Become a Living Donor
A living donor transplant can decrease the time a patient will wait to be transplanted and it can provide a better quality organ. The kidney will usually work immediately after surgery and the patient will experience fewer episodes of rejection. Living donor transplantation can allow a recipient suffering from kidney failure to get a kidney transplant before starting dialysis, which can result in improved outcomes for the recipient.
Becoming a living donor through MedStar Georgetown Transplant Institute requires several steps: evaluation, surgery, and recovery. If you have any questions please call 202-444-3714.
Living donor options include:
To become a living kidney donor, you will complete a comprehensive medical evaluation which includes: completing a donor questionnaire, lab work, evaluation with the living kidney donor team and diagnostic testing. If you are approved as a donor you may go on to donate your kidney. There are multiple pathways for kidney donation.
Living donor options include:
- Direct Donation: A donor who donates his or her kidney directly to their intended recipient
- Paired Kidney Exchange: A donor who donates his or kidney to another person and their intended recipient receives a kidney from another donor.
There are several types of transplant procedures:
- ABO and HLA-Compatible Kidney Transplantation: The donor and recipient have the same or compatible blood type, and the recipient’s immune system is compatible with the donor.
- ABO or HLA Incompatible Kidney Transplant: The donor and recipient have different or incompatible blood types or the recipient has antibodies against the donor, meaning the patient’s body would reject the donated kidney. In some cases, the recipient can be treated before and after the kidney transplant with medication or a treatment called plasmapheresis. Plasmapheresis removes antibodies in the recipient that would cause rejection of the kidney once transplanted.
- Kidney Transplantation with Highly Sensitized Recipients is done with patients who may be considered highly sensitized recipients, patients who have had extended time on dialysis, or patients who have had a previous transplant or pregnancy.
- Paired Kidney Exchange: iThe donor and recipient are not blood type compatible or HLA compatible and plasmapheresis is not an option for a safe transplant outcome.
MedStar Georgetown Transplant Institute is a national leader in kidney exchange and the management of recipients and donors who are incompatible. Only a handful of transplant centers in the United States offer this option to their patients.
Who can be a donor?
Any healthy person can be a kidney donor. The donor does not need to be a family member. The donor can be a friend, an acquaintance, spouse, in-law, or even a stranger.
The donor must be:
- At least 18 years old
- Appropriate candidate for general surgery
- Meet medical, social, and psychological criteria set by UNOS
- Able to give informed consent
How Will I Live with One kidney?
It is safe to live with one kidney and you will be able to resume all of your regular activities after surgery. Your remaining kidney will grow slightly larger to compensate for the donation of the other kidney. You will have scheduled follow-up visits with the transplant team to monitor your kidney function after surgery and will have lab work done 6 months, 1 year, and 2 years after your donation.
What is the Paired Kidney Exchange Program?
Paired kidney exchange (PKE) is a program that assists donor and recipient pairs who are incompatible or poorly matched with each other to find another donor and recipient pair or pairs with whom they can exchange kidneys to allow a more favorable compatibility and allow a transplant take place.
All medically and psychosocially eligible donor and recipient pairs are able to participate in the PKE program. Although pairs will usually participate because the donor and the recipient are incompatible because of blood type or tissue type, the program is not limited to incompatible pairs. Compatible pairs may participate and are encouraged to consider PKE as well. While compatible pairs are not disadvantaged in PKE they may benefit from paired kidney exchange by identifying a younger or better matched donor. Importantly, compatible pair participation in the paired kidney exchange pool allows other incompatible pairs to be transplanted who may not otherwise receive a kidney transplant.
What happens when you enter the Paired Kidney Exchange Program?
- Donor and recipient medical data is entered into the PKE database. The database allows for a computer matching program to find compatible donor and recipient pairs. The goal of the matching program is to find as many compatible pairs as possible and maximize the donation of one kidney from a living donor to allow as many kidney transplants as possible.
- In order to find a compatible kidney, the PKE database requires your name (Georgetown will make up an alias for the donor and recipient to protect your identities), age, blood type, tissue type, avoidable tissue (HLA) antigens for the recipient, kidney function labs, serologies and donor anatomy.
- The exchange match program runs routinely. The goal of the PKE program is to find the best outcome for all pairs involved.
