The Evaluation Process
While many people are willing to be living donors, not everyone has the qualities necessary to participate in living donation. Donors must be chosen carefully.
As a potential living donor, you first undergo a blood test to determine blood type and immunologic ompatibility with the recipient. If the donor and recipient have compatible blood types, the next step for the donor is a medical history review and a complete physical examination. In the examination, doctors may perform the following tests:
The potential living donor’s blood is drawn for tissue typing of the white blood cells. This test checks the tissue match between six codes on the potential living donor and recipient cells.
A blood test is done before the transplant to see if the potential recipient will react to the potential living donor’s organ. Although each test is an important part of kidney selection, the crossmatch is the most important test. To receive a kidney transplant, you must have a compatible crossmatch with the donor.
If the crossmatch is "positive," then the donor and patient are incompatible because antibodies will immediately react against the donor’s cells and consequently cause immediate loss of the transplant.
If the crossmatch is "negative," then the transplant may proceed. Crossmatching is routinely performed for kidney and pancreas transplants.
An antibody is a protein substance made by the body's immune system in response to an antigen (a foreign substance; for example, a transplanted organ, blood transfusion, virus, or pregnancy). Because the antibodies attack the transplanted organ, the antibody screen tests for panel reactive antibody (PRA), a number that describes how likely the recipient is to have anitbodies to a donor. The white blood cells of the potential living donor and the serum of the recipient are mixed to see if there are antibodies in the recipient that react with the antigens of the donor.
Blood tests to screen for transmissible diseases
These tests determine if a potential living donor has HIV/AIDS, hepatitis and other transmissible diseases.
In the case of a kidney donation, urine samples are collected for 24 hours to assess the potential living donor’s kidney function.
A chest X-Ray and an electrocardiogram (EKG) are performed to screen the potential living donor for heart and lung disease. Depending upon the age and medical history of the potential living donor, other heart and lung tests may be needed.
These tests help physicians view the potentially donated organ, including its blood vessel supply. They can include a CAT scan, MRI, and arteriogram, a set of tests involves injecting a liquid that is visible under X-Ray into the blood vessels to view the organ to be donated.
These tests may include:
- Prostate exam
- Skin cancer screening
Your transplant team will determine the individual test needs, depending upon the age and medical history of the potential living donor.
Psychiatric and/or psychological evaluation
Both the potential living donor and the recipient undergo a psychiatric and/or psychological evaluation. These tests assess the mental health of the potential living donor, whether the donor feels pressure from others to donate, the donor’s ability to understand information and make an informed decision, and the donor’s daily life circumstances (such as the possible impact on a job, whether he/she would have any help while recovering from donation, and the donor’s family’s views about the donation).
For all female donors, a complete gynecological examination is required. For females 30 years and older, a mammogram is also required.
Final blood test
Usually completed within 48 hours of surgery, the last blood test is another crossmatch. It is the final comparison of the potential living donor’s blood cells and recipient's blood serum to make sure that the recipient has not created any antibodies that would attack the donated organ.
All of these test procedures are usually done on an outpatient basis, but in some cases, testing may require an overnight hospital stay.
What happens next?
Once the evaluation testing has been completed, and the results indicate that you are a good candidate as a living donor, the transplant surgery will be scheduled. This decision is made jointly by the transplant team, by you, and by the recipient. The transplant team, particularly the physicians involved directly in your recipient's care, will determine as accurately as possible the best time to do the transplant, based on the recipient's medical condition.
However, any number of events could happen that may change the date of the transplant. For example, the recipient's condition might deteriorate to the point where he or she is too sick for a transplant. Or the recipient or donor might develop an infection or some other condition that would need to be treated before the transplant could be done.
Your Independent Donor Advocate and Kidney Transplant Team are good sources for medical information about the living donor surgery and recovery process. Please talk with these professionals to understand what to expect, although the surgery and recovery process can differ among living donors.
For Additional Information
If you have a question about Living Donor transplants at Crozer-Keystone, email firstname.lastname@example.org or call 610-619-8420.