Giving the gift of a kidney, a lobe of a lung, or a portion of the liver, pancreas or intestine, living donors offer patients an alternative to waiting on the national transplant list for an organ from a deceased donor. The number of living organ donors is more than 6,000 per year, and one in four of these donors are not biologically related to the recipient.
What is Living Donation?
The majority of organ donations occur after a donor has died. However, living donation is possible with certain organs and tissues, enabling doctors to save more people in desperate need of a transplant. Living kidney and liver donors can range from family members and friends to anonymous individuals if they meet the requirements to donate.
Advantages of Living Donation
When doctors are able to transplant an organ from one family member to another, the genetic match often decreases the risk of rejection.
Because it is a living donation, the procedure can be scheduled at a convenient time for both the donor and recipient.
Kidney transplant recipients often see an immediate return of normal function.
Types of Organs Supplied by Living Donors
Kidney – Individuals can donate one of their two kidneys to a recipient, making this the most common form of living organ donation. Although donors will see a decrease in kidney function after donation, their remaining kidney will function properly in working to remove waste from the body.
Liver (lobe) – People can donate one of two lobes of their liver. The liver cells in the remaining lobes of the liver regenerate after the donation until the organ has regrown to almost its original size. This occurs in both the donor and recipient
Lung (lobe) – Lung lobes do not regenerate, but individuals can donate a lobe of one lung. Living lung donation occurs when two adults give the right and left lower lobes (from each respectively) to a recipient. The donor’s lungs must be the right volume and size to be a correct match.
Matching Donors and Transplant Patients
Paired donation or paired exchange involves two pairs of potential living kidney donors and transplant candidates who are not compatible. The two candidates “trade” donors so that each candidate receives a kidney from a compatible donor.
Kidney donor waiting list exchange occurs when a living donor who is incompatible with the intended transplant candidate donates to an anonymous candidate on the waitlist so the intended candidate can be given higher priority on the waitlist.
Blood type incompatible donation occurs when a transplant candidate receives a kidney from a living donor with an incompatible blood type. To decrease the risk of rejection of the donated organ, candidates receive specialized medical treatment before and after the transplant.
Positive cross-match donation involves a living donor and a transplant candidate who are incompatible because antibodies (a protein substance) in the candidate will immediately react against the donor’s cells, causing loss of the transplant. Specialized medical treatment is provided to the candidate to prevent rejection.
Certain living donation options may not be available at all transplant centers. Contact transplant centers directly for information on specific programs.
History of Living Donation
The first successful living donation took place when, in 1945, Dr. Joseph Murray transplanted a healthy kidney from Ronald Herrick into his twin brother, Richard. He had been suffering from chronic kidney failure, but lived a healthy life after the transplant until his death from causes not related to the transplant. Ronald, his living donor brother, lived for 56 years after the surgery until his death in 2010.
Altruistic Kidney Donation
Living kidney donors who are not related to or known by the recipient are known as non-directed donors. This type of selfless donation can also be referred to as altruistic or anonymous non-directed kidney donation.
In this case, the transplant center determines how the donor’s kidney will be used. Non-directed donors may help multiple transplants occur by donating to a paired donation program where their altruistic donation may be useful to a “chain” of donations. It is important to note that living donors are never paid – it is illegal to donate an organ for profit under the National Organ Transplant Act of 1984, and transplant centers are prohibited from accepting living donors who have been pressured to donate.
When the organ recipient knows the potential donor, the recipient’s insurance pays for clinical evaluations to ensure they are in the best possible state of health to move forward with the donation. If you are an altruistic donor without a known recipient, your insurance provider will most likely refuse to pay for your evaluation tests. Luckily, most local transplant centers cover these expenses. Please visit CORE’s website to view links to all kidney transplant centers within the CORE service area.
To Become a Living Donor
The health and safety of a living donor is the most important priority in any transplant procedure involving a living donor. Emotionally and physically, living donors must be in top condition.
