A kidney transplant is surgery to place a healthy kidney into a person with kidney failure.
Renal transplant; Transplant - kidney
Kidney transplants are one of the most common transplant operations in the United States.
One donated kidney is needed to replace the work previously done by your kidneys.
The donated kidney may be from:
- Living related donor -- related to the person receiving the transplant, such as a parent, sibling, or child
- Living unrelated donor -- such as a friend or spouse
- Deceased donor -- a person who has recently died and who has no known chronic kidney disease
The healthy kidney is transported in cool salt water (saline) that preserves the organ for up to 48 hours. This gives the health care providers time to perform tests to ensure that the donor's and recipient's blood and tissue match.
Kidney Transplant Donation
- About Living Donation (Benefits, confidentiality, sources)
- Sources of donor kidneys
- Matching and Compatibility
- Donor medical evaluation
- Donor selection criteria
- Independent living donor advocate
- Surgical experience
About living donation
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.
After deciding to donate, you will be working with a team of professionals who are dedicated to your well-being. UF Health Shands has been performing live kidney donor transplants since 1966, and our team is committed to providing expert care to you and your recipient.
There are many benefits that come from living donation.
- First, the recipient has time to plan for a transplant. Research shows that the less time a patient is on dialysis, the longer a transplanted kidney will function and the longer a person will live.
- Second, a kidney transplant doubles the life expectancy compared to staying on kidney dialysis treatment.
- Another benefit can be the positive feelings a patient can experience knowing that the gift came from either a generous stranger or a loved one.
- Avoid the waiting period (3-5 years) on the non-living donor list.
Information about the donor or the recipient will not be disclosed even if the donor requests it. 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).
Sources of donor kidneys
Living organ donors and non-living donors are the two sources of donors. Here’s a look at the different types of donors that fall within both categories.
Transplanting a kidney from a healthy individual into a person with kidney failure is called a living donation. Kidneys can come from living donors who may either be a living related donor (LRD), living unrelated donor (LURD) or a non-directed donor (not related to or known by the recipient). Live donor organs are usually better suited in terms of health, function and longevity in comparison to a non-living donor organ.
Non-living donors are people who have suffered brain death after bleeding in the brain or head trauma, and a patient may have to wait years for a non-living donation. Donation after cardiac death (DCD) is an option for families who have a loved one who has irreversible brain damage but still has minimal brain function. Once the family decides to withdraw care, it is offered the option of donation after cardiac death.
Matching and compatibility
There are three main blood tests that will determine if a patient and a potential donor are a kidney match. They are blood typing, HLA and cross-matching.
Blood typing is the first test that will take place. The four major blood types are type A, B, AB and O. The positive or negative feature in a blood typing is not a factor when determining compatibility between a donor and a recipient.
Blood Type Compatibility
- Blood Type O
Can donate to: A, B, AB, O
- Blood Type A
Can donate to: A or AB
- Blood Type B
Can donate to: B or AB
- Blood Type AB
Can donate to: AB
It’s important to remember that blood type AB is called the universal recipient because they are compatible with any other blood type and blood type O is called the universal donor because they are compatible with any other blood type.
HLA, otherwise known as “tissue typing,” stands for human leukocyte antigen. Antigens are proteins on the cells, and there are six antigens that have been shown to be the most important in organ transplantation. Out of these six, three come from each parent. Half of your HLA markers are inherited from your mother and half from your father. Siblings from the same two parents have a 1-in-4 chance to match all six antigens. Identical twins are considered a “perfect match.” Two unrelated people can just happen to be a good HLA match as well, although it is much less likely.
Thanks to advanced medication known as immunosuppressive or anti-rejection medications, kidney transplants can still be successful if two people don’t have matching antigens.
To determine compatibility for a donor and recipient’s blood type, doctors can also perform a cross-matching test. In this test, blood from the donor and recipient are mixed, and if the results come back positive, the recipient’s antibodies have attacked and killed the donor’s cells. If the test comes back negative, the recipient’s antibodies did not respond to the donor’s, and therefore transplantation should be safe and the pair is compatible. This test can be performed up to 15 times to ensure the result is consistent.
