Giving the gift of a kidney, a lobe of a lung, or a portion of the liver, pancreas or intestine, living donors offer patients an alternative to waiting on the national transplant list for an organ from a deceased donor. The number of living organ donors is more than 6,000 per year, and one in four of these donors are not biologically related to the recipient.
What is Living Donation?
The majority of organ donations occur after a donor has died. However, living donation is possible with certain organs and tissues, enabling doctors to save more people in desperate need of a transplant. Living kidney and liver donors can range from family members and friends to anonymous individuals if they meet the requirements to donate.
Advantages of Living Donation
- When doctors are able to transplant an organ from one family member to another, the genetic match often decreases the risk of rejection.
- Because it is a living donation, the procedure can be scheduled at a convenient time for both the donor and recipient.
- Kidney transplant recipients often see an immediate return of normal function.
Types of Organs Supplied by Living Donors
- Kidney – Individuals can donate one of their two kidneys to a recipient, making this the most common form of living organ donation. Although donors will see a decrease in kidney function after donation, their remaining kidney will function properly in working to remove waste from the body.
- Liver (lobe) – People can donate one of two lobes of their liver. The liver cells in the remaining lobes of the liver regenerate after the donation until the organ has regrown to almost its original size. This occurs in both the donor and recipient
- Lung (lobe) – Lung lobes do not regenerate, but individuals can donate a lobe of one lung. Living lung donation occurs when two adults give the right and left lower lobes (from each respectively) to a recipient. The donor’s lungs must be the right volume and size to be a correct match.
Matching Donors and Transplant Patients
Paired donation or paired exchange involves two pairs of potential living kidney donors and transplant candidates who are not compatible. The two candidates “trade” donors so that each candidate receives a kidney from a compatible donor.
Kidney donor waiting list exchange occurs when a living donor who is incompatible with the intended transplant candidate donates to an anonymous candidate on the waitlist so the intended candidate can be given higher priority on the waitlist.
Blood type incompatible donation occurs when a transplant candidate receives a kidney from a living donor with an incompatible blood type. To decrease the risk of rejection of the donated organ, candidates receive specialized medical treatment before and after the transplant.
Positive cross-match donation involves a living donor and a transplant candidate who are incompatible because antibodies (a protein substance) in the candidate will immediately react against the donor’s cells, causing loss of the transplant. Specialized medical treatment is provided to the candidate to prevent rejection.
Certain living donation options may not be available at all transplant centers. Contact transplant centers directly for information on specific programs.
History of Living Donation
The first successful living donation took place when, in 1945, Dr. Joseph Murray transplanted a healthy kidney from Ronald Herrick into his twin brother, Richard. He had been suffering from chronic kidney failure, but lived a healthy life after the transplant until his death from causes not related to the transplant. Ronald, his living donor brother, lived for 56 years after the surgery until his death in 2010.
Altruistic Kidney Donation
Living kidney donors who are not related to or known by the recipient are known as non-directed donors. This type of selfless donation can also be referred to as altruistic or anonymous non-directed kidney donation.
In this case, the transplant center determines how the donor’s kidney will be used. Non-directed donors may help multiple transplants occur by donating to a paired donation program where their altruistic donation may be useful to a “chain” of donations. It is important to note that living donors are never paid – it is illegal to donate an organ for profit under the National Organ Transplant Act of 1984, and transplant centers are prohibited from accepting living donors who have been pressured to donate.
When the organ recipient knows the potential donor, the recipient’s insurance pays for clinical evaluations to ensure they are in the best possible state of health to move forward with the donation. If you are an altruistic donor without a known recipient, your insurance provider will most likely refuse to pay for your evaluation tests. Luckily, most local transplant centers cover these expenses. Please visit CORE’s website to view links to all kidney transplant centers within the CORE service area.
To Become a Living Donor
- The health and safety of a living donor is the most important priority in any transplant procedure involving a living donor. Emotionally and physically, living donors must be in top condition.
- Living Donors Must…
- Donate voluntarily. At any time during the donation process a living donor may change his or her mind. This decision will be kept confidential.
- Be in good health overall with normal organ function and anatomy.
- Be physically fit. In most cases, donors should not have high blood pressure, diabetes, cancer, kidney disease or heart disease.
- Not be paid. It is illegal to pay or be paid for a donation under the National Organ Transplant Act of 1984 and state law.
- 18-60 years old (in most cases).
- Complete clinical evaluations beyond the initial donation criteria to confirm compatibility with a recipient. These include physical and psychological evaluations.
- Give informed consent. Transplant centers must ensure that the prospective donor has been informed regarding the aspects of living donation and possible outcomes.
Types of Living Donors Directed Donation
- Related Living Directed Donation: Includes healthy blood relatives of candidates:
- Brothers and sisters
- Children over 18 years of age
- Other blood relatives (aunts, uncles, cousins, half-brothers and -sisters, nieces and nephews)
- Non-related Directed Donation: These are healthy, unrelated living donors who are emotionally close to transplant candidates, including:
- Relatives through marriage
- Close friends
- Co-workers, neighbors or other acquaintances
- Non-directed/Altruistic Donation: These living donors are not related and unknown to the recipient. Altruistic donors make their donation for purely selfless reasons and are sometimes called anonymous donors.
- Paired Exchange Donation: This system enables a living donor to initiate a chain of transplants to the benefit of more than one person in need. Non-directed kidney donors who wish to donate to anyone waiting for a kidney can be included in paired exchange donation programs.
The Decision to Donate
The decision to donate is very personal, and potential donors should make their decision with all the available information to make an informed choice. Donation must be a voluntary decision that is free from pressure of any kind.
A living donor may change his or her mind at any point in the donation process. This decision and any reasons will be kept strictly confidential. Potential donors should consider the possible health effects of donation as well as the life-saving potential for the transplant recipient.
Usually, a donor’s life returns to normal within four to six weeks after the surgery, but because of all the effects on donors, particularly unknown long-term effects, the federal government does not actively encourage any individual to make a living donation. They do recognize the wonderful gift provided to transplant recipients, and through the Division of Transplantation, Health Resources Services Administration and U.S. Department of Health and Human Services, the federal government works to support living donors.
Medical expenses for living donation are generally covered by the recipient’s insurance plan. Transplant centers are required to charge recipients an “acquisition fee” upon receiving a transplant, which covers the donor’s pre-donation clinical evaluations, the transplant procedure and postoperative care, also referred to as “donor protocol.” Other costs outside of this protocol are not covered. More extensive and detailed information about the financial aspects of the procedure can be provided by the transplant center.
Who Makes a Good Donor?
Ultimately, a transplant center has the definitive say on whether or not a person can become a living donor. A person who wishes to make a living donation is carefully screened for the best possible physical and psychological outcome for both the donor and the recipient.
Resources for Living Donation
Contact the potential recipient’s transplant center to receive more information or be tested as a potential living donor for someone you know. Ask to speak with the transplant coordinator who will be able to provide you with additional information and get you started in the donation process.
To learn more about non-directed donation, please visit the informational websites below and contact CORE at 800-DONORS-7 (800-366-6777) for more information.
Kidney Paired Donation 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 for Transplantation
- National Kidney Foundation
- Living Kidney Donor Network (LKDN)