Living Donors Must…
Donate voluntarily. At any time during the donation process a living donor may change his or her mind. This decision will be kept confidential.
Be in good health overall with normal organ function and anatomy.
Be physically fit. In most cases, donors should not have high blood pressure, diabetes, cancer, kidney disease or heart disease.
Not be paid. It is illegal to pay or be paid for a donation under the National Organ Transplant Act of 1984 and state law.
18-60 years old (in most cases).
Complete clinical evaluations beyond the initial donation criteria to confirm compatibility with a recipient. These include physical and psychological evaluations.
Give informed consent. Transplant centers must ensure that the prospective donor has been informed regarding the aspects of living donation and possible outcomes.
Types of Living Donors Directed Donation
Related Living Directed Donation: Includes healthy blood relatives of candidates:
Brothers and sisters
Children over 18 years of age
Other blood relatives (aunts, uncles, cousins, half-brothers and -sisters, nieces and nephews)
Non-related Directed Donation: These are healthy, unrelated living donors who are emotionally close to transplant candidates, including:
Relatives through marriage
Co-workers, neighbors or other acquaintances
Non-directed/Altruistic Donation: These living donors are not related and unknown to the recipient. Altruistic donors make their donation for purely selfless reasons and are sometimes called anonymous donors.
Paired Exchange Donation: This system enables a living donor to initiate a chain of transplants to the benefit of more than one person in need. Non-directed kidney donors who wish to donate to anyone waiting for a kidney can be included in paired exchange donation programs.
The Decision to Donate
The decision to donate is very personal, and potential donors should make their decision with all the available information to make an informed choice. Donation must be a voluntary decision that is free from pressure of any kind.
A living donor may change his or her mind at any point in the donation process. This decision and any reasons will be kept strictly confidential. Potential donors should consider the possible health effects of donation as well as the life-saving potential for the transplant recipient.
Usually, a donor’s life returns to normal within four to six weeks after the surgery, but because of all the effects on donors, particularly unknown long-term effects, the federal government does not actively encourage any individual to make a living donation. They do recognize the wonderful gift provided to transplant recipients, and through the Division of Transplantation, Health Resources Services Administration and U.S. Department of Health and Human Services, the federal government works to support living donors.
Medical expenses for living donation are generally covered by the recipient’s insurance plan. Transplant centers are required to charge recipients an “acquisition fee” upon receiving a transplant, which covers the donor’s pre-donation clinical evaluations, the transplant procedure and postoperative care, also referred to as “donor protocol.” Other costs outside of this protocol are not covered. More extensive and detailed information about the financial aspects of the procedure can be provided by the transplant center.
Who Makes a Good Donor?
Ultimately, a transplant center has the definitive say on whether or not a person can become a living donor. A person who wishes to make a living donation is carefully screened for the best possible physical and psychological outcome for both the donor and the recipient.
Resources for Living Donation
Contact the potential recipient’s transplant center to receive more information or be tested as a potential living donor for someone you know. Ask to speak with the transplant coordinator who will be able to provide you with additional information and get you started in the donation process.
Visit websites below for additional information:
Kidney Paired Donation Resources:
National Living Donor Assistance Center (NLDAC)
Alliance for Paired Donation (APD)
National Kidney Registry (NKR)
United Network for Organ Sharing
U.S. Federal Health Resources and Services Administration
American Society for Transplantation
National Kidney Foundation
Living Kidney Donor Network (LKDN)
I’ve heard friends and acquaintances express wonder and concern at how some individuals don’t “play be the rules” during these challenging times. Seeing some people in public wearing what I sarcastically call an “invisible mask” (failing to wear a mask at all), or wearing it around the neck, or below the nose is more than annoying, seems to me to be utterly disrespectful and displays downright indifference (and frankly, spits in the face of safety) regarding the many possible consequences.
