Did you Know?

“But can’t he do dialysis?”

Time is the enemy for a person who needs a kidney transplant. The life span on dialysis is on average 2-5 years.  The experience of being attached to the machine every day or every other day is sickening, debilitating and eventually deadly because of the toxins that build up in the liver, the damage the machine does to the heart and the vascular system, the formation of blood clots causing stroke or heart attack, and the infections and re-surgeries to the access point.

John Oliver produced this eyeopening expose on why Dialysis is not a good option:

 

MORE INFORMATION FOR DONORS

Q. Why is a kidney transplant from a living donor better than one from a deceased donor?

A kidney donation from a living donor provides some major benefits for individuals with renal failure. Data shows that a living donor kidney not only functions better, but it lasts longer. Overall, benefits of a living donor transplant include:

  • Better long term transplant kidney survival;
  • Faster access to transplantation;
  • A reduced risk of rejection.

Q. What does it take to be a kidney donor?

A living kidney donor is usually between ages 18 to 65 and in excellent health. Donors over age 65 are considered on a case by case basis. Individuals interested in being a living donor at UCSF in San Francisco can start the process by going to ucdonor.org and completing the online questionnaire. You will need to fill in my name and birthdate: Ralf Masch, August 29, 1957. If you are an acceptable donor, UCSF will contact you to schedule a 2-day donor evaluation in San Francisco.

Q. What might rule out someone as a kidney 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.

Q. What does kidney transplant surgery involve?

The surgical procedure to remove a kidney from the donor is called a donor nephrectomy and takes approximately 2-3 hours. Surgeons primarily use a minimally invasive technique, using 3 small incisions to insert instruments and a slightly larger incision (~8 cm in length) to remove the donor’s kidney. Typically donors spend 2-3 days in recovery before being discharged from the hospital.

Q. What risks are there to kidney donors?

Once a living donor candidate has been completely evaluated and cleared, the chance of the donation affecting his/her lifespan or lifestyle is extremely low. With any surgery and anesthesia, however, there are risks. Nationally, the risk of having a life-threatening problem with donating a kidney is 1 in 3,000. The risk of minor complications such as a minor wound infection is about 2-4%.

Q. What is recovery like?

Because the kidney donor operation is a major surgical procedure, donors find they have less energy and need about 4-6 weeks to return to their full pre-surgical activity level. For donors who worked prior to surgery, disability coverage allows 6 weeks off for recovery; however, some donors return to work before this time.

Q. Who pays for a donor’s medical costs?

All expenses for the medical work-up and transplant surgery are covered by the recipient’s health insurance. In considering donation, candidates need to consider additional expenses such as:

  • Travel to UCSF Medical Center in San Francisco
  • Parking, lodging, gas, bridge tolls and other incidentals
  • Lost wages if sick time or short-term disability from work is not available.

Our financial coordinator and social workers can discuss your specific circumstances in more detail.

Q. What is the long-term outcome for kidney donors?

The New England Journal of Medicine and Journal of the American Medical Association published long-term studies in 2009 and 2010 analyzing outcomes of kidney donors. One study followed 80,000 live kidney donors dating back to 1994, while the other studied 3,698 individuals who donated a kidney between 1963 and 2007. Results showed:

  • Donor survival was similar to that of the general control population (people who had not had a kidney removed) matched for age, sex, and race or ethnic group.
  • The rate of end-stage renal disease (ESRD) was significantly lower in the group of patients who donated a kidney than the rate in the general population (180 versus 268 per million per year).

After donating one kidney (removing 50 percent of the functioning kidney mass), the remaining normal kidney compensates and the overall kidney function (measured in GFR, or glomerular filtration rate) increases to approximately 70 percent of baseline at about two weeks and approximately 75 to 85 percent of baseline at long-term follow-up.

Q. Can a female donor have children after donating a kidney?

Women of childbearing age can have children after kidney donation because the donor surgery does not affect their reproductive organs. UCSF’s kidney team can work with donors to plan a donation time that works best with family planning if needed.

Q. Does a donor need follow-up medical care after donation?

Two to three weeks following a donor’s discharge from the hospital, the donor is asked to return to UCSF for a medical exam. Six, 12 and 24 months following donation, donors are asked to complete lab work and a questionnaire. Our team also encourages donors to have regular appointments with a primary care provider.

Types of Living Kidney Donation

There are three types of living kidney donation; direct donation, paired exchange donation and altruistic donation. All living donors begin the donation process by completing the living donor questionnaire at ucdonor.org

    • Direct Donation 
      With direct donation, the donor generally knows the recipient and donates directly to them. If the donor is compatible, the donor’s kidney can be transplanted directly into the recipient. One problem with direct donation is that direct donors are often incompatible or poorly compatible with their intended recipients – this means they are not the right blood type or do not pass a cross match test with the intended recipient. However, a donor can still help their intended recipient get a transplant if they are incompatible by participating in a paired exchange.
    • Paired Exchange Donation (SWAP)
      A donor will donate their kidney to another recipient in exchange for a compatible kidney for their loved one. In the example below, the first pair, a mother and her son are incompatible. The second pair, a husband and his wife are also incompatible. In this exchange, the mother donates to the wife of the second pair and the husband donates to the son in the first pair. Often compatible pairs enter into a paired exchange to get a better match donor.
  • Non Directed Donor (altruistic donor)
    With altruistic donation, the donor is giving to a stranger which initiates a chain of transplants. Chains are a way for one altruistic donor (aka Non Directed Donor) to help many patients get transplanted. Chains are also revolutionizing the paired exchange process by facilitating better donor-recipient matches including some six antigen matches, which is important because a great match allows the transplanted kidney to last longer.
    Many altruistic donors choose to start chains because it is a way to help more than one person suffering from kidney failure. One chain typically facilitates anywhere from 2 to 20 transplants.

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