Although most organ donations take place after the donor has died, some organs and tissues can be donated from living donors. With the transplant waiting list increasing and the shortage of organs for transplant available, patients in dire need of a life saving procedure can be aided through living donation. Living donation allows more patients to be moved off of the waiting list, thus increasing the existing organ supply.
Given that the vast majority of the patients awaiting transplants are in need of kidney donation, it is incumbent upon people to consider the possibility of being a living donor.
The best long-term solution to ending the organ shortage crisis is to avoid the need for transplantation all together. Legacy Donor Foundation works to increase awareness about kidney disease prevention, risk factors and connects individuals to other organizations that lead the charge in promoting healthy living as part of our outreach.
A healthy person can become a living donor by donating a kidney, or a part of the liver, lung, intestine, blood or bone marrow. Donors must be chosen carefully in order to avoid outcomes that are medically and psychologically unsatisfactory.
Individuals considered for living donation are usually between 18-60 years of age. Gender and race are not factors in determining a successful match.
As a result of the growing need for donors, living donation has increased as an alternative to deceased donation, and more than 6,000 living donations take place each year. Family members, friends, and even anonymous individuals can become living donors if they meet the requirements to donate. A patient on the kidney waiting list waits an average of 5 years.
Types of Living Donation
In a directed donation, the donor specifically names the person to which they are donating who will receive the transplant. This is the most common type of living donation. In a directed donation, the donor may be:
- A biological relative, such as a parent, brother, sister, or adult child
- A biologically unrelated person who has a personal or social connection with the transplant candidate, such as a spouse or significant other, a friend or a coworker
- A biologically unrelated person who has heard about the transplant candidate’s need
Non-Directed / Altruistic Donation
In a non-directed donation, the living donor is not related to or known by the recipient, but makes his/her donation purely out of selfless motives. The match is arranged based on medical compatibility with a patient in need. Some non-directed donors choose never to meet their recipient. In other cases, the donor and recipient may meet at some time, if they both agree, and if the transplant center policy permits it.
Also called paired kidney exchange or paired exchange involves at least two pairs of living kidney donors and transplant candidates who do not have matching blood types. The candidates “trade” donors so that each candidate receives a kidney from a donor with a compatible blood type.
Advantages of Living Donation
- Transplants from family members that have a stronger genetic match between the living donor and transplant recipient decreases the risk of rejection.
- Living donation allows the procedure to be scheduled at a time that works best for the donor and recipient.
- Transplant patients who receive a living donor kidney usually see immediate function.
Types of Organs Supplied by Living Donors
- Kidney (entire organ) - This is the most frequent type of living organ donation. Living individuals can donate one of their two well-functioning kidneys. Although all living kidney donors will experience a decrease in their kidney function, their remaining kidney provides the necessary function needed to remove waste from the body.
- Liver (segment) - A living donor can donate one of two lobes of their liver. This is possible because liver cells in the remaining lobe of the liver regenerate after the donation until the liver is almost its original size. This re-growth of the liver to near its original size occurs in a short period of time in both the liver donor and liver recipient.
- Lung (lobe) - Although lung lobes do not regenerate, individuals can donate a lobe of one lung. Living lung donation occurs when two adults giving the right and left lower lobes from each respectively to a recipient. The donors' lungs must be the right volume and size in order to be a correct match.
- Intestine (portion) - Although very rare, it is possible to donate a portion of your intestine.
- Pancreas (portion) - Individuals can also donate a portion of the pancreas.
History of Living Donation
The first successful living donation transplant took place in 1954 between 23-year-old identical twins Ronald and Richard Herrick. Dr. Joseph Murray performed the procedure in Boston, Massachusetts by transplanting a healthy kidney from Ronald into Richard, who had chronic kidney failure.
Richard, the recipient, went on to lead an active life until his death eight years later from causes unrelated to the transplant. His living donor brother Ronald lived a full life until his death in 2010, 56 years after the surgery took place.
Resources For Living Donation
If you would like to have more information or to be tested as a potential kidney donor for someone you know, your first step is to contact the potential recipient's transplant center and ask to speak with the Kidney Transplant Coordinator. They can give you additional information about living donation, and help start the process.