In the unfortunate case in which a donor and a recipient are incompatible, either because of incompatible blood types or incompatible cross-match, the potential recipient will stay on the non-living donor waitlist. Paired donation is an option that matches incompatible donor-recipient pairs with other pairs, and the recipients “exchange” donors.
The UF Health Shands Kidney Transplant Program offers paired exchange for all incompatible donor-recipient pairs in our center through the national UNOS/OPTN kidney paired donation system.
If time has passed without an acceptable paired exchange offer, there is another option for some pairs. In some ABO incompatible pairs, the antibodies against the donor cells can be removed by a special treatment to allow a recipient to accept the ABO incompatible transplant from their living donor. Additional testing is required to determine if this is an option.
Donor Medical Evaluation
The purpose of the donor medical evaluation is to ensure that the donation will not pose any risk during and after the operative procedure.
After expressing interest in donation, the donor is asked to complete a questionnaire. Any information shared will be kept confidential, and our living donor coordinator will contact the donor to discuss donation in more detail.
We recommend all donors have a primary care doctor before starting a donor evaluation to ensure continued medical follow-up after donation. We will complete a history and physical similar to an annual visit to a doctor as well as lab work to collect blood for testing. Cancer screens will be required, as per American Cancer Society guidelines.
Once the living donor coordinator has cleared the questionnaire, the donor is contacted for additional information via a phone interview with our living donor coordinator. A cross-match may be performed, if needed, and requires a blood draw from the donor and recipient. When compatibility is confirmed, the donor is scheduled for a visit to our transplant center for a series of appointments and medical tests.
Additional information is sent to the donor prior to the evaluation day and must be reviewed prior to the evaluation. The evaluation testing at our center takes 1-2 days, depending on required testing.
The evaluation for living donation includes:
History and Physical
The transplant nephrologist will go over all information on the health questionnaire and do a physical exam. The transplant surgeon will complete a history and physical. The surgeon is looking at past surgical history, medical history, body habits and general history. The surgeon will also review CT scans that show the kidneys and the blood vessels that will need to be divided to remove the kidney during surgery.
On average, there is one artery bringing blood into a kidney and one vein letting blood leave the kidney. Having two arteries is the most common difference and can often still result in a safe and successful transplant.
In a few people, the anatomy (number of blood vessels or an unusual path of the blood vessels) may make donation more difficult than usual, and in rare cases, donation may not be considered safe. The goal is to confirm that transplantation surgery will be safe for the donor and recipient.
During the psychosocial interview, the donor speaks with our clinical social worker, who also serves as the independent donor advocate. This visit is a very important part of the living donor evaluation. The goals of the psychosocial interview are:
- To evaluate the relationship between donor and recipient.
- To assess the reason for donation and make sure the donor has not been pressured to donate.
- To confirm there are no social or mental health issues that will affect recovery.
- To decide if the donor needs additional education or other treatment before making the final decision.
- To confirm the donor understands all the risks associated with living donation for both the donor and the recipient.
- To make sure the donor is capable of making the decision to donate and cope with the stress of a major surgery.
- To confirm the donor knows his/her evaluation is confidential and he/she may decline at any time.
- To evaluate for high-risk behavior that may give an infectious disease to the recipient.
- To check for history of smoking, alcohol and drug use.
- To be sure the donor understands it is against federal law to receive anything of value in return for donating a kidney (money, gifts, etc.).
- To discuss how donation might impact a job or family relationships.
- To review current or past history of psychiatric disorders and treatments.
- To review the donor’s job and insurance status and financial impact of donation.
- To discuss the donor’s living arrangement and determine that a support system is in place and the donor has a realistic plan for recovery.
- To explain the requirement for six, 12 and 24-month follow up appointments after donation, and to confirm the donor’s commitment to participate in the follow-up care.
If a donor has a history of physiological issues, including depression, anxiety or any past psychiatric diagnosis — or has ever taken medication to treat these problems — he or she may be asked to see a transplant psychiatrist.
This is an educational class with our living donor nurse coordinator. We encourage all who wish to attend to ask questions in an informative and comfortable setting.
Multiple blood tests will be performed to assess general information about your health.
