The Living Donor Kidney Program at UF Health Shands Transplant Center enables people to make an informed decision regarding living kidney donation. The program educates potential donors and the public about living donation. The emotional well-being and health of the living donor is our top priority.

Donating a kidney is a precious gift to give and requires careful consideration from donors. The most common reason for donating a kidney is a strong emotional tie with the recipient, but a donor can be a non-directed, unrelated one as well.

All potential donors must be evaluated for donation by a living donor kidney team that functions independently of the transplant recipient’s team. The job of the living donor team is to protect the potential donor’s physical health, psychosocial needs, emotional well-being and personal preferences.

Patient story

Benefits of living kidney donation

There are several important reasons why living donation may be a good option for potential recipients.

• For some transplant candidates, a living donation can be a life-prolonging option. Typically, there is about a three- to five-year wait for a deceased donor kidney. Unfortunately, not all patients will remain healthy for that long and a living kidney transplantation is their only option.
• Living donation provides the following benefits:
• Live kidney donation helps to facilitate preemptive transplantation, or a transplant before the recipient begins dialysis, which is associated with better outcomes for the recipient.
• Being able to schedule surgery at a time that is convenient for donor and recipient helps to ensure that both are prepared, mentally and physically.
• Kidneys from living donors usually have a longer life span.
• Living donor transplant means a shorter waiting time for the recipient, meaning less time on dialysis.
• Kidneys from living donors usually begin to function while the recipient is still on the operating table instead of taking a few days to work. This means less risk for delayed kidney function.

First in Florida, First for Florida

UF Health Shands Transplant Center completed the first kidney transplant in the state of Florida in 1966 and the first living donor transplant in 1969. Since the beginning, the transplant center has provided world-class expertise in the realm of solid organ transplantation. UF Health Shands Transplant Center staff are helping to lead regulatory change and bring more organs to people needing lifesaving organ transplants.

UF Health is the fastest growing transplant program in our country. We have excellent outcomes that exceed the national average based on data from the Scientific Registry of Transplant Recipients (SRTR). It is our goal to help as many patients as possible to receive the gift of life.

Once again, UF Health is leading the way in transplantation with its partnership in the Kidney Paired Donation, or KPD, program. The KPD program is partnered with the Organ Procurement and Transplantation Network, or OPTN, which is managed by the United Network for Organ Sharing, or UNOS.

When you become our patient, we promise to:

• Treat you as the center of our health care plan. You are the most important member of our health care team
• Ensure your care is focused on your needs, values and personal beliefs
• Respect your right to privacy
• Work with you and your personal schedule to make the process as stress-free as possible

Donor selection criteria

Most people over the age of 18 (in some cases, over the age of 21 for altruistic donors) who are in good general health and have normal kidney function and anatomy can become kidney donors.

Similar to getting a blood transfusion, kidney transplantation requires that the donor and recipient have compatible blood types.

• A recipient with blood type A can receive a kidney from a donor with type A and O blood.
• A recipient with blood type B can receive a kidney from a donor with type B and O blood.
• A recipient with blood type AB can receive a kidney from a donor with types A, B, AB, and O blood.
• A recipient with blood type O can receive a kidney from a donor with type O blood.

However, due to the availability of Kidney Paired Donation programs, donor and recipient pairs that are blood type or crossmatch incompatible can “swap” with other pairs. These new compatible pairs now allow each recipient to receive a transplant.

Potential donors should be free of major diseases such as diabetes, high blood pressure, liver disease or severe heart disease. Other history, such as certain cancers, multiple kidney stones, family history of polycystic kidney disease, and obesity (BMI>35) may exclude people from donating. Visit the CDC to calculate your Body Mass Index (BMI)

Testing of the potential donor will ensure there is adequate kidney function, so the donor can survive on one kidney alone. The donor needs to be living in a stable environment with social support and should have medical insurance before donation. The potential donor must be able to demonstrate understanding of the donation process, the risks involved in the surgery and the need for follow-up visits after donation.

Confidentiality

Information about the donor or the recipient will not be disclosed. All interactions with the living donor team are strictly confidential. However, the donor is free to share any information with the recipient regarding the donation process. This is to protect the confidentiality of the donor and maintain the integrity of the living donor program by staying in compliance with the Health Insurance Portability and Accountability Act (HIPAA).

