Chapters Transcript Video Living Kidney Donation Welcome to the living kidney donation education video. Thank you for taking the time to consider becoming a living kidney donor. Your willingness to explore this option means a great deal and could potentially make a life-changing difference for someone in need. Our goals throughout this presentation include reviewing benefits of living kidney donation, the types of donation, evaluation process, our multidisciplinary committee, surgery, post donation complications, post donation follow up, and SRTR data. Today is the start of your living donor evaluation. Every step of the evaluation is done to ensure that it is safe for you to donate a kidney. The Centera Kidney Pancreas Transplant Center is in Centera Norfolk General Hospital, which is located at 600 Gresham Drive in Norfolk, Virginia with zip code 23507. Our main phone number to our office is 757-388-3906. Our office also has two different fax numbers which can be used interchangeably. Living kidney donation is a completely voluntary process, and you can decide to not move forward at any time. At our center, we keep our team separate. We have a team for the donor and a team for the recipient. Donor information is only discussed with the donor, and likewise, recipient information is only discussed with the recipient. You have already received a phone call from our Independent Living donor advocate, or ILDA. Their role is to be a neutral person for you to utilize if you have any questions or concerns regarding donation and to advocate for your rights and wishes by ensuring you have been afforded and given informed consent. The ILDA is available to you throughout the entire consenting and donation process and serves as support should you have any hesitation about proceeding. There are no medical benefits for the living kidney donor, however, there is an emotional benefit from helping someone in need. There is also the possibility that during your evaluation, our team identifies a health problem that you were unaware of prior to your evaluation. For the recipient, receiving a kidney from a living donor has the potential for shorter wait times for a transplant, better outcomes, and the potential for shorter recovery time. There are several different routes for kidney donation. There's the directed donor. This donor directly donates to their intended recipient. The donor must be compatible with the recipient to donate this route, which we will discuss in the next slide. If you are incompatible to directly donate, kidney paired donation allows you to still help your recipient receive a living donor kidney transplant. This option has the added benefit of helping more than one person, the person your kidney goes to, and your intended recipient. There is a kitty pair donation, which is a voluntary program where a donor and recipient pair that is not a good match can enter into a registry to find another incompatible pair to swap donors with. If your recipient is not quite ready for a transplant, this program also allows donors to donate in advance using a voucher, which we will talk about later in the presentation. The last route for donation is non-directed donation, which occurs when the donor does not have an intended recipient. In order to directly donate to a recipient, the donor must both be blood type compatible and tissue type compatible. Our lab will perform a cross match between you and your intended recipient to ensure there is no reaction between the donor and recipient blood. If there is a reaction, that means that the recipient has antibodies to the donor's blood, which tells us there would be a high likelihood of organ rejection after transplant. Compatibility can change over time due to several different factors including pregnancy, blood transfusions, and previous organ transplants. There are some instances where recipients are able to receive an organ from a living donor with low levels of antibodies. These cases are reviewed with the physicians at the transplant center. Kidney pair donation is an option that allows you to still help your intended recipient if we find that you are incompatible to directly donate to your recipient, or it could be suggested if our team feels that you are not a good match to the recipient. This could be due to compatibility or difference in size or age. If you look at the picture to the right of the screen, you can see an example of a paired exchange or swap. In this example, you can see that the mother is incompatible with her son and the husband is incompatible with his wife. By entering a pair exchange, the mother is able to donate to the wife and the husband is able to donate to the son. While the donors were unable to directly donate to their intended recipient, they were the key that helped to facilitate the recipient receiving a living donor kidney transplant. Without their donation, their intended recipient would not have been able to receive a kidney from a living donor. As mentioned earlier, if your recipient is not quite ready for a transplant, this program also allows you to donate in advance using a voucher. Your recipient will also receive a voucher similar to a coupon that they can redeem later on down the road after you have donated. This may also be a good option if you plan to be a recipient support person, and vice versa. An added bonus of these types of donation is that you are helping more than one person get transplanted. Voucher donation gives donors more control over their donation day versus pair exchange. Donors are asked to provide a 3-week window to the National Kidney registry, and surgery will be planned within that time frame. There are 2 different types of voucher donations, the standard voucher program and the family voucher program. With the standard voucher program, you are donating on behalf of someone who is in imminent need of a kidney transplant. This means that it is likely that your intended recipient will need a transplant within the next year. You may also list up to 9 other family members or friends in the event your intended recipient is unable to redeem the voucher. The family voucher program is available for donors who want to donate, but do not know anyone in imminent need of a transplant. This program allows