Evaluation Parts One & Two
The order of the first two steps in your evaluation process will depend on your transplant center. In both cases, the transplant center will draw your blood, but the tests that they will run first might differ. The two steps, which may be performed in either order are:
Testing blood type
The transplant center will test your blood type to see if it is compatible with the recipient’s blood type. They will also check your Human Leukocyte Antigens (HLA) type and compare it to the recipient’s HLA type. A person’s HLA type is based on proteins along the surface of white blood cells, the main cells of the immune system. It may take up to two weeks to get the results of these tests. Once the results are ready, a transplant coordinator will call you to discuss them. If your blood type doesn’t match, you can still donate your kidney. There are a couple of options, which are discussed more here.
The transplant center will ask you more questions and run additional tests to make sure that you are healthy enough to donate a kidney. Donors undergo the following tests:
- Basic blood and urine tests: these check that you are healthy and that your kidneys are working well. These include checking the cells in your blood, the levels of certain kidney markers in your blood (e.g. creatinine), and how long it takes your blood to clot.
- Serology: these tests tell the transplant team how well your immune system is working, as well as if you have had certain diseases in the past or received certain vaccines.
- HIV screening: at all transplant centers, all donors are tested for HIV
- Microbiology: these tests look for infections in your blood or urine. If you have an infection, you would be treated for it before you could donate your kidney.
- Cancer markers: if the transplant team is worried about any possible cancers, they might check for certain markers in your blood.
Your donor evaluation might also include imaging. The type of imaging would depend on the organ of interest. The possible tests include (but are not limited to):
- Chest x-ray: an image that shows the transplant team your heart, lungs, and some other organs. A chest x-ray requires a very low dose of radiation.
- CT scan: a sort of fancy x-ray, which shows sections of a person’s body like and lets the transplant team take a closer look at specific organs.
- Ultrasound of the kidney: ultrasound is the same technology that is used to look at a baby while it is inside a pregnant woman’s uterus. It uses sound waves; it does not use any radiation. With ultrasound, the images appear in real time and can show the blood flow into and out of the kidney.
- Biopsy: this is when the transplant team takes a small piece of tissue, usually using a thin needle. They can then look at the tissue under a microscope to check for diseases or other problems.
- Cardiology testing: these tests make sure your heart is healthy. They may include:
- EKG: This test involves putting stickers on your chest and looking at how the heart uses electricity to pump blood around the body.
- Stress test (for donors > 50 years old): This usually involves walking on a treadmill until your heart rate rises to a certain level. It checks that your heart is healthy and pumps blood well, even under stress.
- Echocardiogram (for donors > 50 years old): This uses ultrasound (see above) to look at your heart. It allows us to watch your heart move as it beats and pumps blood to the rest of the body.
- Pulmonary testing: these tests make sure your lungs are healthy.
- Cancer screening: to donate, you must be up to date on all cancer screenings recommended by national guidelines. These screenings may include:
- For women: Pap smear (to test for cervical cancer) and/or mammogram (x-ray of the breast tissue to look for breast cancer)
- For patients greater than 50 years old or who have certain risk factors: colonoscopy (using a long, thin camera inserted through the rectum to look for cancer of the intestines).
Some of the blood tests are repeated 1-2 weeks before surgery to check that nothing has changed. Donors also must avoid “high risk” activities between when they receive medical tests and their surgery. This is for the safety of both the donor and the recipient. Activities to be avoided include:
- Getting a new tattoo
- Using injection drugs
- Having sex with someone who uses injection drugs
- Having high-risk unprotected sexual activity
Evaluation Part Three
If there are no problems during your medical testing, your transplant team will schedule evaluation visits with your living donor team. The team typically includes:
- A nephrologist: a nephrologist is a kidney doctor.
- A transplant surgeon: If you decide to donate, a transplant surgeon is the person who will be doing your surgery. That is, if you decide to donate, he or she will remove one of your kidneys so it can be put into the recipient.
