Living Kidney Donor (LKD) Program

DRAFT VERSION FOR REVIEW

 

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If you or a loved one have end-stage renal disease, the UW Medicine Kidney Care and Transplant Program offers comprehensive and compassionate care with a special emphasis on living donor kidney transplantation. If you are interested in donating a kidney please take the Potential Living Kidney Donor Screening and our Independent Donor Advocate will follow up with you.

UW Medicine’s transplant team is experienced at planning and performing sophisticated living-donor transplants.

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Expert care for living kidney donors and living kidney transplant recipients

The gift of a kidney can save a life. And with living kidney donation, patients can receive transplants faster and move on with the rest of their lives.

To maximize the possibility that our patients will get a living donor kidney transplant, we are active members of the largest national living donor exchange program, the National Kidney Registry. More than 20 institutions across the country participate in this kidney sharing network.

And at UWMC, special care is given to our kidney donors whom we admire for their generosity. All those who wish to give a kidney to another are carefully and respectfully evaluated by our team to make sure that it is safe for them to donate.

Why do patients come to UW Medicine Kidney Care for Living Kidney Transplantation?

Better outcomes: According to the Scientific Registry of Transplant Recipients (SRTR), the UWMC transplant rate is statistically significant, 57% higher than the expected rate for our patient population. This represents the highest rate of adult kidney transplantation in the Pacific Northwest.

This correspondence also includes a new version of the SRTR data indicating a 5 Bar Comparison to National Rates. Our center reflects the highest rating.

This report includes the 1-year patient survival of 99.35% at the University of Washington Medical Center, which is statistically significant above the expected patient survival of our center’s 97.59% and the national patient survival of 97.71%.  So is the UWMC 3-year kidney patient survival of 97.46% when compared with our center’s expected rate of 94.39% and the national patient survival of 93.49%.

The 1-year kidney graft survival at UWMC of 98.84% is statistically significant better than the expected survival of our center’s 96.00% and the national graft survival of 95.90%.  So is the UWMC 3-year kidney graft survival of 94.74% when compared with our center’s expected survival of 90.77% and the national graft survival of 89.02%.

These outcomes comply with Medicare and United Network for Organ Sharing Membership and Professional Standards Committee requirements. For additional data, you may also visit the website for the United Network for Organ Sharing (UNOS), the national organization that reports transplant results, at www.unos.org and www.SRTR.org.    

  • Our nephrologists’ extensive experience caring for post-transplant patients contributes to these excellent outcomes.
  • UWMC nephrologists’ extensive experience caring for post-transplant patients contributes to these excellent outcomes.
  • Our patients with a history of cancer are seen by UW Medicine providers at the renowned Seattle Cancer Care Alliance.

Shorter waits: There is a shorter waiting time for living donor kidney transplantation. However, our patients being evaluated for living donor kidney transplantation are also placed on our transplant waiting list to provide additional options.

One-stop patient care: Throughout the pre- and post-transplant process, our patients often see specialists from other disciplines, such as radiology, oncology, cardiology, vascular and infectious disease. All are experienced in treating kidney dysfunction and all are here at UWMC.

  • And if necessary, we can also transplant other organs — the pancreas, liver or heart — at the same time we perform your kidney transplant.

Living kidney donations


Review our donor checklist for an overview of what the transplant workup process involves and explore the living kidney donation overview. If you wish to be considered for living kidney donation, please complete the potential living kidney donor screening

Potential living kidney donor screening

living kidney donation overview


Paired kidney exchange

When potential kidney donors cannot donate to their intended recipients because of mismatched blood type or tissue incompatibility, they can now enter the donor exchange program and donate to another person, which will allow their intended recipient to receive a kidney from another donor. See diagram below.

kidney matching chart

Once a donor and recipient are approved for the transplant, they join a private registry (computer program) of other people, consisting of pairs of donors and recipients who are not compatible with each other. A computer program then matches these donors and recipients to people with whom they are compatible.

Donor exchange can also be started by a non-directed donor, someone who donates anonymously without having a specific recipient. This situation starts a donor chain. See diagram below.

kidney registry chain chart

What Registry does University of Washington Medical Center use?