Kidney paired donation

Approximately one-third of patients who need a kidney transplant and come forward with potential living donors will be incompatible with their donor(s) due to blood type or crossmatch. Unfortunately, we cannot transplant a kidney from an incompatible donor directly into these individuals. Through the Kidney Paired Donation Program, options are available to the recipient and potential donor.

The KPD program assists donor/recipient pairs who are incompatible with each other to find another donor/recipient pair with whom they can exchange kidneys, thus enabling two or more transplants to take place.

Two-pair exchange

A Two Pair Exchange occurs when two incompatible pairs “swap” donors to enable two compatible transplants.

Three-pair exchange

A Three Pair Exchange occurs when three incompatible pairs “swap” donors to enable three compatible transplants.

Evaluation

Once the recipient has been evaluated and approved to be placed on the national kidney transplant waiting list, we can start the donor evaluation. The donor team will contact the donor and go over the donation process and the donor application form or questionnaire.

During the donor’s evaluation, he/she will meet with all members of the transplant team.

• The Transplant Nephrologist will take the donor’s detailed medical history and perform a physical assessment.
• The Transplant Surgeon will also take a history but will be looking at the donor’s abdomen to see if there are any scars, masses, hernias or other abnormalities that would not allow for the donation to take place. He or she will also discuss the donor surgery with the donor.
• The Donor Advocate functions independently from the transplant team and ensures that the donor’s rights are protected and that the decision to donate is free from coercion.
• The Living Donor Nurse Coordinator serves as your primary contact by teaching you about the process and answering questions related to donation. He or she will also organize your evaluation, including coordinating the tests and consultations needed for a complete evaluation.

The donor team exists to ensure that the potential kidney donor:

• Is not at high risk for developing kidney disease, usually caused by chronic health problems such as high blood pressure, diabetes, and obesity, either now or in the future
• Does not feel coerced into donating
• Is not assuming psychosocial, emotional or socioeconomic risk by donating

Testing

The donor will undergo the following tests during a medical evaluation (additional tests may be required depending on medical history and findings on physical examination).

• Blood tests: Blood tests are taken to check for infectious diseases, blood count, cholesterol and basic chemistries, which give information on the function of the kidneys/liver. If the donor has a close blood relative with diabetes, the donor may also have a glucose tolerance test, which screens for diabetes.
• Blood typing: The donor and recipient must have compatible blood types. Due to the availability of Kidney Paired Donation programs, donor and recipient pairs who are blood type or crossmatch incompatible can “swap” with other pairs.
• CT Arteriogram: This test involves injecting an intravenous liquid that is visible under X-ray into the blood vessels to view the kidney and its blood supply prior to surgery.
• Cancer screening: This is based on age and the recommendations of the American Cancer Society.
• Chest X-rays: A chest X-ray is performed to screen for lung disease.
• Crossmatching: A blood test is conducted to see if the recipient will react to the donor organ. An antibody is a protein made by the body’s immune system in response to an antigen (a foreign substance like a transplanted organ). Certain antibodies can attack the transplanted organ, which we can predict by mixing donor cells with recipient blood serum, also known as crossmatching. If the crossmatch is “negative,” then the transplant may proceed. This test is performed prior to the transplant.
• Electrocardiogram or EKG: An EKG is performed to screen for heart disease. An exercise stress test may be performed if the donor is 50 years of age or older.
• Nuclear Medicine Renal Scan: This test may be required if there is a question about kidney function on urine tests.
• Psychosocial Evaluation: This is done by the Clinical Social Worker, who also serves as the Independent Living Donor Advocate. This is done to make sure the donor is capable of making the decision to donate and cope with the stress of a major surgery, as well as to assess for any social or mental health issues that may affect recovery.
• Renal ultrasound: Assesses the donor’s kidney for abnormalities.
• Tissue typing: This blood test checks the tissue (HLA) match between the donor and recipient cells. Tissue typing between the donor and recipient does not need to match to have a successful transplant.
• Urine tests: Urine samples are collected for 24 hours to assess the donor’s kidney function. A single sample is also obtained to check for protein and infection in the urine. Special 24-hour urine testing is done if the donor has a history of kidney stones.

Costs and financial assistance

Most recipients’ insurance pays for the evaluation, surgery, hospital stay and initial follow-up care of living organ donors. The donor would have to make a minimum of two trips to the transplant center, one for the evaluation and one for the surgery. Insurance rarely pays for donor travel expenses.

About the surgery

Once the donor evaluation is completed, the donor’s case will be discussed at the Donor Board meeting for approval. Once the case is approved, surgery can be scheduled.

