The sad reality of organ transplantation is the demand for healthy organs far exceeds the supply of organs from deceased organ donors. However, with the option of a living donor kidney transplantation, patients can now receive an organ from a family member, friend, or a kind stranger, without waiting on a long UNOS organ list.
NewYork-Presbyterian is a leader in living donor kidney transplant. Our living organ donation programs at NewYork-Presbyterian/Weill Cornell Medical Center and NewYork-Presbyterian/Columbia University Irving Medical Center were founded in 1963 and 1970. Over the years, our transplant teams have revolutionized the kidney donation operation — perfecting the minimally invasive kidney donation procedure (laparoscopic nephrectomy), which leaves only a three-inch incision mark, and three smaller ½-inch marks at the site. We have also pioneered offering transplantation for incompatible donors and recipients at our transplant centers.
What is Living Donor Kidney Transplant?
A living donor kidney transplant is a surgical procedure in which a kidney from a living donor is placed into a patient who no longer has functioning kidneys. Since the body can survive on one functioning kidney, the living donor is able to undergo surgery to have one kidney removed and donated safely.
Kidney transplants, in adults and children, typically treat kidney failure (end-stage renal disease), which can be caused by conditions like diabetes, uncontrolled high blood pressure, polycystic kidney disease, or chronic glomerulonephritis. For patients with kidney failure, a kidney transplant is needed for the body to remove waste from the bloodstream.
A living kidney donation is different from a deceased donor kidney transplant, in which the donor kidney comes from a deceased person. Living donor transplants make up about one-third of kidney transplants in the U.S., while deceased donor transplants are more common.
Is living donor kidney transplant right for you?
The ultimate goal of any transplant surgery is to improve the organ recipient's quality of life and longevity. Deceased-donor and living donor kidney transplants both offer recipients a chance at a longer life that is unencumbered by the need for dialysis, which puts you at an increased risk for infection. However, living donor transplantation has many benefits that deceased donor transplant does not, including:
- Better survival rates. On a national level, long- and short-term survival rates for living donor kidney transplants are higher than that of deceased-donor transplant. At NewYork-Presbyterian, our living donor transplant patients exceed the national average at the one-month, one-year, and three-year post-transplant review periods.
- Shorter waiting time. Patients with a designated living donor can bypass the United Network for Organ Sharing (UNOS) waiting list for organs, which is an average five to seven years in New York State. By shortening your waiting time for an organ, our doctors can prevent potential complications, further health deterioration, and possibly death.
- Immediate kidney function. Studies have shown that patients who undergo deceased-donor kidney transplant are more likely to have delayed kidney function (a “sleepy kidney”) than those who undergo living donor transplant. This delayed kidney function means patients may need to continue dialysis for some amount of time (usually days to weeks) after the surgery.
As with all transplantation surgeries, there are risks involved, including organ rejection. Our doctors will explain your potential risks and allay your concerns.
Criteria to Become a Living Kidney Donor
To make sure the kidney transplant will be safe and effective, transplant centers have selection criteria for living donors. The criteria may require you to:
- Be over the age of 18. Other criteria may exclude people over the age of 65 from being a living donor.
- Have compatible blood types, or determining whether your blood type matches with the recipient’s blood type. For example, donors with type A blood are compatible with recipients who have types A and AB blood. However, recipients with living donors who are blood-type-incompatible can still achieve the benefit of a living donor kidney transplant by entering into a kidney paired exchange (aka “kidney swap”).
- Have a body mass index (BMI) of 35 or under. Morbid obesity may prevent people from becoming living donor candidates.
- Be in good overall health. Your healthcare team at the transplant center will run various tests to determine lab values, blood pressure, and cardiac health to see if you qualify to be a living donor.
- Have healthy and functioning kidneys. A healthy kidney is needed to increase the chances of success for a transplant.
- Not have a current diagnosis of cancer, diabetes, or kidney stones. A history of other conditions like cancer or autoimmune issues may not prevent a candidate from being a living donor.
- Have no current substance abuse issues. Chronic alcohol or drug abuse can damage organs and prevent a person from becoming a living donor.
Types of Living Donor Transplant
A living donor kidney transplant gives people suffering from chronic kidney disease or renal failure an opportunity to receive a functioning kidney from a family member, friend, or sometimes a stranger.
In addition to the usual compatible living donor kidney transplant, we perform:
- Paired donor exchanges or “swaps”. If you have a medically suitable and willing living kidney donor who is immunologically incompatible with you, doctors at NewYork-Presbyterian are still very often able to find you a compatible living kidney donor. Since 2004, NewYork-Presbyterian’s kidney transplant teams have performed paired donor transplants, in which an incompatible donor and recipient are paired with another recipient and donor, who are incompatible with each other but compatible with the other patient's living donor.