Today there are several major groups organizing kidney exchanges across the United States. These kidney registries are different than the national kidney waiting list through UNOS. The national kidney waiting list is for people to receive a kidney from a donor who is deceased. Patients on the kidney exchange registries may stay active on the national kidney waiting list through their transplant center while they are also registered with a kidney exchange program.

The University of Washington Medical Center belongs to the National Kidney Registry (NKR). The website for the national kidney registry is www.kidneyregistry.org.

Is there additional testing needed for Donor Exchange? 

Living kidney donors and transplant recipients participating in the donor exchange have the same medical work up and evaluation as traditional living donation. However, there could be some additional testing required for the NKR.

Will I have to travel for the transplant or donation?

The donor kidney may be given to someone who lives in Washington or to someone who lives in another state. If a donor matches with a recipient in another location, the kidney would be shipped from the donor’s center to the recipient’s center. Shipping the kidney should not cause any decrease in success of the transplant.

Does a donor have to give a kidney before their recipient receives a kidney?

No. Typically, the kidney donation and transplant happen within the same 24 hours. There are alternate options, which can be discussed with your providers.

How long does it take to find a match once the donor and recipient are added to the NKR?

The average wait time is about 10 months. How quickly a match can be found for a potential recipient can depend on blood type and whether there is a high level of antibodies against human tissue already present (high panel reactive antibody [PRA]). In addition the blood type of the possible donor can make a difference—if the donor has a more common blood type, a match can be found more quickly. The transplant center can evaluate more than one donor per recipient to be entered into the registry since this can potentially increase the speed of finding a match and allow more transplants to be done.

If you would like to participate in Paired Kidney Exchange or have questions, please contact University of Washington Medical Center at 206-598-3627.

Other information about living donation can be found at, www.unos.org; www.kidneyregistry.org; and https://www.myast.org/patient-information/live-donor-toolkit.

Non-directed kidney donation

The process of non-directed donation is for people who wish to donate a kidney, but do not have a specific person selected to receive the donation.

How it works

First, the potential donor will undergo an extensive medical and psychological evaluation to determine that he or she is a suitable candidate. If the person is approved to donate, his or her kidney would then be given anonymously to someone in need of a kidney transplant.

The donor has the option of choosing whether he or she would want their gift to be given to an adult through the University of Washington Medical Center transplant list, a child through the Seattle Children’s Hospital transplant list, or to a recipient through the National Kidney Registry. If the donor chooses to donate to an individual through the National Kidney Registry, he or she can start a chain of transplants (see www.kidneyregistry.org for more information).

Risks and rewards

Living donation can improve the quality of life of the kidney recipient and be a highly rewarding experience for the living donor. However, there are risks involved, and it is important to think carefully about the physical, emotional and financial impact of donation.

If you have any questions about non-directed donation or are interested in becoming a non-directed donor, please contact our Living Donor Advocate at 206-598-3627.


Interested candidates must meet certain requirements and undergo a full medical evaluation.

criteria

Medical evaluation

living donor checklist

Living Kidney Donor Map

What is Paired Kidney Donation?
When potential kidney donors cannot donate to their intended recipients because of a mismatched blood type or tissue incompatibility, they can participant in a donor exchange program and donate to another person. This option allows the intended recipient to receive a kidney from another donor.

DONOR EXCHANGE FACT SHEET

The evaluation for being a living kidney donor includes many tests, procedures and visits with doctors. It also consists of meeting with many members of the transplant team (link to team site). The evaluation helps us determine if you are a good match with your potential recipient and if you are healthy enough to donate your kidney.

Please be aware that the evaluation may reveal health conditions that need to be corrected prior to donation; if they cannot be corrected, you may not qualify to donate.