The surgeons and nephrologists decide which kidney to donate based on the kidney function, size, any abnormalities and anatomy. The better kidney stays with the donor.

The types of surgery that living kidney donors undergo to remove their kidney has evolved significantly over the past 50 years.

Laparoscopic donor nephrectomy is a minimally invasive surgery that uses a camera called a videoscope and other instruments to remove the kidney through small incisions. This type of surgery has several benefits over open nephrectomy, including a faster recovery time, shorter hospital stay and less post-operative pain.

Hand-assisted laparoscopic donor nephrectomy

UF Health predominately uses the hand-assisted laparoscopic nephrectomy. In this procedure, one of the incisions is slightly larger to be able to accommodate the surgeon’s hand, which allows the surgeon to use one hand to feel the kidney and surrounding areas. Once freed, the kidney is then removed by hand through the incision.

Potential risks and complications

Kidney donation is generally very well-tolerated. Kidney donors on average live much longer than the general population, but this is because we only use very healthy donors. After donation, the lifetime risk of needing dialysis is slightly higher for donors compared with very healthy people who do not donate, but it still well below the lifetime risk for the general population.

However, rare surgical, medical, psychosocial and financial risks are possible. These risks may be temporary or permanent and can include, but are not limited to, the following:

• Bleeding necessitating conversion to open surgery;
• Blood clots, wound infection, incisional hernia;
• Scars, pain, fatigue and other consequences typical of any surgical procedure;
• Decreased kidney function (25-35% overall loss of function);
• Developing abdominal or bowel symptoms such as bloating and nausea and developing bowel obstruction;
• Kidney failure and the need for dialysis or kidney transplant;
• Death in one out of 3,300;
• Difficulty obtaining, maintaining or affording health, disability and life insurance. Future health problems experienced by living donors following donation may not be covered by the recipient’s insurance;
• Need for lifelong follow-up with the living donor’s primary care physician annually;
• Psychosocial risks, including feelings of emotional distress or bereavement, if the transplant recipient experiences graft failure or disease recurrence.

Recovery

Most living kidney donors will be in the hospital for one to three days after their surgery. During this time, they will have a foley catheter (tube in the bladder) to accurately measure their urine output. Also, our team will make sure that donors have adequate pain control and blood clot prevention measures during the immediate post-operative period. Early ambulation, coughing and deep breathing exercises are encouraged to minimize complications related to surgery. Progressive diet and stool softeners will be provided to aid with comfort.

The most common complication experienced by donors is tenderness, itching, and/or pain associated with the gas used to inflate the abdomen, and/or pain at the site of the surgical incision(s). Donors may also experience gastrointestinal upset. Two weeks after surgery, the donor will be seen in our clinic for an exam to make sure everything is going well and that their body is adjusting to having one kidney. During this visit, the surgeon will review activity restrictions. At two weeks and when no longer taking narcotic pain medicine, the donor can resume driving. Donors should not lift anything heavy (greater than 10 pounds) for about four to six weeks after the surgery. Most donors who work in an office setting return to work within two to three weeks of the donor’s surgery. Donors with more physically demanding professions generally need four to six weeks of recovery before returning to that type of work.

Symptoms such as fever, bleeding, severe pain, bulging or swelling of incision site, and any urinary symptoms like decreased urine output or blood in the urine are alarming symptoms and require medical attention. It is important that these are reported to the medical team to ensure proper treatment.

Follow-Up After Donation: Transplant Centers are required to follow living kidney donors for two years after their surgery. Certain information about the health of the donor must be submitted to the United Network for Organ Sharing, as required by transplant regulations. Donors may see their own primary care physician, who can then forward the pertinent information to the transplant center. We will be contacting donors at six months, one year and two years after donation to collect required data. Donor follow-up is essential to enable the transplant community to assess the true risk of donor complications.

At UF Health, our team is available 24 hours a day for any questions or concerns or any medical issues that require immediate attention.

Resources

• UF Health Shands Transplant Center
• United Network for Organ Sharing
• Transplant Living
• OPTN Kidney Paired Donation Program
• National Kidney Registry
• National Kidney Foundation
• National Living Donor Assistance Center (NLDAC): NLDAC is available to those who qualify to help remove financial barriers to donation.
• American Transplant Foundation (ATF): The ATF helps to provide monetary assistance to prevent financial trouble for giving the “Gift of Life.”