you to list up to 10 family members or friends to receive a voucher in the event they ever need a transplant later on down the road. Only one of the people you list on your voucher are able to redeem the voucher. If you were to enter a pair exchange, you may be part of a kidney donation chain. These chains are a way to facilitate living donor kidney transplants for the maximum number of people. These chains are generally started by either a non-directed donor, someone who does not have an intended recipient, or a voucher donor, someone who is donating on behalf of the recipient ahead of time, and the chains generally end with a voucher holder or a recipient who is redeeming a voucher they received from someone who has donated on their behalf. The National Kidney Registry, or NKR has a donor assistance program available that offers several different perks. These include the ability to apply for lost wage reimbursement for up to $2000 per week for up to 6 weeks, up to $5000 for travel and lodging expenses for both the donor and the donor's caregiver. They offer kidney prioritization in the unlikely event you ever find yourself needing a kidney transplant yourself in the future. They allow voucher donation, which we discussed earlier in the presentation. They assist with a remote donation to help avoid air travel for the donor evaluation and surgery. They can link you up with another person who has donated in the past, so you can talk to them about their experience. They help maximize the impact of your donation by finding the best match possible for your kidney, and they have legal support available if needed for termination and or discrimination. The non-directed donor is also known as a good Samaritan donor or altruistic donor. This is a donor that does not have an intended recipient. Options for donation for this donor include donating through a registry to potentially start a donation chain, or they can choose to donate directly to Centera's deceased donor waitlist. Another assistance program available to donors is the National Living Donor Assistance Center, or NALDAC. This program can help cover travel expenses, lost wages, and dependent care expenses. For directed donors, eligibility is determined based on the recipient's household income. For non-directed donors, recipient income is not a factor in determining eligibility. Our financial coordinators can provide assistance in applying for this program if you are interested. All donors can apply to this assistance program. Expenses related to your evaluation are covered by the transplant center, with the exception of your basic cancer screenings. Expenses related to the living donor surgery are billed to the recipient's insurance. If you happen to receive a bill for testing order during your evaluation, please let us know as soon as possible, so our financial coordinators can work to get this resolved. Some bills can take up to 6 months to be fully resolved, but we ask that you keep us updated with any statements you may receive. Donating a kidney could impact your ability to find employment, health insurance, disability, and life insurance. It's important that you talk with your own insurance carrier before making a decision about being a living donor. While rare, your premiums could increase. If you do not have health insurance, serving as a donor could be considered a pre-existing condition if you apply for insurance later. There are alternatives to living kidney donation for the recipient. These include waiting for a deceased donor or remaining on dialysis. If you choose not to proceed with your living donor evaluation, the potential recipient will continue to receive the same care as they would have if you did not show interest in donating. There is a possibility that the recipient may receive a deceased donor transplant before you are able to complete your evaluation. It is also possible that the donor kidney could fail, and the recipient may need to be placed back on the waitlist for another kidney or returned to dialysis. Candidates not suitable for kidney donation include people under the age of 18 for directed donation, and under the age of 21 for non-directed donation, or over the age of 65. Candidates are not suitable if they're deemed psychologically unstable, if they're unable to give informed consent. If we suspect any donor inducement, coercion, or other undue pressure, if we suspect the donor is knowingly or unlawfully acquiring, receiving, or otherwise transferring anything of value in exchange for their human organ. If they're found to be HIV positive, if there's an incurable malignancy or cancer, or incompletely treated malignancy that requires treatment other than surveillance, or has more than a minimal risk of transmission, If they're type 1 or type 2 diabetic, if they're currently taking more than one blood pressure medication, have uncontrolled high blood pressure or hypertension, or have a history of hypertension with evidence of end organ damage. If the donor has any current or recreational drug use with the exception of marijuana, if the donor has a body mass index or BMI, which is greater than 35, this is a calculation of your height and weight, or if the donor has a GFR ystatin C calculation, less than 80 on two separate occasions. The basic living donor evaluation consists of meeting with our independent living donor advocate or ILDA, our social worker, and the living donor coordinator. We will review your cancer screenings, then schedule you for your evaluation testing, which we will break down on the next slide. All donors will have imaging of their abdomen called a CTA scan and complete a 24 hour urine collection. Once this is done, donors will meet with one of our nephrologists or kidney doctors to review testing. A dietician and pharmacist will review donor charts for clearance to move forward. Once these have been completed, your evaluation will be presented at our multidisciplinary committee for final decision of your candidacy to donate. Depending on your route of donation and or your imaging results, you will either meet with our surgeon before our multidisciplinary committee or at your pre-op appointment prior to donation. Completing an evaluation does not guarantee that you will be able to donate. The