgery care both in and out of the hospital.

Is the information provided to the transplant team confidential?

Yes. It is important that you feel completely comfortable disclosing all requested information. Anything discussed in the course of the donor evaluation is between the donor and the transplant team. Any information about the recipient that is shared with you as a donor also should be treated as confidential.

When will I be told if I can be a donor?

Generally, we let you know within two weeks of completing the evaluation. Further tests may delay your clearance. It's important that you allow yourself time to digest the information you are reading here and the additional information you will get when you meet with us. The decision to donate your kidney is not one to make lightly. Consider it carefully and discuss it with your family and significant others.

If I'm approved to be a donor, when will the transplant take place?

This decision is made jointly by the transplant team, you and the recipient. The transplant team — particularly the doctors involved in the recipient's care — will determine the best time for the transplant, based on the recipient's medical condition. Once we know this, we will ask for your input and try to accommodate your schedule, if possible.

Unfortunately very little is written in stone. A number of factors could affect our plans. For example, your recipient's condition might deteriorate so that he or she is too sick for a transplant. Or, the recipient or donor might develop an infection or other condition that must be treated before a transplant.

How should I prepare for the surgery?

The medical evaluation of potential living donors is extremely thorough. Once you complete your evaluation and we decide to proceed, there is not much additional testing to be done. If you'd like to donate your own blood in the event you need a transfusion, you should donate a unit of blood two to four weeks prior to surgery. We may need to repeat some blood tests, if they were done more than 30 days before your surgery date. You also must give a blood sample to our blood bank within 72 hours of surgery.

We will ask you, your recipient and your immediate family to attend a final pre-transplant review for any minor tests that may be needed and to answer any remaining questions two to three days before surgery.

To prepare, you also should:

• Stop smoking, even if you're a light smoker. Smokers have an increased risk of cardiovascular and pulmonary complications with any surgery.
• Stop drinking alcohol. If you have a history of heavy alcohol use, it's important that you tell our doctors. You should not return to drinking alcohol after surgery until advised it is safe to do so by the transplant team.
• Avoid aspirin or non-steroidal medications, such as Advil or Motrin, for seven days before surgery. These medications can affect the ability of the blood to clot and put you at higher risk of bleeding. You may take Tylenol, if needed. Women who take birth control pills are advised to stop taking them 30 days before surgery because of increased risk of blood clots after surgery. Continue to take your regular medications until instructed otherwise by your doctor.

You can eat and drink normally until noon the day before the surgery. You will have a liquid diet from noon to midnight then nothing by mouth until surgery. You will take a laxative the day before surgery. If you regularly take any medications, we will instruct you about these when you come in for the final appointment before surgery.

You and your recipient will be admitted to the hospital on the day of the surgery.

What should I bring to the hospital?

Bring only minimal belongings and no valuables. Because we have your insurance information, there is no need to bring any documentation with you unless we specifically request it. Leave all jewelry and other valuables at home or give them to your family for safekeeping. You may want to bring a basic toiletry bag for your use in the hospital.

How is my kidney removed?

The kidney is removed one of two ways — an open incision on the side of the abdomen or several small incisions with the aid of a scope and camera, called a laparoscope. The open incision technique has been the standard for the last 35 years and involves a five to seven inch incision on the side, division of muscle and removal of the tip of the 12th rib. The operation typically lasts three hours and recovery in the hospital averages four to five days with time off work of six to eight weeks.

The newer technique, using the laparoscope, was first used at our center in 1999 and involves four half-inch incisions on the left or right side of the abdomen. These small cuts are used to introduce special instruments that dissect the kidney. In the final step, a 3.5-inch cut is made on the lower abdomen (at the "bikini line") for removal of the kidney. This technique takes about four hours and doesn't require cutting muscle. The usual hospital stay is two to three days, with a potential to return to work in three to four weeks. The amount of pain from the incisions and bloating that occurs after the surgery is typically less in patients that undergo the laparoscopic procedure.

Kidneys recovered with either technique work equally well. We won't know if we can perform the laparoscopic procedure until we take the final X-rays of your kidney.

The operations on the donor and the recipient take place simultaneously, in separate operating rooms.

Will I require a blood transfusion?

Blood transfusion during this surgery is uncommon. As a precaution, we ask you to "donate" one or two units of your own blood before the surgery. If you do need a transfusion, we can use your own blood so you're not exposed to possible risks of a transfusion from someone else. There may be shipping charges if you donate blood at your local blood bank. Often, your insurance provider does not cover these costly charges. Should this be the case for you, arrangements can be made for you to donate the sample at the UCSF Blood Donor Center.

What are the possible complications?

In any surgery involving general anesthesia, there are possible complications of the anesthesia itself including heart complications, stroke and blood clots in the legs or lungs. Risks associated with any operation on the abdomen include bleeding, infection and failure of the wound to heal as well as death. We will discuss these risks in detail during the evaluation.

How long will I be in the hospital?

The average hospital stay for donors is two to five days after surgery.

You will have one or two intravenous lines during and after the surgery so we can give you fluids to keep you hydrated and give you medications. One of these lines may be used to administer your pain medication.

