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/clinical/pted/hffy/transplant/5285.hffy

201711318

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UWHC,UWMF,

Clinical Hub,Patient Education,Health and Nutrition Facts For You,Transplant

Kidney - Living Donor Evaluation (5285)

Kidney - Living Donor Evaluation (5285) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Transplant

5285


Kidney - Living Donor Evaluation

Who can be a kidney donor?
There are several things to consider when
thinking about living kidney donation. The
donor team will help you find your answers
to these questions. Do you want to donate?
Are you healthy and medically fit? Are you
able to donate directly to the person who
needs the kidney, or would you be willing to
consider ‘paired exchange’ transplant? How
will donation affect your own, and your
family’s lives? Are you ready and able to
do this?

Living kidney donors should be 18 years of
age or older. They can have any type of
relationship with the person who needs the
kidney: brothers, sisters (blood related or
adopted), parents, children, aunts, uncles,
cousins, nieces, nephews, spouses, partners,
in-laws, close friends, co-workers,
club/organization members, church
members, or connected via social media. A
so-called directed donor knows someone in
need of a kidney transplant and wants to
help this specific person while a non-
directed donor is a person who wants to help
anyone in need of a kidney transplant.

Any living donor needs to be in good
physical and mental health. They cannot
have a history of chronic or multiple kidney
stones, uncontrolled high blood pressure,
diabetes, heart bypass or heart stent(s), a
current cancer. Other health problems such
as many kidney or bladder infections, minor
heart disease or obesity will be looked at on
a case-by-case basis to decide if the risk is
acceptable.

UW Health supports living kidney donor
transplant in many ways and there are
several options to consider when thinking
about living kidney donation. These options
are shown on page 7. Once a donor
candidate is medically approved, the goal is
find the best option for the donor and
recipient pair. UW Health is partnered with
the National Kidney Registry, a paired
kidney exchange (PKE) program. This
registry can help identify matches for the
person who needs a kidney transplant.

The benefit of live donor transplant for
the recipient
Studies have shown that long-term success
for the recipient candidate is better with a
living kidney donor. With a living donor,
the health of their kidney is well known. The
donor is a healthy person who has just
completed a full medical evaluation.

Having a kidney from a living donor lets
everyone plan for the surgery. The
transplant date is made ahead of time, unlike
a deceased donor transplant where the
surgery date can happen at any time.
Recipients may not need to begin dialysis
and may not have the long waiting period
often linked with the waiting list. A living
donor organ is healthy and has not had a
medical trauma, unlike a kidney donated at
the time of death. Most often, the living
donor kidney will start to work right away
whereas the deceased donor kidney may
have a delay before starting to work.

What if I want more information about
living kidney donation or if I want to be
tested?
If you are thinking about being a living
kidney donor you can start learning about
donation at any time. We highly encourage
donors to start by going to the UW Health
website: www.uwhealth.org/transplant
Other online learning sources include
www.kidneywi.org/living-donation

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www.exploretransplant.org/for-
familyfriends/become-a-living-donor
www.asts.org/resources and
www.kidneyregistry.org It is important for
the donor to learn about kidney donation as
well as kidney transplant.



A person who knows a specific person in
need of a kidney transplant, called a directed
donor, is welcome to come to the recipient’s
transplant evaluation. During the transplant
evaluation process, patients are given
information about how a possible donor
should contact the UW Health donor team
and is asked to provide it to any potential
donor(s).

A person who doesn’t know a specific
person in need and is considering living
kidney donation, called a ‘non-directed
donor,’ can complete the UW Health online
application at a time they feel ready to take
the next step in looking at being a kidney
donor.

How does the living kidney donor
application work?
First, the possible donor provides basic
information and a brief health history
through the UW online application at
www.uwhealth.org/canibeadonor. This is
reviewed by the UW Health donor team. If a
person’s health history is acceptable, a
donor coordinator will contact the person to
discuss donation considerations, next steps
to the evaluation and testing.

How does the evaluation work?
It is best if the medical evaluation takes
place at UW Health in Madison WI. This
allows the possible donor a chance to visit
the hospital and meet the donor team. The
evaluation is a full day outpatient
appointment. If you don’t live nearby, it
might be possible to arrange some testing
closer to your home. If testing is done
outside of UW Health, it may take longer to
complete. All non-directed donors must
complete the evaluation at UW Health. The
non-directed donor evaluation usually
requires two separate visits.

The medical evaluation includes:
ξ Complete history and physical
ξ Chest X-ray
ξ EKG
ξ 24-hour urine collection
ξ Urinalysis with urine culture
ξ Spiral CT/CAT scan of your
abdominal organs; including your
kidneys
ξ Blood tests
ξ Kidney specialist evaluation
(medical &/or surgical)
ξ Social Work/Health psychology
evaluation
ξ Dietitian evaluation
ξ Living donor advocate evaluation
ξ Consultation with Transplant Nurse
Coordinator
ξ Additional tests may be
recommended based on medical
history or test results






The preferred way for any donor
who wants to be tested is to contact
the UW transplant program by
completing the UW Health online
Living Donor Application
at www.uwhealth.org/canibeadonor
If you don’t have computer access,
you can contact the transplant
office by phone and one of our
assistants will help to complete the
online application. Our Transplant
office phone # is 608-263-1384.