transplant center can stop your evaluation at any time if we deem you not a candidate. You have the right to pursue evaluation elsewhere. Psychological clearance by a clinical psychologist or psychiatrist may be required if recommended by the living donor team. Genetic testing may also be required. We follow the recommendations from the American Cancer Society regarding cancer screenings. All females are required to have a current Pap smear or pelvic exam. All females aged 40 or above are required to have a current mammogram. There are some instances where this may be required prior to age 40. All patients age 45 or older will be required to have a current colonoscopy. In some cases, you may be required to have a colonoscopy earlier than age 45. For example, if you have a family history of colon cancer, it may be recommended that you have a colonoscopy earlier. Patients over the age of 50 with a current or previous smoking history may also be required to have lung imaging via a chest CT scan. If you are not up to date on your cancer screenings, please reach out to your primary care physician or PCP to get these set up. If you have already completed your cancer screenings, please have your results faxed to our office to help expedite your evaluation. You are responsible for scheduling your cancer screenings. Remember, these tests are billed through your insurance and not covered by the transplant center. Here you can see the testing ordered during the living donor evaluation. Initially, we will look at your blood type, your blood counts, look at a comprehensive metabolic panel, which tells us your kidney function, liver function, and electrolyte levels. We will check your urine for blood or protein. Check a hemoglobin A1C, which tells us how well controlled your blood sugar has been over a three-month period, and check HLA incompatibility if applicable. This tells us if you can directly donate to your intended recipient. The second set of testing includes a chest X-ray to look at your heart and lungs, an EKG to check your heart rhythm. We recheck your blood counts, check hepatitis labs, check for HIV and syphilis. We check a drug screen on all donors. Order a cystatin C, which gives us more information on your kidney function. We check to see if you've ever been exposed to two different viruses, cytomegalovirus or CMV, and Epstein-Barre virus, or EBV. Which are important when choosing medications to use for the recipient after transplant. We may recheck your hemoglobin A1C at this point. We check a glucose 2-hour tolerance test. For this test, you come in fasting with nothing to eat or drink at least 8 hours before and have your blood sugar checked. You then drink a sugary drink, and 2 hours later, you get your blood sugar rechecked to see how well your body is able to tolerate the extra sugar. For females of childbearing ages, we check a pregnancy test. We check PSA for males 45 and older. Between May and November, we check donors for West Nile virus. All donors are checked for tuberculosis, and if applicable, some donors may require endemic area screening if they have ever traveled to Africa, Asia, or the Gulf Coast. In some instances, we may combine the first two boxes to complete all blood work at the same time. The living donor coordinator will determine if we are able to do this for you. The last box is done at the end of your evaluation. This involves completing imaging of your abdomen called a CTA scan and completing a 24 hour urine collection. If you have any abnormal results during your evaluation, you may be required to have further testing or to see a specialist for clearance. Our center will cover your initial visit with a specialist. However, if that specialist orders additional testing or follow-up, it will then be billed through your insurance as it is then considered medical management. Please contact us if you receive any bills for any testing we order for you, or if you are not sure if you are responsible for payment. At our center, we follow the enhanced recovery after surgery or ERAS care plan. This care plan is designed to help reduce stress of surgery on your body by helping you heal quickly and return to your normal routine as soon as possible. Some things that are within your control prior to surgery are to start exercising. If you do not routinely exercise, start a walking program. Start off with a 10 to 15 minute daily walk at a comfortable pace, leading up to a more intense walk, increasing your distance and speed. A good goal may be working up to a 30 minute brisk walk. Exercise will prepare your body to heal faster. You can also optimize your nutrition. Focus on a diet high in vitamins and protein, which will include whole grains, fruits, vegetables, and lean protein. Improving your nutrition will help with wound healing. You can also avoid drinking alcohol. Another thing you can do is to stop smoking. Consider calling your primary care doctor for help in quitting smoking. Studies show that stopping smoking as early as possible before surgery helps reduce the risk of wound complication, helps with healing, and reduce pulmonary complications. On the bottom right of your screen, there are additional resources if you need help to stop smoking. The kidney donation procedure entails removal of the kidney, a portion of the main artery and vein through which the blood flows into and out of the kidney, and the ureter, the tube through which the urine passes from the kidney to the bladder. The surgeon makes 4 small incisions in your abdomen. A camera or scope is inserted into these incisions to help your doctor perform the surgery. At our center, we utilize the left kidney from the donor as the vein and artery are longer on that side, giving our surgeons more room to perform the surgery. There are 2 different surgical approaches we use at our center, the hand-assisted laparoscopic living kidney donor nephrectomy and the robotic assisted living kidney donor nephrectomy. With the hand-assisted procedure, your surgeon uses the scope and surgical instruments to manually detach the kidney and remove it through an incision in your abdomen. With a robotic assisted procedure, your surgeon uses a computer console to control the arms of a robotic device that detaches your kidney. A second