Living Kidney Donor Transplant

As with any major operation, there is a chance of complications. However, kidney donors have the same life expectancy, general health and kidney function as non-donors. Donating a kidney doesn't affect a woman's ability to have children. Any healthy person can safely donate a kidney.

Having a living donor benefits patients in several ways:

Better long-term results

Shorter wait time until transplant

Ability to plan surgery at a convenient time

Lower risk of complications or organ rejection and better early function of the transplanted kidney

Donor Eligibility and Evaluation

Potential donors must meet certain criteria to be considered. They must be at least 18 years old (with the exception of emancipated minors) and must not have any of the following:

• Uncontrollable hypertension
• History of pulmonary embolism or recurrent thrombosis (blood clots)
• Bleeding disorders
• Uncontrollable psychiatric illness
• Morbid obesity
• Uncontrollable cardiovascular disease
• Chronic lung disease with impairment of oxygenation or ventilation
• History of melanoma
• History of metastatic cancer
• Bilateral or recurrent kidney stones
• Chronic kidney disease of stage 3 or less
• Proteinuria, or high levels of protein in the blood (more than 300 mg/d, excluding postural proteinuria
• HIV infection

The donor must be in excellent health, well informed about transplantation and able to give informed consent. Before donating a kidney, the person must successfully complete a full medical, surgical and psychosocial evaluation.

The evaluation will include tests to ensure that the donor and recipient have compatible blood and tissue types. Some patients have several family members who are compatible potential donors. In other families, none are suitable. UCSF offers several programs to help patients with willing but incompatible donors (see "Special Programs for Living Donor Kidney Transplantation," below).

Laporoscopic (Minimally Invasive) Donor Surgery

UCSF has been using a minimally invasive procedure, called laparoscopic donor nephrectomy, to remove kidneys from living donors since 1999. We have performed hundreds of these procedures, making our program one of the most experienced in the country.

In a laparoscopic donor nephrectomy, the surgeon uses very small incisions, a thin, flexible scope equipped with a camera to view inside the body, and wand-like instruments to remove the kidney. Compared to the kidney donation procedure used in the past, laparascopic surgery has several advantages for donors:

• Decreased need for strong pain medications
• Shorter recovery time in the hospital
• Quicker return to normal activities
• Very low complication rate

The operation usually takes three hours. Most patients require a hospital stay of only two to three days and return to work within three to four weeks.

In some cases, due to the donor's individual anatomy, the surgeon decides to perform traditional open kidney donation surgery instead. This procedure was standard for removing a living donor's kidney before the laparascopic technique was developed.

The traditional open procedure involves making a 5- to 7-inch incision on the flank, dividing the muscle and removing the tip of the twelfth rib. The operation typically takes three hours. Donors remain in the hospital four to five days on average, and return to work in six to eight weeks.

The technique used does not affect the quality and function of the donated kidney.

Donor Follow-Up Care

After discharge from the hospital, the donor receives follow-up care in the transplant clinic. Donors who live outside the San Francisco region should stay in the area for at least a week after discharge.

Donors don't need medication or special diets once they recover from surgery. They do need lifelong monitoring of their overall health, blood pressure and kidney function.

Special Programs for Living Donor Kidney Transplantation

Many patients have family members or friends who wish to donate a kidney but are not able to because their blood type or tissue type doesn't match the recipient.  In such cases, the donor and recipient are said to be "incompatible." UCSF offers several programs to help these patients receive a kidney.

Live Donor to Deceased Donor Waiting List Exchange

This program allows living donors to help their friend or loved one receive a kidney, even though they're incompatible.

Here's how it works: The donor gives a kidney to another patient who has a compatible blood type and is at or near the top of the waiting list to receive a deceased donor kidney. In exchange, the donor's relative or friend takes the recipient's place on the deceased donor waiting list.

For example, if the donor's kidney went to the patient in the fourth spot on the deceased donor waiting list, the donor's friend or relative would move to the fourth spot on the list for his or her blood group, and would receive kidney offers once at the top of the list.

Paired Exchange Kidney Transplant or "Family Swap"

This program is another way for a living donor to help a friend or loved one get a kidney even though their blood or tissue types don't match. It works by matching two recipients who have willing but incompatible donors.

For more information, see our article on paired exchange kidney donation.

Blood Type Incompatible Kidney Transplant

This program allows patients to receive a kidney from a living donor with an incompatible blood type.  To be able to receive such a kidney, patients must undergo several rounds of plasmapheresis, which is similar to dialysis, before and after the transplant. Plasmapharesis removes antibodies from the patient's blood that can lead to rejection of the transplanted kidney.

Patients require multiple treatments with plasmapheresis before transplant, and may need several more after transplant to keep their antibody levels down.

Some patients also need to have their spleens removed at the time of transplant surgery to lower the number of cells that produce antibodies. The spleen, a spongy organ about the size of a person's fist, produces blood cells. Located in the upper left part of the abdomen under the rib cage, the spleen can be removed using laparascopic (minimally invasive) surgery.

Positive Crossmatch and Sensitized Patient Kidney Transplant

This program makes it possible to perform kidney transplants in patients who have developed antibodies against their kidney donor, a situation known as "positive crossmatch."

The process is similar to that for blood type incompatible kidney transplants. Patients receive medications to decrease their antibody levels or they undergo plasmapheresis treatments to remove the harmful antibodies from their blood. If their antibody levels are successfully reduced, they can then go ahead with the transplant.

Blood type incompatible kidney transplants and positive crossmatch/sensitized patient kidney transplants have been very successful in the United States and internationally. Success rates are close to those for transplants from compatible living donors and are better than success rates for deceased donor transplants.