- If a potential exchange pair is found, the match will be reviewed by the transplant surgeon, transplant nephrologist, and program staff. If the match is favorable, a crossmatch will be performed to confirm compatibility. A crossmatch is the mixing of blood between the donor and recipient to find out if they are compatible. Transplant centers will exchange donor charts to review records and confirm the donor is an appropriate for the potential recipient.
- Further donor evaluation or testing may be requested by the recipient center. Once all centers accept the donor/recipient matches and the crossmatches are acceptable, the transplants can be scheduled. The donor and recipient surgeries are usually scheduled on the same day.
- Donor and recipients will remain in the databases as long as each pair is medically and psychosocially acceptable and willing to participate.
- Yearly evaluation updates are required to maintain your active status in the database.
When would the donor and recipient surgeries not happen on the same day?
- If the number of pairs in the swap is very large it might be necessary to schedule the surgeries over multiple days. The surgeries may happen out of sequence which means the donor surgery can happen before the recipient surgery.
- The swap involves a non-directed donor (a person willing to donate a kidney, who does not have an intended recipient) who often begins a kidney swap chain. When kidney exchanges involve a non-directed donor (NDD), the swap becomes an open-ended chain, which often results in an end-of-chain donor without an immediately paired recipient. This donor is referred to as a bridge donor and will be informed of this prior to the beginning of the transplant chain. A bridge donor will then begin a new chain and the surgery can happen a few days to a few weeks later. Although you may withdraw from the program at any time, we do strongly urge bridge donors fulfill their commitment to the program and start a chain at a future date.
Donors and recipients participate in the Advanced Donation Program (ADP). There are four types of ADP cases:
- Short-term cases, where the intended recipient is on dialysis or is in need of a kidney transplant soon
- Short-Term Swap Saver, where the paired donor proceeds with donation to keep the rest of a chain swap on schedule but the recipient remains in need of a kidney transplant now
- Voucher cases, where the intended recipient is currently not in need of a kidney transplant or may not need one for a long time or ever
- Voucher Swap Save, where the paired donor proceeds with donation to keep the rest of a swap on schedule after their intended recipient is transplanted by a different donor or received a deceased donor transplant resulting in the patient no longer being in current need of a kidney transplant
Remote donation allows someone who wants to donate a kidney to a friend or family member in a distant center without requiring the donor to travel to the recipient’s transplant center. Remote donation uses logistics pioneered by the NKR to safely transport kidneys from the donor’s local hospital to the recipient’s transplant center.
MedStar Georgetown Transplant Institute offers several benefits to donors who donate at our center.
- Benefits offered to donors through the NKR:
- Lost wage reimbursement for up to 4 weeks for donors who earn less than $47,000/year or less
- Travel and lodging reimbursement up to $1,000 for donors who earn less than $47,000/year or less
- Life insurance with a $5000,000 principal sum: The insurance coverage lasts for a period of 365 days post donation.
- Disability insurance for $1,000/week up to a maximum coverage of 52 weeks
- Legal support
Coverage for uncovered donor complication costs: In the unlikely event that a kidney donor experiences post-surgical complications (for example, a hernia) related to the kidney donation, the medical costs should be paid for by the recipient’s medical insurance. Sometimes insurance companies will not pay the cost by limiting the time they cover the donor complications or ask the donor for a co-payment. While these instances are rare, they do happen and the costs will be covered.
In living donor liver transplantation, a piece of liver is removed from a living donor and transplanted into a recipient.
The liver's unique ability to regenerate itself combined with the expertise of our physicians and staff allow for more people with liver failure to obtain a liver transplant.
If you donate part of your liver through the MedStar Georgetown University Hospital's Liver Transplant Program, both the transplanted piece and the piece that remains will grow to pre-surgery size. The donor liver typically regenerates to its original size in 30 days, on average.
The number of patients waiting for organ transplants far exceed the number of organs donated, which has significantly increased awareness about living donor transplantation.
Evaluation: Who can be a Donor?
To meet living donor criteria, an individual must:
- Be physically fit and in good general health
- Have a compatible blood type with the recipient
- Be free from uncontrolled high blood pressure, diabetes, cancer, liver disease and heart disease
Spouses, friends, and individuals unrelated to the recipient can become living donors.
Benefits of Living Liver Donation
Living donor liver transplantation offers immediate organ availability. Patients who receive transplants from living donors can better prepare for their surgery, knowing well in advance when the transplant will take place.
Living donors will need to have a series of tests to ensure they meet the criteria for living donation. Blood tests, family history and medical tests are preformed to ensure it is safe for the individual to donate.