So, do these cloth or paper masks give us a false sense of security? Not the point. Are there some who assure themselves that they won’t contract this virus or if they do, they’ll survive it with outside effects? Again, not the point.
What ever happened to treating each other with dignity and respect? I cannot imagine how I would feel if, through neglect or carelessness, I were the cause of someone catching this, or worse, not surviving it. Whether a loved one, friend, acquaintance or stranger; it makes no difference. We must care for and protect each other, rather than taking a cavalier attitude towards everything and everyone. Life is precious. Precious!
A day for remembering. A day for cherishing. A day for gratitude for the memories, the love, the laughter and the tears. God Bless not only all those here with us but also those gone, missed and still loved, honoring and holding them forever in our hearts.
I’ve done a lot of reading to help understand the meaning of my experiences with Josh. Some, in fact many, are about reincarnation, some about healing after the loss, much about the spirituality experience that I have grown to accept and celebrate. These have been the most helpful and emotionally supportive while attempting to move forward in life and gain an understanding of why things happen as they do.
I’m not going to say any of it was easy. My life throughout the past 20-some years has been an ever-evolving process of mind and spirit. Challenging, but well worth the effort, as I have learned to accept my personal history and be grateful for all that has unfolded. Yes, all, good, bad, and everything in between because I believe there are lessons in our experiences. The challenge is just to recognize them.
It seems pretty silly to be excited about playing golf, but at this point, it is fantastic freedom. Last week my partner (in two different golf leagues) and I wanted to play a practice rounds (practicing both golf and Social Distancing). The weather, however, was very uncooperative, being in the low 40’s (and probably 5 degrees colder way up on the hill course) and accumulating some snow overnight. We opted out for both days. For me, cold can be only so much fun when golfing. My most comfortable cold is about 66 degrees. So much for last week’s foray into freedom!
So, back to F-R-E-E-D-O-M. What we used to consider regular, everyday life now seems a rare gift. How will we interact in the future? Will we be distrustful, wondering who is carrying an illness that could possibly sicken or kill us? Will we ever again be comfortable to hug each other again? Will we experience freedom from worry, be as carefree and trusting as we once were a few short months ago?
I’ve just now realized that we have taken so much for granted. My husband and I used to do “Friday night Dinner & a Movie” – during non-golf season. Even back then we unknowingly practiced Social Distancing, as we went for the matinee: sometimes there were as many as six of us in the theater at 4:30 p.m. This would get us out of the theater and into our choice of a restaurant before most of the crowd arrived. We could then arrive back home before eight o’clock and fall asleep in front of the TV before nine. Hmm…are we getting old?
Well, the point is, what will we be doing in the future as we wait for the “Second Wave”? Have friends in, instead of going out? But only after we take their temperature out in the driveway? Sorry, a little sarcasm there. How are our freedoms being affected, at least for the wiser of us? Yes, I suspect our way of life will change and perhaps not so subtly or temporarily.
Freedom may just take on a slightly different meaning. Again, this will be a reinventing of ourselves and our environment. I’ll tell you what, I’m so glad I’m not 25. What a strange world these people are going to have to monitor for decades to come. Will it eventually settle into something do-able for everyone? And our parents thought it was bad back in the 50’s and 60’s? My goodness, what would they be thinking now?
As I sit here at my keyboard this beautiful sunny morning, I see a normal Spring day outside my window. I wear earphones as I listen to “God’s Healing Frequencies” on YouTube. The neighborhood seems so green and beautiful, yet strangely barren to me. It makes me wonder what it was like for my mom and her family all those years ago, going through the Great Depression. Was her world a lonely, sad and angry place then? How did that change the population as a whole?
The wait for transplant was a very difficult and emotional phase of our experience. It began in August of 1994 with one of our regular Pulmonary Clinic recheck appointments. This was when we learned that the transplant could wait no longer. Josh was running out of time and time was not on our side when it came to waiting for a donor. The wait for lungs, we were told, could be up to two years.