4. Determine if you will get a kidney from a living or deceased donor.
5. Wait for your surgery date in the case of a living organ donation or wait for an organ to become available and prepare for transplant.
Now that you have completed your evaluation, you will need to determine what type of transplant is best for you.
There are two broad sources where organs come from and they are from living and deceased donors and there are subcategories of each that will be covered in a later chapter. Live donations come from close relatives like a mother/father or sister/brother; however they can also come from spouses, friends, coworkers or anyone else that is interested in helping another person. Of course there are qualifications to become a living donor, including:
- Need to be within the ages of 18-65
- Must be a compatible blood type and have a good cross match (so your body will accept the organ)
- Can’t have any severe medical or psychiatric illness
- Can’t be pregnant
- Must be in good physical condition and able to handle the surgery and meet transplant center requirements such as non-smoking and weight requirements.
More generally, living donors need to be able to handle the surgery and not have a diminished quality of life afterward as a result of the surgery.
Live donors are less common and last year (2012) made up 5,619 out of 16,487 transplants or 34% of transplants. The rest (10,868) came from deceased donors.[1] Those organs come from individuals that signed up to be organ donors and their wishes were carried out by their families. Donors are normally between the ages of 18-65, were in good physical health and passed away from a condition that didn’t impact their kidneys. The kidneys and other organs/tissues are collected and can last up to 72 hours but commonly last 36-48 hours outside of the body.[2]
There are many steps before a potential deceased donor organ becomes available for transplant:
1. The individual chooses to register in their state’s donor registry, which often happens when they go to apply for a driver’s license or come in to renew it. A listing of the state registries can be found here.
2. This individual is either ill and already in the hospital or comes in due to an accident or trauma. The hospital does their best to save the individual, and if the individual can’t be saved doctors perform multiple tests to check for brain activity.
3. If no brain activity is found, the hospital contacts the local organ procurement branch and the first step in the matching process occurs. The individual’s information is checked again to ensure they are a qualified donor and a representative comes to the hospital. If a person isn’t listed on a registry, there is opportunity for the organ procurement agent to speak with the next of kin to get family consent. No one pressures the family and any family wish is upheld.
4. After receiving consent, the individual undergoes an evaluation and if successful, this information is given to the national Organ Procurement and Transplantation Network (OPTN) and they use their database of wait listed candidates to search for a match. Matches are determined using characteristics such as wait list time, illness type, location to the potential donor and physical characteristics such as blood and tissue type, height and weight.
5. From this, a list is generated and the organ is offered to the patient at the top of the list. Medical experts can determine that this particular organ is better for another patient because the person at the top of the list is currently too sick to be transplanted or won’t make it to surgery in time. Most organs stay local, but sometimes they are given to other regions.
6. The donor’s body is maintained to keep the organ alive while the hospital and OPTN representatives work to coordinate the surgeries to remove and implant the new organ.
This is just a brief overview of the steps involved, but we shared it with you to show that it is a multi-step process and a lot of thought and effort goes into matching donors with recipients. Recently, there have been several proposals to update the matching process and make sure that organs go to those that need them the most.
There are several advantages of getting a kidney as outlined in the introduction, but there is also a difference between getting an organ from a living donor as compared to a deceased donor.
|
Type of Donor Organ |
Pro |
Cons |
|
Living |
Can qualify for a preemptive transplant |
Not only you but a family member or friend needs surgery |
|
|
Shorter waiting time |
Takes time to test and evaluate potential candidates |
|
|
Better match means less chance of rejection |
Especially if from the same family, there aren’t many resources to cover lost time at work or expenses for travel |
|
|
Kidney usually works from the start |
|
|
|
|
|
|
Deceased Donor |
Doesn’t require a family member or friend to get surgery too |
Substantial wait times are likely |
|
|
Potential to be less costly on a single family |
Kidney might not work right away |
|
|
|
Higher rejection rate |
|
|
|
Still have individual costs for the surgery and medication |
|
|
|
|
Even though there are advantages to getting a live donation, this is not an option for everyone and receiving an organ from a deceased donor still has a great track record and is a good treatment option.
[1] United States Department of Health and Human Services. Organ Procurement and Transplantation Network. Transplants in the U.S. by Recipient Age. Accessed 4-16-13. Retrieved from http://optn.transplant.hrsa.gov/latestData/rptData.asp.
[2] United States Department of Health & Human Services. Donate the Gift of Life: About Donation and Transplantation. Retrieved from http://www.organdonor.gov/about/organmatching.html.
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