Kidney Paired Donation Resources
If you would like to pursue more information regarding non-directed donation, please use the websites listed below as resources
- National Living Donor Assistance Center (NLDAC)
- Transplant Living
- Alliance for Paired Donation (APD)
- National Kidney Registry (NKR)
- United Network for Organ Sharing
- U.S. Federal Health Resources and Services Administration
- American Society of Transplantation
- National Kidney Foundation
- Living Kidney Donor Network (LKDN)
Who can be a Living Donor?
Living donors should be in good overall physical and mental health and older than 18 years of age. Some medical conditions could prevent an individual from being a living donor. Since some donor health conditions could harm a transplant recipient, it is important that living donor candidates share all information about their physical and mental health. It is important to be fully informed of the known risks involved with donating and complete a full medical and psychosocial evaluation. The decision to donate should be completely voluntary and free of pressure or guilt.
Living donation is major surgery. All complications of major surgery apply. These may include:
- Infection at the incision site
- Incisional hernia
- Blood clots
- Potential need for blood transfusions
- Side effects associated with allergic reactions to the anesthesia
The best source of information about risks and expected donor outcomes is the transplant team. In addition, it is important to take an active role in learning more about these potential surgical risks and long-term complications.
Living donors may also experience negative psychological symptoms right after donation or later. The transplanted organ may not work right away. There is also the chance it will not work at all. Donors may feel sad, anxious, angry, or resentful after surgery. Donation may change the relationship between donor and recipient.
Living donors must be made aware of the physical and psychological risks involved before they consent to donate an organ. Please discuss all feelings, questions and concerns with a transplant professional and/or social worker.
Medical expenses associated with living donor evaluation are covered by either the recipient's insurance or in certain circumstances, by the Transplant Centers Organ Acquisition Fund (OAF). In either instance, the living donor should not incur any expenses for the evaluation. However, expenses related to another health concern that may identified during the evaluation process will not be covered by the recipient's insurance or the OAF.
The actual donation surgery expense is covered by the recipient's insurance. The transplant center will charge a recipient's insurance an "acquisition fee" when he or she receives a transplant. The medical costs related to the donation procedure and this fee also covers required postoperative care. In some instances, the actual itemized bill for the donor procedure is submitted to the recipient's insurance.
Anything that falls outside of the transplant center's donor evaluation is not covered by insurance. These costs could include annual physicals, travel, lodging, lost wages and other non-medical expenses. Although it is against the law to pay a living donor for the organ, the recipient may cover these costs. Be sure to check your specific insurance policy or ask a transplant financial coordinator about concerns related to your specific circumstances. You may also want to learn more about the National Living Donor Assistance Program, which provides financial assistance to those who want to donate an organ.
The cost of a transplant, including preliminary testing, the surgery itself and post-operative recovery costs vary across the country and depend on the hospital and organ type. These costs start to add up, even before your transplant. Therefore, patients commonly rely on several sources to help pay for their medical and non-medical costs of pre- and post-transplantation.
Medical costs might include:
- Insurance deductibles
- Insurance co-pays
- Pre-transplant evaluation and testing
- Fees for the recovery of the organ from the donor
- Follow-up care and testing
- Additional hospital stays for complications
- Fees for surgeons, physicians, radiologist, anesthesiologist and recurrent lab testing
- Anti-rejection and other drugs, which can easily exceed $2,500 per month for organ recipient. Note: anti-rejection drugs are not required for a living donor
Did you know?
Most transplant programs have social workers and financial coordinators who can help you with the financial details of your transplant. Depending on the structure at your center, one or both will help you develop a strategy.
Information sited from: https://transplantliving.org/living-donation/financing-living-donation/costs/
Non-medical costs include:
- Food, lodging and long distance phone calls for you and your family
- Transportation, to and from your transplant center, before and after your transplant
- Plane travel to get to your transplant hospital quickly
- Child care
- Lost wages if your employer does not pay for the time you or a family member spends away from work
- If your transplant center is not close to your home, lodging close to the center before and after your surgery. Some centers offer free or low-cost hospitality houses for you and your family.
Explore the Possibility of Being a Living Donor
If you are interested in inquiring about helping an individual with living donation, we encourage you to discuss with the person and contact someone from the transplant program where the person is listed. To be a non-directed living donor, contact a transplant center to find out if they have this type of donation program.
References: TransplantLiving.org, UNOS.org, OPTN.transplant.HRSA.gov, and Kidney.org.