Kidney transplant is the best treatment of the end stage renal failure. Waiting for 6 months to a year on dialysis means wasting time for the patients with end-stage kidney failure who absolutely need dialysis for the management. It is not a correct approach to place a patient on dialysis, if overall health is good and the patient has a chance of transplant.
Detailed examinations are performed to avoid a hazard for your health, when you decide to donate one of your kidneys to your relatives and your kidney donor status is decided afterwards. Actually, one of the tenets practiced by physicians while treating their patients is “primum non nocere” which means “first, do no harm”. Considering a living-donor kidney transplant, our primary responsibility is not to make the healthy donor sick. Moreover, we have vast knowledge on this subject, as living-donor kidney transplant surgeries have been performed for a very long time. Kidney transplant literature reports that living with only one kidney is not a risk factor for the donor’s life.
All donors can donate kidney to a recipient with same blood type. Moreover, donors with blood type O can donate kidney to recipients with all other blood types. On the other hand, recipients with blood type AB can receive kidney from donors with all other blood types. RH factor does not bear any significance. RH compatibility between the donor and the recipient is not taken into consideration in kidney transplant.
A detailed investigation begins if blood type of the donor is compatible and the legal criterion of blood relation degree is met. Here, another critical factor should be fulfilled: the transplant team or any other relevant authority should be convinced that the decision of donation is made freely and voluntarily without any pressure or coercion. Donor candidate is examined in detail, including all body organs and systems, after the medical history is reviewed in depth (past diseases and surgeries, documented diseases, current treatments, documented familial diseases, habits such as alcohol consumption and smoking). Tissue compatibility is checked with a technique called cross-match, if the examination results are normal and there is no history of a disease which may hinder the donation; at this stage, lymphocytes of the donor are mixed with recipient’s blood sample to check the reaction and a positive result is a contraindication for the transplant. Blood and urine tests are analyzed; electrocardiography is studied and chest X-ray is scanned. Urine sample is collected for 24 hours to evaluate functions of kidneys better and to check creatinine clearance and protein leakage into urine. Assessment continues with more advanced techniques if a healthy donor is identified by these multi-stage tests; scintigraphy helps review of filtering function for both kidneys. Contrast-enhanced computerized tomography of abdomen not only evaluates other intra-abdominal organs, but it provides detailed information about structure, blood vessels and excretory systems of bilateral kidneys. Recently, CT angiography replaced both conventional angiography and intravenous pyelography. The donor is referred to cardiologist, pulmonologist, gynecologist, urologist and psychiatrist for a further details evaluation, if necessary. Donor status of the person is approved and verified, only if all these investigations and tests are unremarkable.
One should be older than 18 and have mental capability to make own decisions in order to be a living donor. On the other hand, the upper age limit is controversial; while all adults with no abnormal results in aforementioned tests and studies are deemed living donor candidates, it cannot be overlooked that aging is factor also valid for body organs. Diabetes mellitus is a contraindication for kidney donor status, even if renal functions are completely normal. Although hypertension and kidney stones were absolute contraindications, they are, now, deemed acceptable, provided certain conditions are met. Besides, active infection and a medical history notable for documented malignancy are also factors which hinder being a donor.