- A transplant coordinator: your coordinator will guide you through this process and help you to set up all of your appointments.
- A psychologist and/or social worker: the psychologist or social worker will talk to you about why you have decided to donate, any hesitations or concerns that you may have, whether anyone has pressured you to become a live kidney donor, and other topics. If you have any worries about living kidney donation, they can help you to figure out whether living kidney donation is right for you. A social worker might also provide additional resources, such as information about organizations that can help cover the costs of donation.
- A living donor advocate: at some centers, the living donor advocate is a social worker. His or her job is to make sure that you have someone that is advocating on your behalf. If you have questions or concerns, you can always turn to your living donor advocate.
Your evaluation appointments might be on separate days or they may be back-to-back on a single day. These appointments will be full of information and can be tiring. Many donors find it helpful to bring a family member, friend, or partner along to meet the team, as well as to help ask any questions. Since this person hears the information provided by the transplant team, they can help you remember important details later. When you pick the person who should come with you to the appointment, we recommend that you bring your significant other or the person who will be helping you during your recovery. Then, that person also has a chance to ask any questions they have. Of note, if the person who accompanies you to your appointments is the recipient, the team may ask them to step to of the room for certain aspects of the visit.
Evaluation Part Four
After your in-person evaluation visit(s), the transplant team may ask you to get a few more tests done. Once all testing is complete, a multidisciplinary committee at the transplant center discusses each donor’s case and decides if the donor is a good candidate for transplantation. The transplant team would not want to remove a donor’s kidney if the donor was unhealthy, felt pressured to donate, or did not have someone to help them during their recovery. The transplant team will also evaluate the transplant recipient and make sure they are healthy enough to have the transplant surgery. The transplant team will also discuss whether the recipient is “cleared” for surgery.
If the committee approves the donor and recipient AND the donor still wants to donate, the transplant team will schedule a date for surgery. Usually, the kidney donation will take place about 4-6 weeks after the donor gets approved. This gives the donor time to arrange time off from work, child care, and other daily responsibilities. Donors are usually in the hospital for two days after surgery. After leaving the hospital, donors should stay near the transplant center for a week so that they can go to their follow-up appointment. Later follow-up can usually be completed closer to home if a donor doesn’t live near their transplant center.
Packing for the Hospital
For tips on packing for the hospital, see our module on Practical Advice from Other Living Kidney Donors.
You will arrive in the hospital early in the morning. Most people bring a family member or friend who can hold on to their belongings while they are in surgery. You will change into a hospital gown. One of the surgeons and an anesthesiologist will come to see you, answer any questions that you have about the surgery, and have you sign a consent form. A nurse will also insert a needle into one of your veins, usually in your arm near your elbow. This “IV line” will be used to give you medicine to help you fall asleep during the surgery and also to give you fluids during the surgery. Your family member or friend can usually accompany you to “pre-op” area but will be asked to go to a waiting area as you get ready to go to the operating room. Your family member of friend will next be able to come and visit you after you have woken up from surgery.
When the operating room is ready, you will be wheeled to the room on a hospital bed. The anesthesiologist will give you medicine to make you fall asleep, and the surgery will begin. Once you are asleep, the anesthesiologist will put a breathing tube down your throat to help you breathe during surgery. A nurse will place a Foley catheter in your bladder – this is a long skinny tube that will allow urine to drain out of your bladder while you are asleep and during the first day or two after surgery while you are recovering. The medications used to put you to sleep can also make your bladder “sleepy” and it may need some time (hours to a couple of days) to “wake up” and be fully under your control.
Waking Up from Surgery
Your breathing tube will be removed in the operating room before you wake up, but you will still have the Foley catheter to drain your bladder and the IV line in your arm for medications and fluids. Your throat might be sore from the breathing tube but will usually feel better over the next few days. You may feel puffy and bloated from all of the fluid that you were given during surgery. This feeling will gradually resolve after surgery as your body figures out its new balance and removes this extra fluid as urine. You should lose all of this extra fluid by 1-2 weeks after surgery.
