Five Facts Living Kidney Donors Need to Know

The wait list of people who need a kidney transplant has around 90,000 names on it. According to the National Kidney Foundation, every 14 minutes, a new person is added to that list. Now, consider that 18 people die each day while waiting for a kidney. There is a massive, nationwide shortage of kidneys for transplant because the demand far exceeds the number of available donors. The wait for a deceased donor kidney transplant can be several years depending on various factors including blood type. Living donation helps to overcome these long wait times and increase access to transplantation.

1. You do not have to be biologically related to be living donor and the importance of the National Kidney Registry and paired kidney donation.

A living kidney donor can be a family member, friend, or stranger to the recipient. When the donor gives a kidney to a specific identified person this is called ‘direct’ donation. A donor who gives a kidney to someone they do not know, is called a ‘non-direct’ or ‘altruistic’ donor. Living kidney donation can also happen through paired donor exchanges via the National Kidney Registry. This is when two or more living donor and recipient pairs work together to result in compatible living donor transplants for their recipients.

It is important when looking for a living donor that the recipient does not try to screen for a specific blood type, age, or medical concerns. That is the job of the transplant center to medically evaluate the potential donor and ascertain if they can truly be a living kidney donor.

2. The living donor evaluation process is thorough, and the donor’s health is a priority.

All potential living kidney donors must pass an initial health questionnaire screening that includes a review of their medical history. Once the potential donor passes this process, they will move forward with further medical testing and evaluation. The purpose of this testing is to determine if the potential donor is healthy enough for the donation and life after transplant with one kidney. In addition, testing is completed to determine the compatibility of the potential donor with the recipient.

The transplant center’s living donor team includes a transplant nephrologist and surgeon, pharmacist, dietitian, social worker, transplant psychologist, an independent donor advocate, and a dedicated living donor transplant coordinator. The transplant coordinator helps the donor navigate all aspects of the living donation process. After the evaluation is complete, the living donor team meets for discussion, and a decision is made to accept or deny the potential living donor candidate. This decision is communicated with the potential living donor, and through a shared decision model, the final decision is made to move forward with the living donor candidate for donation.

When you undergo the medical tests, your care team will make sure that your kidneys, heart, lungs, circulatory system and overall physical and mental health are strong and that it is safe for you to donate. You will need to undergo blood tests, a urine test, a chest X-ray, an electrocardiogram (EKG), a cancer screening, a CT scan, an MRI scan and a psychosocial evaluation.

Carefully screened kidney donors are not more likely to develop kidney disease in the future. Overall, a living donor will lose 20 – 40% of kidney function and is not significantly more likely to develop kidney disease in the future. A living donor can go on living their usual life, with the recommendation to avoid medications that are toxic to the kidneys and maintain a healthy lifestyle. A living donor can have successful pregnancies after donation.

3. What about the living donor surgery and medical follow up afterwards?

The overall risks associated with kidney donation surgery are low. The surgery takes about 2 – 3 hours, and the patient is usually discharged within 1 – 2 days after donation. About 3 weeks after the surgery the patient is seen in the transplant surgery clinic. The donor is asked to avoid heavy lifting or strenuous exercise for the first 6 weeks post-donation. It is highly recommended for donors to have a primary care physician and long-term follow up with them.

4. Living donation is covered by the recipient’s insurance and the need for medical leave and job security is legally enforced.

Your health insurance should not be affected by donating a kidney. The recipient’s insurance will cover your medical evaluation, surgery, follow-up tests and medical appointments. If you have specific insurance or financial questions, your hospital’s transplant coordinator may be able to answer them or can refer you to a financial liaison.

Many states give tax deductions or credits to living donors for unreimbursed expenses associated with donation, which could include travel to the hospital, lodging and any lost wages. In Wisconsin, living organ donors are eligible for a state tax deduction of up to $10,000.

Froedtert Hospital & the MCW living donor program as part of the National Kidney Registry offers the Donor Shield program which allows for lost wage reimbursement, coverage of travel costs, and legal support.

Of note, the typical recovery period for a living kidney donor is four to six weeks. Effective July 1, 2016, the Wisconsin Bone Marrow and Organ Donation Leave Act allows employees up to six weeks of leave to undergo and recover from a bone marrow or organ donation procedure. Additionally, in August 2018, the U.S. Department of Labor released a legal opinion stating that living organ donation is eligible for protection by the Family Medical Leave ACT (FMLA) as it qualifies as a “serious health condition.”

5. What is National Kidney Registry (NKR) Voucher and Prioritization Program?

This program is a good option if a living donor is not compatible with their intended recipient, if they are compatible but a better match is possible, there is an issue with time where the donor has a specific time frame to donate but the intended recipient might not be ready, for altruistic donation, and for protection of family members if they need a kidney transplant in the future. In the last part, if an individual comes forward to be a living donor via the NKR, they can use the Family Voucher Program and give five family members not in imminent need of transplant a voucher to be prioritized for a living donor kidney in the future if they ever need one. If the living donor themselves ever needs a kidney transplant, through the NKR Prioritization program they are given priority access for a living donor kidney transplant.