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Blood tests include:
ξ A fasting glucose test and a HgbA1C
level (screening for diabetes)
Routine chemistry and hematology
panels
ξ Clotting studies
ξ Viral infection screening

Blood samples: are drawn for
matching, other blood samples make sure
you are in good health. The site where your
blood is drawn might have a small amount
of bruising or be painful.

Urine samples: includes a 24-hour urine
collection for protein and creatinine
clearance to tell us how well your kidneys
are working. A urinalysis and a urine
culture are also done. These tests can detect
possible kidney problems or infection.

Chest x-ray and ECG
(electrocardiogram): are done to check
your heart and lungs.

A Spiral CT/CAT scan: to evaluate your
kidneys and their blood vessels is done. This
helps determine the health of your kidneys
and their anatomy. It helps the surgeon
decide which kidney would be easier on you
to have removed. The CT also evaluates
other organs in the abdomen to see if there
are problems. If you have any known
allergies to contrast dyes, seafood or
shellfish, be sure to tell us before having
this test. If you have any of these allergies,
you may receive medicine before the test, or
possibly an MRI scan may be done.

Consultation interviews with medicine,
social work, psychology, nursing, and
dietician: provides you as much possible
information about what donating a kidney
might mean for you in the short- and long-
term. You and the team will talk about your
history and current situation so as to be able
to assess risks of donation.
After all the tests are finished, it takes about
one week to collect the results. The donor
team will review the information at our
weekly donor committee meeting. More
tests or consults with other doctors may be
needed once the test results are
reviewed. These often, but not always, can
be done closer to your home.

“Matching,” and who can receive my
kidney?
One main goal of transplant is to have the
recipient’s body accept someone else’s
kidney. Blood samples are used to identify
good matches. Using blood samples we can
identify blood type, antigens (also called
HLA-tissue typing or genetic markers) and
Donor Specific Antibody (DSA) levels. This
information is used to find the best match
for the person who needs the transplant.

Blood Type: There are four blood types: A,
B, AB and O. A person’s Rh factor
(positive/negative) does not matter for
kidney transplant. The blood type between
the donor and the recipient should be
compatible. The chart below shows what a
well-matched blood type is for each blood
group.

If a RECIPIENT is
Blood Type:
The
DONOR must
be Blood Type:
O O
A A or O
B B or O
AB A, B, AB or O

Antigens (also called genetic markers,
tissue typing): Everyone is born with 46
special cells that make up the body’s genetic
code. These cells are called chromosomes
(DNA –genetic markers). It is the sixth
chromosome that affects our immune
system. The immune system controls the
rejection process after a transplant. On this

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sixth chromosome there are six specific
antigens we match between a donor and
recipient.
Though it is thought the more antigens
matched the better, with today’s improved
anti-rejection medicines, matching antigens
is not needed. Once the genetic markers are
identified, the Donor Specific Antibody
(DSA) levels can confirm a true match.

Donor Specific Antibody levels. Over a
person’s life time antibodies are formed as a
protective process of the body. A blood test
is done for all recipients to identify any
antibodies against human antigens. We look
at whether a recipient has antibodies that
may react towards the donor. The Donor
Specific Antibody (DSA) level measures
any reaction a recipient has towards a donor.
No reaction or a low reaction level is needed
for a match.

In order to move forward with
transplant, we look for a compatible
blood type and an acceptable (low) DSA
level between the donor and
recipient. The DSA level will tell us what
anti-rejection medicine or treatments the
recipient needs before and after the
transplant.

What if I am the Wrong Blood Type or
the DSA levels are too high with my
planned recipient? As shown on page 7,
there are ways for willing kidney donors to
donate for a planned recipient even if you
don’t match each other. UW Health
participates in the National Kidney Registry
program designed especially for this
situation. When willing donors are not
compatible with their planned recipient, this
option is discussed.

The paired kidney exchange program will
look for a match for you and your planned
recipient with a different donor and recipient
pair. If medically suitable, each donor
would donate his or her kidney to the other
recipient. In this way, both recipients would
get a matched kidney from an unrelated
living donor. To find out more about the
kidney exchange program you can go to
www.kidneyregistry.org

Blood Type incompatible transplants are
possible in certain situations. Because of
added risks involved with this type of
transplant, it should be considered only if
necessary.

What if a problem is found during the
donor evaluation?
During the donor evaluation, new
information about your health may be
identified. These findings may mean that
you are not able to be a kidney donor.
Further care may also be advised. You
should follow up with your local doctor.
The cost of this follow up care will be your
responsibility. With your consent, records
from the donor evaluation will be sent to
your local doctor.