A urine test will be performed to check for obvious signs of kidney disease or infection. In addition, we ask that donors collect urine at home for a 24-hour period. This collection gives us much more information on the kidneys’ functions. When a donor provides us with the urine collection, he or she will also have blood drawn.
An EKG evaluates whether your heart rhythm is normal and if you have any previous heart injuries.
If you are over age 50 or have a history that causes concern for possible heart disease, more extensive testing is done to rule out heart disease. This usually involves walking on a treadmill while your heart is monitored.
A chest X-ray is done to rule out lung disease or tumors.
If you are over age 50, you will need a colonoscopy to rule out colon cancer. This is a routine part of health maintenance and is recommended for all adults near this age. It can be ordered through your primary care doctor.
Abdominal ultrasound is completed to confirm kidney anatomy and to look for abdominal abnormalities. This is usually done just prior to a CAT scan when you visit us. If there is an abnormality seen on the ultrasound, the radiologist will discuss this with the transplant team and this may prevent an unnecessary CAT scan.
Also known as a CAT scan, this test evaluates the anatomy of the blood vessels going to and from the kidneys to analyze the kidney tissue, screen for kidney stones and examine the ureters draining the kidneys. This test helps our surgeons decide which kidney to remove.
During this test, an IV line is placed in your arm and a contrast solution is injected into the IV to help make the vessels clear to see. The contrast solution will give you a warm feeling when injected, and the procedure usually takes about an hour. Tell us if you have had a reaction to IV contrast in the past, as medications can be given a day or more prior to prevent these issues.
Pap smear and mammogram
Female patients require a Pap smear and mammogram, as recommended by the American Cancer Society. These tests are a routine part of health care maintenance and should be arranged through your primary care doctor.
Hepatitis B core antibody positive donors
UF Health allows donations from patients who have had hepatitis B in the past but have tested negative for more serious hepatitis B surface antigen and viral proteins (NAT testing). These organs are only used in recipients who have antibody against hepatitis B.
Testing will be done to check if the donor has hepatitis virus in the blood, which is rare. If the recipient were to test positive for the virus, the anti-viral treatment would continue for a longer period of time.
Hepatitis C antibody positive donors
Hepatitis C antibody positive donor organs are only offered to hepatitis C positive recipients. Testing is done for strains of hepatitis C virus in the blood. The majority of patients with hepatitis C infections can be treated with medications after transplant to try to get rid of the virus.
To be offered a hepatitis C positive donor organ, patients must give consent ahead of time. Donors will be sent a consent explaining the risks and the benefits. Accepting a hepatitis C positive donor organ will not decrease the possibility of receiving an organ from any other donor.
Donor selection criteria
The following are criteria for selection of living donors:
We do not take donations from anyone under the age of 18 or anyone who is not mentally capable of making an informed decision.
- Smoking has many health risks and can cause life-threatening respiratory issues during or immediately after anesthesia for a surgical procedure. Other risks it may cause include developing blood clots in the leg veins, heart and vascular diseases, decreased wound healing and increased mucus production/decreased ability to clear the lungs.
- Candidates will not be considered for donation unless they have abstained from tobacco, including chewing tobacco, for at least 4 weeks prior to donation.
- Donors are expected to remain tobacco-free for 6 weeks after surgery and are strongly discouraged from smoking after donation as it raises the risk for kidney failure.
- Potential donors are assessed for use of any illicit drugs.
- Potential donors who use chronic pain medication experience more post-operative pain after donation.
- These individuals may be asked to see a surgeon and/or psychiatrist prior to being considered for donation. our transplant team may request random drug screening if there is concern and decline donation if the potential donor does not comply with the request.
- Donors must be healthy. If a donor has a history of medical problems, or if these are discovered during the medical evaluation, he or she may be declined.
- Our living donor coordinator will discuss the donor’s health history in detail before the evaluation begins, and the physician will review it again at the first office visit.
- High blood pressure treated with medication (there may be special situations when the team may consider a donor over 50 years old on no more than two blood pressure medicine at low doses).
- Diabetes. In some cases, young donors may be declined for a very strong family history of diabetes even if the donor does not currently suffer from diabetes, due to the risk of developing it later in life.