You also will have a catheter or drainage tube in your bladder so we can monitor your kidneys during and after the surgery. Having the catheter in your bladder means you will not need to go the bathroom immediately after surgery. The tubes and intravenous lines are usually removed within two to three days.

As soon as your intestines start to work again after surgery, you will begin to eat and drink. If you're not nauseous after sipping water, you'll progress to clear fluids and then to a regular diet within the next two days.

The kidney recipient is generally on the same floor of the hospital but in a different room.

Will I have a scar?

In most cases, the incision heals quickly, leaving a scar that fades over time but will always be visible. If a wound infection develops, you may be left with a wider scar. Occasionally, patients develop what is called a keloid, the over-growing or over-healing of the skin that results in a raised scar. Keloids can be corrected by plastic surgery if you choose. This corrective cosmetic surgery for the donor is unlikely to be covered by the recipient's insurance.

Will I have pain after the surgery?

Unfortunately, you may have significant pain after this surgery. We will give you pain medication but you will still be very uncomfortable for at least the first week. You will begin to have less pain as each day goes by, but most donors say they have significant discomfort for one to two weeks after surgery. Most pain medications make you drowsy, can effect your breathing and may cause nausea and constipation. We will try to get the right balance of pain medication to make you comfortable, but not drowsy, so you can do deep breathing exercises, cough and walk. A prescription for pain medication will be provided before you leave the hospital for pain control at home.

We use a variety of methods to administer pain medication. You will have what is called a patient controlled analgesia (PCA). With PCA, an intravenous line is attached to a computer-controlled pump. You press a button when you need pain medication, which is administered into your vein. Once you are eating normally, we will switch you to oral pain medication.

Will I have a normal life after surgery?

We expect most patients to return to a normal life within two to three months after surgery, provided there are no serious complications.

How long will it take to recover?

Recovery time will depend in part on whether your kidney is removed by an open incision, which involves a larger incision and longer recovery time of about eight weeks, or by laparoscope, which involves several small incisions and a shorter recovery of about four weeks.

The minimum amount of time you should allow yourself to recover is four to six weeks. Because people recover at different rates, with varying degrees of fatigue and pain, you may need as long as eight to 12 weeks leave from work. We prefer that you allow eight weeks from work to recover, should you need it.

Will I be entitled to disability pay?

If your job provides disability coverage, you most likely will be entitled to disability pay.

Will I need to return to the hospital for check-ups?

We must monitor you very closely at first to ensure your recovery is progressing normally. You must return for a check-up about a week after you leave the hospital. You will need another check-up at four to six weeks and an annual follow-up with a local doctor for the rest of your life.

You should remain close to UCSF Medical Center for at least two to three weeks after surgery and return to UCSF if you experience any problems during your recovery. We recommend that you have a relative or friend stay with you, especially immediately after you leave the hospital.

Will I require special medications or care at home after the surgery?

You will not need any medications except for some pain medication. If you develop a wound infection, you might be prescribed antibiotics. We should not need any medications specifically related to kidney donation in the long term.

Although you will be tired and weak, you should not need any professional nursing care at home. You will need a friend or family member to help with food shopping, perhaps cook your meals, provide assistance if have any difficulties and take you to and from the UCSF clinic for your check-ups.

When will my sutures be removed?

Usually the wound is closed with sutures beneath your skin. These sutures dissolve and do not require removal. Small strips of tape are placed over the external incision and can be removed about one week after surgery.

When can I resume normal activities?

The goal is to be back to normal health within two to three months.

As soon as you wake up after surgery, you'll begin "exercising." You'll take deep breaths and cough to get air into your lungs and prevent pneumonia. You'll exercise your legs by flexing and relaxing them periodically. The day after surgery, you'll be helped out of bed to begin walking.

Walking is very important to your recovery. Each day, you should push yourself a bit more. By walking as soon after your surgery as possible, you will help prevent complications such as blood clots, pneumonia and muscle wasting.

If you feel well, you may slowly return to normal exercise and activities, and build up your strength and stamina. You must avoid heavy lifting for the first four weeks until your abdomen has completely healed.

We advise that you not drive for at least the first two to three weeks after surgery. You must be physically and mentally strong, with normal reflexes and no abdominal pain or discomfort before you drive. If you drive, you should not take any pain medication containing narcotics, such as Vicodan, Percocet or Tylenol with codeine, that can affect your mental alertness.

Refrain from sexual intercourse for a couple of weeks until you have less discomfort and feel stronger. This decision is based on how you feel.

We advise you to wait for a minimum of three months after surgery to resume taking birth control pills and at least six months after surgery before becoming pregnant. It is not yet known if this operation will affect a woman's fertility.

Don't plan any trips outside the United States for at least four weeks and preferably eight to 12 weeks after surgery. If you wish to return to your home in the United States and you have a good local doctor, you may be able to do so within two weeks after the surgery, depending on how you feel and how you're recovering.

If you have any concerns about possible complications, please return to UCSF Medical Center for evaluation and treatment.

Please read this information carefully and discuss living donor kidney transplant with your family and loved ones. If you have further questions, please call the UCSF Transplant Center and speak with the nurse coordinator.