The first day after surgery, you will receive your pain medication through your IV line. On the second day, or as soon as you start to eat food again, you will receive your pain medication as pills instead of through your IV line. This will help to control your pain for longer periods of time and will also help you find a medication plan you will use when you go home to recover. You might feel aches and pain in some strange places, like your shoulder. This is because, during laparoscopic surgery (surgery performed through several small holes), gas is used to inflate your belly and the body’s nerves sometimes misread this as irritation in your shoulder. This should go away after several days to a week.
When you come out of surgery, you will be placed on a clear liquid diet. You will then build up to solid food. Your nurses and the rest of the transplant team will encourage you to get out of bed and walk around the floor of the hospital. This might seem difficult, especially because you are in pain, but walking can help you recover faster, prevent infections and blood clots, and control your pain. It may seem strange that walking can help make your pain more manageable, but we hear this time and time again from living donors at our center.
On the second day after surgery (“post-operative day 2”), if there are no problems, many donors are discharged from the hospital. Being discharged means that your medical team thinks you are well enough to leave the hospital. The major milestones that you need to meet before discharge are being able to:
- Urinate without the help of a catheter (the tube inserted into your bladder)
- Walk around the floor
- Eat food and keep it down
- Control your pain with pills rather than IV medication (medication that goes directly into your blood through a thin tube in your arm)
It will take a while to get used to your recovery routine. There will be surprises – some things will hurt more than expected but other things may not be as bad as you had feared. A bumpy ride on the drive home may be painful. You may feel normal more quickly or slowly than you expected. Every person’s experience is different, but most donors are back to a fairly normal routine within 1-2 months.
Things to avoid after surgery:
After surgery, you should not drive while you are still taking prescription painkillers. You should also avoid lifting anything heavier than 10 pounds for six weeks after surgery. Lifting heavy objects puts pressure on your incision (the cut they make for your surgery), which can make it harder for you to heal.
For more information, go to our module on Life After Donation.
Things to do after surgery:
Get up to walk several times a day. This will help prevent blood clots and other complications of surgery. It will also help you to feel “normal” faster. Be patient with your body and kind to yourself. Recovery and healing take time. You will need some assistance during the first week with everyday activities, including child care, so ask your friends and family for help.
For more information, go to our module on Life After Donation.
Returning to Work
The amount of recovery time needed before returning to work depends on the type of work that you do. If you work at a desk, you may be able to return as soon as three to four weeks after surgery. If you do strenuous physical labor, you may need six to eight weeks before you feel ready. Even though you may feel almost back to normal after a couple of months, some donors still get tired easily for a few more months after surgery. This tiredness gradually goes away. Again, recovery and healing take time. Listen to what your body is telling you.
You will return to your transplant center for a follow-up appointment about one week after you leave the hospital. As a result, we recommend that donors stay close to the transplant center for a week if they live far from our hospital. As you recover, the best person to ask questions is your Post-Donation Nurse Practitioner (NP). He or she can answer health-related questions and help you schedule appointments and lab work to monitor your health and kidney function. If you experience any donation-related complications, your NP will help you to work through these.
The current national policy is to follow living kidney donors for at least two years. This will involve appointments with your primary care doctor and blood work at the lab. You will receive a questionnaire and a slip of paper with lab orders on it. For your convenience, you can do these blood tests close to home and have the results sent to your transplant center. The transplant team will check in with you at 6 months, 1 year, and 2 years after donation surgery. These check-ins are very important and will help you and your remaining kidney stay healthy.
Living kidney donors should see a doctor annually for the rest of their lives. They should also always let doctors and other health professionals know that they have one kidney. We know that living kidney donors are very healthy and some don’t want to see a doctor every year. However, if a donor develops a health condition that can hurt their remaining kidney, such as high blood pressure or diabetes, they should receive treatment as soon as possible to protect their remaining kidney. This early diagnosis and early care will allow them to live the healthiest life possible. With lifestyle changes and/or medication, the donor can prevent most kidney damage.