- Gestational diabetes (diabetes during pregnancy). Donors are considered on a case-by-case basis.
- Systemic lupus erythematosus
- Polycystic kidney disease
- Substance abuse
- Psychiatric illness. If a donor has a history of mental health problems including a remote history of anxiety or other common disorders, the team may request a psychological evaluation. Donors with current mental health concerns may not be candidates for living kidney donation.
- Heart / heart valve disease or peripheral vascular disease (disease of blood vessels in the legs)
- Lung disease with impaired oxygenation or ventilation.
- Recent cancer or a history of cancer that was not completely treated
- Low kidney function shown by creatinine clearance testing
- Protein in the urine
- Active hepatitis B or C infection or HIV infection.
- Required use of medicines that are known to cause kidney damage
- History of blood clots
- A candidate being overweight is a risk factor for kidney disease.
- Candidates with a body mass index of over 32 will generally not be considered for donation unless an individual is very muscular or can lose weight to reach a BMI of 30 or less.
- Candidates with a BMI of less than 32 may be asked to lose weight depending on weight distribution.
Our dietician will review your health and provide guidance on healthy eating before and after donation.
- Our social worker will evaluate psychosocial aspects of living donation with the potential donor.
- Donors may be declined if they have inadequate support for recovery, questionable donor-recipient relationship or motivation for donation, a history of poor coping or psychiatric illness or a history of not taking good care of their health and other similar concerns.
Insurance coverage and primary care doctor
It is vital for donors to have ongoing medical care to monitor the function of the remaining kidney. The United Network for Organ Sharing has recommended that all donors be required to have health insurance and a primary care doctor prior to donation, which our program follows.
The independent living donor advocate
All transplant programs are required to identify an independent living donor advocate (ILDA) to potential donors. This person promotes the best interest of the potential living donor, advocate for the rights of the potential living donor and assists the potential living donor in obtaining and understanding information regarding:
- The consent process
- The evaluation process
- The surgical procedure
The benefit and need for follow-up in six months, one year and two years after donation.
The ILDA and or the donor coordinator will contact you six months, one year and two years after donation to check on your well-being and to obtain basic information about your health.
The surgical experience
On pre-op day, the donor and recipient will have blood drawn for the final cross-match and for updated lab testing. Both the donor and recipient will update their health history, review the surgical procedure and sign consents in our transplant clinic. Information will be provided regarding pre-op instructions for the evening and morning prior to surgery. A dialysis run will be required before the transplant if the recipient is on dialysis, and the transplant coordinator will make the arrangements at our UF Health dialysis unit.
If you don’t live close enough to the transplant center, there are hotels nearby where most offer a UF Health discount upon request. Reservations must be made directly by calling the hotel rather than online.
- The morning of the surgery, the donor and recipient will arrive at the pre-surgery admissions area in the UF Health Shands Cancer Hospital on the south side of Archer Road. Maps and instructions will be provided ahead of time.
- The surgical procedure will take about four ½ hours, including a 60-90 minute period in the operating room before and after surgery for the patient to be placed under general anesthesia and to wake up after the surgery.
- The donor surgery is completed using the laparoscopic technique because it has a quicker recovery time. During surgery, an incision is made about three inches long to remove one kidney with its artery, vein and the ureter.
- Families wait on the 2nd floor surgical waiting area in UF Health Shands Cancer Hospital. After surgery, the surgeon will let the family know how the procedure went and the family may visit the patient once he or she returns to a room.
After the donor returns to a room, he or she will be monitored closely by our staff. The donor will be asked to breathe deeply and cough periodically to prevent pneumonia. Donors normally are discharged 2-3 days after surgery. Until then, the patient will have an IV in the arm for hydration.
Clear liquids are offered usually 24 hours after surgery, and the patient may return to a regular diet 2-3 days after surgery. Pain in the abdomen is normal, and pain medicine is provided to make the discomfort more tolerable. The ILDA and live donor coordinator will see the patient before discharge to discuss care after donation and plans for follow-up, including post-operative follow up and the required 6 month, 1- and 2-year post-donation follow up. They work with the team to ensure you are ready for discharge. The donor is provided information regarding care, numbers to call with problems and additional resources as needed.