To help you understand this process, we’ve created a visual guide (pdf here) to illustrate the steps you need to take.

living kidney donor map

Evaluation and testing

Some or all of the following tests may be included in your evaluation process. Other tests may need to be done based on the results of these tests or the medical evaluation performed by your physicians:

  • Blood tests — A variety of blood tests will be performed. These include blood typing, HLA typing, and cross matching to determine organ compatibility. A blood draw screening for exposure to infections, including HIV and hepatitis, will also be performed.
  • Urine tests — Urine tests are done to screen for blood, protein and urinary tract diseases. Two 24- hour urine collections are also completed to test your kidney function.
  • EKG — An electrocardiogram shows how well your heart is beating and the function of your heart valves. This helps your doctor decide if your heart is strong enough for donation.

Routine health care — A pap smear, mammogram, and/or prostate-specific antigen (PSA) blood test and colonoscopy are general health and cancer screening tests that we require based on your age, gender, and family history. These tests are part of your own standard health care and are therefore not paid for by the Living Donor Program.

  • CT Scan - A computerized tomography (CT) scan with contrast will provide an image of your abdomen to check the anatomy of your kidneys, liver, spleen and bladder. This test will determine if surgery is safe, as well as which kidney would be donated.
  • Chest X-ray – A chest x-ray screens for illnesses of your lungs, heart and primary blood vessels.

Selection Committee

After you see a surgeon and the CT scan is completed, the results of your evaluation will be presented to the UWMC Living Kidney Donation Selection Committee. At this meeting, it will be determined if you are a candidate for a living donor surgery. The committee members will determine whether you are medically able to undergo the transplant procedure, and if you have shown that you have the social, financial and support resources for the donation.

The committee will decide:

  1. To accept you as a donor.
  2. Not to accept you for donation and explain why you were not accepted.
  3. Request more visits and tests before they make a decision.

You will be contacted about the decision within 10 business days of your presentation to the committee.

The Donation Operation (Nephrectomy)

Once you are approved as a donor, we will schedule your surgery based upon your schedule, the operating room schedule and the recipient’s schedule. During your pre-operative appointment, your surgeon will review the procedure and related risks again.

Care and Recovery After Surgery

After your surgery, you will be taken to the inpatient unit. The length of your stay in the hospital typically varies between two and four days, and will depend on the rate of your recovery and/or complications after surgery.

After you leave the hospital, you will still be recovering. For the first eight weeks, your doctor may recommend limiting your daily activities.

You will meet with the living donor team approximately 9 to 12 days after surgery for a post-operative appointment. We also request that you to have an exam and lab tests at 3 to 6 months, 1 year and 2 years after donation. These follow-up appointments can be at UWMC or with your primary care provider. It is also important to maintain long-term follow-up with your primary care provider.


At UW Medicine, our multidisciplinary team ensures you get the best care possible during the Living Kidney Donation (LKD) process. Here are some of the people you’ll meet with:

  • An Independent Donor Advocate (IDA), a licensed clinical social worker, will be available to you throughout the donation process and recovery to promote your best interest and advocate for your rights. The IDA is independent of the recipient's care team. The IDA will assist you with obtaining and understanding information regarding the medical, psychological, and financial risks associated with being a living donor. The IDA will be available to you to discuss any concerns or questions you may have. The IDA will make sure that you feel comfortable moving forward with the living donation and that you do not feel any pressure to donate. The IDA will be your voice at the donor selection conference.
  • Psycho/Social Evaluation -- A licensed clinical transplant social worker will complete a full psychosocial evaluation, including review of your mental health and alcohol and drug use. The purpose of this evaluation is to determine if you understand the emotional, financial, and physical stress you may experience as a kidney donor. This interview will also allow you to become acquainted with the support systems available at the UWMC. The social worker can also recommend options for assistance with expenses not covered as part of the donation e.g., housing and transportation. Support of the transplant social worker will be available throughout the living kidney donor process to help with stress-related problems to you and your family.
  • A Transplant Nephrologist meets with you to determine if you are a good medical candidate for donation. The nephrologist will review your medical history, ask many questions about how you are doing and what infections you might have been exposed to, plus review the medical risks for donation. A full history and physical will be performed. The nephrologist will also follow up with you after donation to review medical recovery.
  • A Transplant Surgeon meets with you to discuss whether donation is an option for you, based on the results of your evaluation. The surgeon will also discuss the significance of having the surgery, the procedure itself, the risks of the surgery and the possible complications after your donation and during the recovery phase.
  • The Nurse Coordinator provides education about the donation process and your responsibilities before and after surgery. The nurse coordinator discusses test results and reviews any medical testing needed throughout the process.
  • A Program Coordinator discusses and schedules testing and blood draws, and provides information about visits to the UWMC.
  • A Psychiatrist/Psychologist may conduct a more in-depth psychiatric evaluation and assessment. Some patients with a history of drug or alcohol abuse may be required to participate in a rehabilitation program and/or to abstain from substance use prior to donation.


