DEAR DOCTORS: I was surprised to find out that a co-worker gave his nephew a kidney several years ago. He never mentions it and I don't want to invade his privacy, but I would like to know more about the process. What does it take for someone to donate a kidney? Is it safe for them to do it?
DEAR READER: Your co-worker is what is known as a living donor. It's just as it sounds -- the donation of an organ by someone who is still alive.
The kidney is the most frequently transplanted organ from a living donor. While less common, it is also possible to donate a lobe of the liver, all or part of a lung, a portion of the pancreas or part of the intestines. The majority of the 6,000 organs provided by living donors each year come from relatives, loved ones or close friends. A small number come from a donor who has chosen to help someone they don't know but who is in great need. Whatever the circumstances, becoming a living donor is a weighty decision that requires serious thought.
Depending on the transplant centre, the prospective donor must be at least 18 or 21 years old. They must also be mentally competent to make the decision to donate and be in good health. Conditions that can interfere with becoming a living organ donor include diabetes, cancer, uncontrolled high blood pressure, hepatitis, HIV or an active infection. All of this is ascertained during the evaluation that is required of all potential donors. This begins with blood tests and tissue typing to see if a potential donor is a good match. If so, the person undergoes additional testing, including heart and lung exams, a colonoscopy, and liver and kidney function tests.
Not surprisingly, given the enormity of such a decision, a mental health assessment is an important part of the screening process. The transplant centre also makes sure the donor has the financial, medical and personal support required when someone undergoes major surgery.
The transplant itself is done under general anaesthesia and takes three to four hours. Most kidney transplants are now done laparoscopically, which means small incisions and a faster recovery time. The timing of a return to work and a regular routine varies, but typically takes three to six weeks.
Short-term risks to the donor include those involved in any surgery. These include infection, pain, blood clots and an adverse reaction to anaesthesia. Long-term risks include the natural decline in kidney function that accompanies ageing and developing a disease that itself impedes kidney function. This includes Type 2 diabetes, high blood pressure and obesity. A donor loses 25% to 35% of their kidney function. To compensate, the remaining kidney increases in size.
The data show that donating a kidney does not affect the donor's life expectancy. People on the kidney transplant list wait an average of three to five years for an organ. Tragically, some don't survive the wait. In donating a kidney to his nephew, your co-worker has made a courageous and generous choice. Universal Features Syndicate
Dr Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health.