What does it cost to donate a kidney?
The recipient’s insurance and/or Medicare
will cover the donor pre-donation medical
work up, the hospital stay, any doctor
charges and a post-surgery clinic visit. If
you receive any bills for the work up or
hospital stay, please call the transplant office
at (608) 263-1384.

Unfortunately, the recipient’s insurance
typically will not pay for travel costs and
does not cover a donor’s time off
work. These are a donor’s responsibility. If
you are working, and have disability
insurance, the time needed off from work to
donate a kidney may be a covered benefit.
Other employers may require you to use
your sick time. You should check with your
employer to see what benefits you have. Our
Social Worker can assist you with planning
for these expenses. A federal government

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grant is now available to donor’s to help
offset some of these costs. Certain
household income criteria must be met in
order to qualify for this assistance.

If you live in Wisconsin, you may qualify
for benefits under the Wisconsin Donor
Tax Exemption Bill. Also, State of
Wisconsin employees may qualify for
special leave time under Act 125. The
Social Worker or coordinator can give
you more details about this.


Two Different Types of Donor Surgery -
Open versus Laparoscopic (“Lap”)
Approach

Laparoscopic surgery is a less invasive
type of surgery. Often the recovery time
and pain are less. Special instruments and a
video monitor are used to look at the kidney
and blood vessels and to remove the kidney.
Most donors are able to have their surgery
done this way.

Although rare, a person who has had major
abdominal surgery and/or has difficult left
and right-sided kidney anatomy may not be
able to have laparoscopic surgery. Your
coordinator and doctor will talk to you about
this if an open surgery is recommended.

The laparoscopic method uses 3-4 small
incisions (about 1 inch each) on the
abdomen to fit the instruments and the tiny
camera. There is also one larger incision
(about 3-4 inches) made below the belly
button. This is where the kidney is taken
out. Some donors are now able to have a
laparoscopic surgery that uses only one
incision (single port). Your surgeon will let
you know if a single port laparoscopic
surgery is possible. Laparoscopic surgery
may take about 3 hours.
It is important to know that if problems
occur during a laparoscopic surgery, the
surgeon may have to change to an open
method to remove the kidney. This very
rarely happens, but is a possibility.
Open surgery allows the surgeon to see the
kidney and blood vessels directly. This
surgery is used in patients with more
complex kidney anatomy, such as several
kidney blood vessels or who have had major
abdominal surgery in the past. The open
incision is about 8-10 inches in length.
Open surgery will take about 2-3 hours.

The Hospital Stay
A pre-surgical clinic visit at UW Health is
needed before the surgery and is typically
done the day prior to surgery. If you do not
live nearby, a hotel room will be provided
the night before the surgery. On the day of
surgery the donor will come to the hospital
as an outpatient through the first day surgery
clinic. Following surgery a donor is
admitted to the hospital unit

Please bring comfortable loose fitting
clothing and walking shoes to wear after
surgery. Walking often helps prevent
pneumonia and blood clots. It also helps
restore normal bowel function.

Your nurse will get you up to walk about 6
hours after surgery. The average hospital
stay is 1-3 days after the surgery.

Once discharged from the hospital you will
recover at home for another 2-6 weeks. It
may take as long as 4 to 6 weeks before you
feel close to normal. We ask you to limit
your daily routines, such as no driving,
heavy lifting or strenuous activities. You
should not lift more than 10 pounds or do
strenuous activities/exercise for about 8
weeks. You should be able to start driving
again when you are no longer taking any
pain pills and can move without pain. Your
surgeon will let you know when you can
begin to increase what you are doing.


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What long-term follow up is needed and
recommended?
You will have a post-surgery check-up in
the UW Health transplant clinic between 3
and 4 weeks after the surgery.

We will monitor your recovery and kidney
function at 6 months, one year and two years
following the donation. Our office will
contact you and help obtain the needed
information at these time points. The follow
up cost associated with the 6 month, one
and two year visits are yours or your
insurance providers’ responsibility.

We suggest that you see your local doctor
every year for a complete check-up after
donating a kidney. This exam should
include a physical exam, a blood pressure
check, blood creatinine level and urine
testing to see how your kidney is working.
The cost of your ongoing annual check-up
will be your responsibility.

Hotel Accommodations
If you are coming from out of town, you and
your family may want to stay in Madison the
night before any clinic visits or the hospital
stay. The UWHC Housing Office, (608)
263-0315, has a list of nearby hotels from
which to choose, as well as information
about the Restoring Hope Transplant House.
A discount rate is given for any additional
nights when you make the reservations
through the hospital housing
accommodations office - again we will
cover the cost of the room the night before a
donor surgery.

Parking and Validation
One visitor can have a parking pass
validated before leaving the hospital. You
can have this validated at the Admissions
Desk/Information Desk during normal
business hours.


Phone Numbers
Transplant office number: (608) 263-1384
Fax Number: (608) 262-5624
Main Hospital number 1-800-323-8942 (you
will need to ask for the transplant office
telephone number listed above or the
department number you want to reach)
















Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 10/2017 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5285


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