How do I get more information about living kidney donation?

Please contact the Living Donor Program at University of Washington Medical Center (UWMC). You can also find information on the Internet and in magazines and books. We’ve put together additional resources in our documents and forms section.

How do I get started?

Just call the living donor phone line at 206-598-3627. We’ll do a brief phone interview and give you some information about the donation process. You’ll also have the opportunity to ask any questions you may have.

How long does the evaluation process take?

The process, from your initial inquiry to potentially being approved as a donor, takes approximately 3–6 months, and depends upon the required tests, the test results and the recipient’s status. We’ve put together a checklist with some further details (link here).

Who pays for living kidney donation?

The Living Donor Program pays for appropriate testing ordered by the program. Please note that the recipient must be cleared financially and medically prior to proceeding with testing. Transportation costs and lost wages are not covered as a part of donation. However, the National Living Donor Assistance Center does provide financial assistance for travel costs. Some people may be eligible for paid leave or disability through their employer. If you have questions about financial assistance, please contact the living donor phone line at 206-598-3627.

Am I a match?

The results of three tests determine your level of match with your intended recipient:

Blood type

You must have a compatible blood type to donate directly to your intended recipient. If your blood types are not compatible, then donation is possible through the donor exchange program. (See PAIRED KIDNEY EXCHANGE section in this document.)

Crossmatch

A crossmatch combines the recipient’s blood cells and the donor’s blood cells to check for interaction. No interaction, or a negative crossmatch, is needed for transplant. If there is an interaction, or a positive crossmatch, then donation is possible through donor exchange. If there is a negative crossmatch, the evaluation process continues with tissue typing to determine antigen matching.

Tissue Typing

This is a blood test that determines whether your tissue is compatible with your intended recipient. Because of advances in medicine, tissue matching is not as important as it was previously, so people who are not matched for any antigens may still donate with very successful outcomes for the recipient. Please note that results from these tests can take up to 10–14 business days to be received.

What if I am not a match with my recipient?

If you are not a match with your intended recipient, you may consider participating in donor exchange. We participate in the National Kidney Registry for donor exchange. For more information on donor exchange, visit kidneyregistry.org .

What if I don’t live in the Seattle area?

Initial testing can be done outside of the Seattle area. You will then need to be seen at University of Washington Medical Center for further testing in order to be approved as a donor. You will also need to return to the Seattle area for surgery and recovery.

How long is the recovery?

The length of your stay in the hospital typically varies between two and four days, and will depend on the rate of your recovery and/or complications after surgery. You will meet with the living donor team approximately 9 to 12 days after surgery for a post-operative appointment. Typically, you should be able to return to work within four to six weeks, but you may require longer depending on your job duties and personal recovery. If there are no complications from the surgery, you should be able to return to your normal level of activity within two to three months.

How long will the kidney last for the recipient?

It depends upon a number of factors, including what disease the recipient has, the anti-rejection medication being prescribed and the compliance of the recipient. The average is between 10 and 15 years.

What if I do not know someone who needs a kidney transplant?

If you do not have a specific transplant recipient, you can become a non-directed donor and donate anonymously to someone waiting for a transplant at UWMC, at Seattle Children’s Hospital, or through the donor exchange program.


Interested in finding out more about our services? Contact us and let us know how we can help.

University of Washington Medical Center
Kidney Care & Transplant Program
1959 NE Pacific Street
Seattle, WA 98195

Phone: 206.598.3627
Fax: 206.598.2201
Hours: 9 a.m. – 5 p.m.

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