Living Donor Screening and Evaluation
What Does it Take to Be a Kidney Donor?
by Steven Katznelson, M.D., medical director, Kidney Transplant Program, California Pacific Medical Center
Receiving a kidney transplant from a living donor remains the best option for patients interested in kidney transplantation. Some reasons for the superior success of a living donor versus deceased donor transplant include:
- Better long term transplant kidney survival;
- Faster access to transplantation; and
- A reduced risk of rejection.
The Screening Process
There are several ways an interested living donor can be screened for donation. A living donor candidate can accompany his/her recipient to the initial kidney transplant evaluation and learn about the transplant process. If interested, the candidate then undergoes a verbal screening (outlined below) and blood pressure check. If appropriate, the donor candidate then has his/her blood testing done at the same time as the recipient.
If a donor candidate cannot accompany his/her recipient to the initial evaluation, then he/she should call the recipient’s kidney transplant outreach nurse coordinator for a phone screening. If appropriate, the nurse will send blood tubes to the donor candidate’s home. The donor candidate takes the tubes to a local lab for a blood draw and samples are returned to California for compatibility testing.
When the Kidney Team screens living donor candidates, questions address one’s demographics, medical history and psychosocial issues.
What May Rule Out a Donor
A history of heart disease, chronic lung or liver disease, kidney disease, hypertension, diabetes, cancer or untreated psychiatric disease is usually a contraindication to donating (i.e. the donor candidate is “ruled out”). Smoking, obesity and other health issues are considered on an individual basis. The age range for an acceptable donor is 18 to 65, though California Pacific’s Kidney Team prefers donors age 20 or above and will consider some donors over 65 years of age.
On-Site Donor Evaluation
If a donor is compatible with his/her recipient (or not compatible but interested in California Pacific’s Kidney Paired Donation program), the Kidney Team will encourage him/her to come to the Medical Center in San Francisco within three weeks for a complete evaluation. Katznelson explains, “This on-site evaluation includes a meeting with a transplant nurse coordinator, nephrologist and social worker. Unless problems are identified, the donor will undergo blood and urine testing, a chest X-ray and EKG. Additional tests will also be arranged including the final test, a CT scan that looks at the actual anatomy of the donor’s kidneys. In all, this evaluation takes two days and hotel accommodations near the hospital are available.”
If a donor lives too far from San Francisco and can’t come to the Medical Center for his/her evaluation, the Kidney Team can help arrange the evaluation closer to home. This is usually done in conjunction with another kidney transplant center.
“All donor candidates are discussed at our Living Donor Selection Committee which meets every other week,” says Katznelson. “Attendees at this meeting include our transplant nurses, social workers, nephrologists and surgeons, as well as our financial coordinator and ethicist. Here we discuss any areas of concern before moving forward.” Following this meeting and the review of all tests, a transplant date can be arranged.
“Because a living donor transplant offers the best outcome, we work closely with prospective donors so that the process flows smoothly,” says Katznelson. “Our goal is to make the donor evaluation process easy and rapid for donors so that the recipient in need of a kidney can be transplanted in a timely manner.”
article published in April 2010 Kidney Review newsletter