Living Kidney Donation

When someone is waiting for a kidney to be donated by someone who dies, there's no guarantee when — or if — they'll get it. In many cases, it takes years. During that wait, their health may decline.

Living kidney donation offers the best chance for a high-quality kidney without a long wait. We do a careful evaluation to make sure the donation is safe for you. If you qualify, we help your recipient prepare so that the process will be as easy as possible for them. This ensures everyone gets the best results.

A living donor kidney transplant may:

• Begin working immediately and work better. Deceased donor kidneys can take several weeks to start functioning
• Last longer than a deceased donor kidney. (Living donor kidneys typically function for 12–20 years, compared to 8–12 years for a deceased donor kidney)
• Result in a quicker recovery for the recipient — often because they're in better health at the time of transplant than they would be after a long wait
• Shorten, or perhaps even help them avoid, time on dialysis. A preemptive transplant — one that occurs before the person needs dialysis — can lead to better overall health and life expectancy for the recipient

To be considered for living kidney donation, in general you must:

• Agree to quit smoking for at least four weeks before surgery.
• Be in good mental and physical health. Certain health conditions, such as heart disease, hepatitis C, diabetes and cancer can prevent you from being a donor.
• Be older than 18 years of age. 
• Be willing to commit to the physical, emotional and financial challenges of the donation evaluation process, surgery and recovery.
• Donate your kidney voluntarily, free from coercion, pressure or financial gain.
• Have adequate social support to help you during your recovery.
• Ideally have a body mass index (BMI) less than or equal to 35. We evaluate those with a higher BMI on a case-by-case basis.

There are several ways to participate in living kidney donation. You may:

• Give your kidney to a family member, friend or someone you know.
• Make your kidney available to someone you don't know. This is known as non-directed, or altruistic, donation.
• Participate in a kidney exchange program. This may be a good option if you're willing to be a living donor for a loved one, but you aren't a good match for that person.

At BIDMC, we participate in the National Kidney Registry (NKR). The program allows you to swap places with another donor/recipient pair who aren't compatible with each other. You give a kidney to that recipient, and that donor gives their kidney to your loved one.

Possible complications from surgery are minimal. They're similar to complications from any abdominal surgery. They may include, but are not limited to, these issues:

• Allergic reactions
• Bleeding
• Blood clots
• Incisional hernia
• Injury to abdominal organs
• Nerve injury
• Pain
• Pneumonia
• Wound infection

Mental health risks include these and others:

• Feelings of guilt
• Depression
• Generalized anxiety

Living kidney donation is a very safe surgical procedure. Death of a kidney donor is an extremely rare event (about 3 in 10,000 according to large studies).

It's not unusual for people to assume they wouldn't make a good donor. But if you're interested in kidney donation, let us be the judge. Transplant Institute staff determine if you're eligible.

The process begins with a call from our donor nurse coordinator. The coordinator does a brief telephone interview and answers any questions you have. If we determine you're eligible and you still want to donate, we schedule a more in-depth evaluation.

As part of your evaluation, we look at your medical and surgical fitness and perform both lab and imaging tests.

We also consider how social, cultural and environmental factors influence your thinking and behavior. We take your risk for health problems in the future into account, too. Our focus is on making sure it's safe for you to donate and not against your best interests.

First, you complete an online questionnaire. Then you have:

• A 24-hour urine collection to evaluate kidney function.
• A chest X-ray to evaluate the lungs.
• A glucose tolerance test if you're overweight or have a family history of diabetes.
• Blood and urine tests to determine your blood type, blood count, cholesterol levels, possible presence of disease and more.
• Computed tomography (CT) scan to determine if there are any abnormalities in your kidneys or the blood vessels leading to them.
• Consult with the living donor social worker.
• Consult with the nephrologist (kidney doctor).
• Consult with the transplant surgeon.
• Electrocardiogram (EKG) to evaluate your heart.
• Meeting with the ILDA.
• Meeting with the transplant nurse coordinator.

All of the information we learn is confidential. We don't provide it to your potential kidney recipient.

Surgery to remove your kidney is known as donor nephrectomy. It's a major operation. But minimally invasive surgery techniques make the experience much easier to tolerate than traditional open surgeries.

In most cases, surgeons remove your kidney in a minimally invasive procedure called a laparoscopic nephrectomy. They perform the operation while you're under general anesthesia using small incisions and instruments. With smaller incisions, you experience less pain and have less visible scarring. You also recover more quickly and return sooner to your normal activities.

During a laparoscopic nephrectomy, the surgeon:

• Inserts a small tube connected to a camera through a half-inch incision in the middle of your abdomen.
• Makes two more half-inch incisions — usually on the same side as the donor kidney — and passes additional instruments through them to prepare to remove the kidney.
• Makes a 2- to 3-inch incision in your abdomen to remove your kidney.

Once the surgeon removes your kidney, we take it to a nearby operating room and transplant it into the recipient. Your remaining kidney begins to do the work that both your kidneys previously did.

BIDMC's transplant surgeons are particularly skilled in laparoscopic techniques. We perform laparoscopic nephrectomies in one of the medical center's advanced endosuites for minimally invasive surgery.

Rarely, issues such as bleeding, difficult anatomy or safety concerns force us to convert laparoscopic kidney removal to an open procedure that requires a larger incision. Other times, the surgeon may decide before surgery that a laparoscopic approach is not possible. Usually, that's due to your anatomy.

On average, after surgery, you can expect a one- to two-day hospital stay in our transplant unit. You may have some pain, but we manage it with medication. You're likely to feel tired and emotionally drained for a while, as well.

We encourage you to get out of bed and walk as much as possible. With blood and urine tests, we carefully monitor how well your remaining kidney is functioning. It takes most people about four to six weeks to fully recover after donating a kidney. Many living donors return to work in about four weeks. This might be sooner if you have a desk job, or later if you do strenuous physical work.

To protect yourself as you heal:

• Avoid lifting anything heavier than 10 pounds for the first six weeks after surgery.
• Do not get pregnant for the first year after donation. Please discuss any plans for pregnancy with your transplant donation doctor.
• Don't drive until you have stopped your narcotic pain medication. Many donors take these medicines for about two weeks after surgery.

To make sure you are recovering well, we conduct follow-up appointments at these intervals:

• One week
• Six weeks
• Six months
• One year
• Two years