doctor then makes an incision along your lower abdomen to remove the kidney. There are post-op risks associated with living kidney donation. You will have pain after surgery. Our center utilizes non-narcotic pain medications after donation. Acetaminophen or Tylenol will be given postoperatively to help assist with pain control. We do ask that you refrain from requesting narcotics as much as possible, as they can delay your recovery and oftentimes are associated with multiple side effects. Other risks include fatigue, bleeding, infection, including in the surgical incision, damage to bowel, spleen, liver, stomach, kidney, or blood vessels in the abdomen, kidney failure, bowel obstruction or blockage, bloating, nausea, vomiting, hernia, testicular pain, inflammation of the pancreas, also called pancreatitis, blood clots in the leg or lung, pneumonia, nerve injury, heart attack or stroke. All donors are given stool softeners for 2 to 4 weeks after donation to help with bowel function, and are encouraged to walk at least 3 times a day. The average length of stay for living donors is between 1 to 3 days in the hospital. Most donors are discharged the day after surgery, as long as their pain is well controlled, they are up walking around, they're able to urinate on their own, and are eating and drinking without difficulty. On average, living donors will have anywhere from a 25% to 35% permanent loss of kidney function after donation. The current practice today is to prioritize prior living kidney donors who become kidney transplant candidates. For females in childbearing ages, the risk of developing preeclampsia or gestational hypertension is increased in pregnancies after donation. You may be considered high risk and be referred for closer monitoring during your pregnancy. There are some psychological effects after kidney donation. These include permanent scars on your body, which can lead to problems with body image, changes in lifestyle due to donation, donors are unable to drive or lift anything heavy after surgery, possibility to experience feelings of anxiety, guilt, depression, and post-traumatic stress disorder. And the recipient may not return to optimal health after transplant. This can be related to the transplant or other related illnesses. Please reach out to the living donor team if you experience any of these feelings, so we can provide assistance. While in the hospital, the living donor coordinator, independent living donor advocate, or ILDA pharmacist, dietitian, and social worker will all see you. Our team is available to speak with you at any time, both throughout your evaluation and after donation. Once you are discharged from the hospital, you may contact the living donor coordinator at any time with questions or concerns. We will be available to you 24/7. Restrictions after donation include no driving for 2 weeks after surgery, no lifting anything heavier than 20 pounds for 6 weeks, and no soaking in any form of water until your incisions are fully healed. Incisions are closed with skin glue and left open to air. There's no need to use any creams or lotions to your incisions. Donors are typically out of work anywhere from 4 to 8 weeks post donation. If your job is physically demanding, expect to be out of work closer to the 8-week time frame. In the event of a potential disease or malignancy transmission within the 1st 2 years after donation, we may be required to report to our local, state, or federal public health authorities, as well as your kidney recipients transplant center in the OPTN or organ procurement and Transplantation Network patient safety portal. After discharge, all donors should follow up with their primary care provider or PCP at least once a year for routine exams and lab tests for the rest of their life. After donation, donors should avoid all NSAIDs or non-steroidal anti-inflammatory drugs. Common NSAIDs include ibuprofen, Advil, Motrin, naproxen, Aleve, Excedrin, NBC or goodies powder. While these medications work well, they are filtered out of the body through the kidneys. Excessive use can cause damage to your remaining kidney, which could lead to kidney failure. If you currently take NSAIDs on a regular basis and are unable to stop, please reach out to our team to discuss if donation will be safe for you. After donation, acetaminophen or Tylenol should take place of these medications. After donation, we require all donors come back to see their surgeon between 2 and 4 weeks post- donation. After this, we will see you again around your 6 month, 1 year, and 2 year post donation anniversary. At these visits, we will check basic labs that will tell us your kidney function and check your urine for blood or protein. We will also be checking your weight and blood pressure at these visits. Don't forget, we want every donor to follow up with their PCP once a year as well. Every transplant center has SRTR data. This stands for scientific registry for Transplant recipients. You can go online and see outcomes for both patient and organ survival rates for every center. We will provide you our statistics letter in the packet that will be mailed to you. Please reach out to us if you have any questions or need help understanding this data. On your screen, you can see a list of additional resources that contain great information regarding living kidney donation and transplantation. Please don't hesitate to reach out to our center with any questions. Once you have finished watching this presentation, please reach out to our schedulers by calling 757-388-4055 to set up an appointment to meet with one of our social workers in our independent living donor advocate or ILDA. Our team will also be mailing you an educational folder that contains a copy of this presentation, our most current SRTR data, a copy of our surgical consent, information regarding the National Living Donor Assistance Center, or NALDACs assistance program. Pamphlets for the National Kidney registry, or NKR regarding pair exchange, voucher donation, and information on their donor assistance program called DonorShield, and contact information for our living donor teams. As mentioned earlier, please don't hesitate to reach out to our team with any questions or concerns. Published January 22, 2025 Created by