- Incompatible transplant. NewYork-Presbyterian is one of the few institutions to offer "incompatible" kidney transplants for recipients who have anti-donor antibodies and are therefore more likely to reject a donor kidney. This method requires techniques and medications to reduce antibody levels in the recipients' blood to enable successful transplantation. Our research has shown that long-term kidney transplant survival among incompatible recipients is better than waiting on the list for a compatible deceased donor kidney.
How is Living Donor Kidney Transplant Performed?
It’s important to understand all the steps involved in a living donor kidney transplant, from the pre-surgery testing to post-operation recovery. Being prepared for the process will help ensure a successful transplant. Some key points of the living donor/recipient process to consider include:
- Pre-operative testing. To make sure your potential donor is compatible and fit to undergo this task, we perform a series of tests, such as a general physical exam, urine tests, blood tests, blood and tissue typing (compatibility testing), routine cancer screening, kidney function testing, and psychological examinations.
- Donor operation. Living donors undergo surgery in a separate operating suite from the recipient. In the past 50 years, we have made significant advancements in surgical technique, which allows donors to recover faster with smaller incisions. Our surgeons can perform laparoscopic (minimally invasive) surgery to remove the donated kidney, which leaves one to four small incision marks.
- Recipient operation. Kidney transplantation takes about two to four hours. In most cases, we place the new kidney into the body and do not remove the damaged kidneys. Damaged kidneys are removed if they are prone to infections or cause other complications.
- Post-transplant period. After the surgery, we closely monitor the recipient to ensure the kidney is functioning, and the body is not rejecting the organ. We also place the patient on anti-rejection medication. After the procedure, which can last from two to four hours, patients who undergo the surgery will generally spend about three to four days in the hospital. They will then continue to have frequent checkups with their doctor as part of follow-up care.
Risks to Consider
As with any surgical procedure, there are risks and complications to consider before undergoing a living donor kidney transplant. It’s important to understand those potential risks and to discuss them with your doctor to make the best decision for you.
Risks for donors of a living kidney can include:
- Blood clots
- Anesthesia reactions
- Kidney failure. There have been rare cases involving kidney failure after living donation, and donors may have to undergo a kidney transplant themselves.
- Pregnancy complications for donors. In rare cases, some women who donate a kidney and become pregnant could be at a higher risk of developing complications like gestational diabetes, preeclampsia, and fetal loss.
What to Expect after Living Donor Kidney Transplant
People who have donated a kidney can live long, healthy lives with just one kidney. After the donation surgery, your remaining kidney will “pick up the slack” by increasing its filtering to achieve roughly 70% of the original kidney function.
Following the procedure, living kidney donors may spend several days in the hospital recovering, and your doctor may recommend that you avoid heavy lifting or contact sports moving forward. You may also be encouraged to commit to long-term medical follow-ups with your doctor. These yearly checkups will aim to monitor the health of your remaining kidney, such as urine tests, blood pressure tests, and blood tests for kidney function.
If you are a patient who receives the donor kidney, you may stay in the hospital under the care of a transplant team for several days or weeks as you recover. The new, healthy kidney should begin producing urine immediately or shortly after surgery, removing the need for dialysis. You are also placed on immunosuppressant medication, which you will take for the rest of your life, to make sure your body doesn’t reject the new organ.
Once your care team deems you stable enough to leave the hospital, you’ll have several follow-up checkups with your doctor throughout your recovery, so they can monitor your new kidney. You may undergo blood tests or have your medication adjusted during this time.
A living donor kidney can last for 15 to 19 years, depending on the age of the donor and recipient, and other factors. Kidney transplants from a deceased donor last about 10 to 12 years.
Living donor kidney transplants have more advantages than deceased donor transplants. Some of those advantages include the ability of the donor kidney to function immediately, as it has been out of the body for a shorter time. Living donor kidney transplants also have better survival rates and shorter wait times.
Receive a Living Donor Kidney Transplant at NewYork-Presbyterian
At NewYork-Presbyterian, we have been performing living donor kidney transplantation for more than 50 years. Our team of exceptionally trained nephrologists, transplant surgeons, intensive care nurses, and other medical staff can help guide patients and their families through the process of identifying a donor, planning and performing the surgery, and aftercare.
Contact us to make an appointment with one of our specialists, so you can learn more about the treatment options available for you.