When initially considering living kidney donation, one may consider the question of how or why the medical profession would allow someone to undergo surgery to donate a kidney to give to someone else in need of a transplant.

Many studies have been performed to assess the risks of kidney donation on the people who made the choice to become a donor. 

The majority of studies have found that:

• The risk to a donor's physical health is minimal in both the short-term (surrounding the surgery) and long-term (in terms of kidney function, high blood pressure, and the donors lifespan).

• Kidney donors tend to have higher quality of life scores after donation, as compared to the general population.

• Donors have similar or improved psychosocial health after donation.

• The overwhelming majority of donors would choose to donate again.

The Basic Principles of Living Kidney Donation

1. The prospective living organ donor should be:

• Capable of making the decision to donate

• Willing to donate

• Free of coercion, manipulation, or undue solicitation by any party regarding the decision to donate

• Medically suitable to donate

• Psychosocially suitable to donate, based on an evaluation that includes a series of specific components

• Fully informed of the risks and benefits to the donor, as demonstrated by the donor's expression of understanding of these risks and benefits

• Fully informed of the risks, benefit and alternative treatment available to the recipient, within the constraints of the transplant center's obligation to maintain the confidentiality of recipient medical information

• Willing to sign a statement attesting that the donor is not providing the organ for monetary gain

2. The prospective live organ donor should not be called upon to donate in clinically hopeless situations

3. The benefits to both the donor and recipient should outweigh the risks associated with the donation and transplantation of the living donor organ

4. Medical and psychosocial follow-up of the living donor after donation should be undertaken by the living donor program

from Guidelines for the Psychosocial Evaluation of Living Unrelated Kidney Donors in the United States (Dew MA et al, Am J Transplant 2007; 7(5):1047)

There is no definite answer to this question. Sometimes, children wait only a few weeks or months before receiving a donor organ,usually when a living donor is available to donate their kidney.

If your child has a blood type or crossmatch incompatible living donor, you may enter a registry to try to find a suitable match for your child and a suitable recipient for their donor's kidney.

If no living donor is available, it may take years on the waiting list before a suitable donor organ is available. Options such as choosing to accept an increased risk organ may help to reduce your child’s waiting time. 

At Weill Cornell Medicine, we are proud that our innovative programs enable us to maximize use of available living and deceased donor organs, giving our patients a shorter waiting time compared to other transplant centers.

While your child is on the waiting list, you will receive close follow-up with your child’s physicians and the transplant team and you and your child will come back for a re-evaluation visit every year. Various support groups are also available to assist you during this waiting time.

Any potential donors and transplant candidates who have received medical clearance to donate are eligible to participate in a KPD program.

Both donors and recipients undergo standard donor or transplant evaluation prior to entering the database. Although most pairs participate because the donor and recipient are incompatible due to blood type or presence of a positive crossmatch, compatible pairs looking to improve their genetic and/or age match are encouraged to participate as well.

Most exciting about these types of transplants are the amazing possibilities that can occur if blood type and crossmatch compatible patients routinely enter the registry, as described below. 

Imagine a world where everyone who needs a kidney and has a potential living donor would selflessly enter a national registry so that living donation could be optimized.

Sure, patients who have an incompatible donor (blood type or antibody incompatibility) have a good reason to enter a registry program. But what about these other scenarios?

- A 75 year-old gentleman needs a kidney and his compatible 25 year-old granddaughter wants to donate. Perhaps if this pair entered a registry, the elderly gentleman could get a kidney from a 60 year-old donor and his granddaughter's kidney could be given to someone who is 32 years old.
- A 40 year-old man is blood type AB, which means he can get a kidney from anyone. His wife is going to be his donor, and she is an O blood type. If this pair enters the registry, his wife's kidney could go to someone in desperate need of an O kidney since patients with O blood type can only get a transplant from someone with O blood type.

The possibilities are amazing and endless if compatible pairs would routinely participate in kidney paired donation programs!

It is up to the individual participants as to whether or not they meet their donor/recipient.

 Regardless of their individual preferences, all participants in the transplant chain are kept anonymous at least until after the transplant has taken place. If participants then wish to meet each other, the Transplant Coordinators at the various Transplant Centers will work together to arrange this. 

Due to the fact that donor and recipient pairs matched through the registry may be on opposite sides of the country, all donors in the transplant chain may not go to the operating room at the same time to donate their kidney.

Often donors go to the operating room first thing in the morning and are followed by the recipients later that same day. Other times, particularly when the donor is on the West Coast and the Recipient on the East Coast, the donor may go to the operating room in the evening, the kidney is sent on a "red-eye" flight, and the recipient's surgery occurs early the next morning. 

In other cases, a donor may be asked to donate their kidney a few weeks to months after their intended incompatible recipient is transplanted with their matched KPD donor kidney. In this situation, the donor is referred to as being a bridge donor because they will continue a transplant chain at some point in the future.

Alternatively, if a bridge donor does not have a good match within the registry and/or has personal obligations that prevent them from waiting to donate, the bridge donor's kidney may be given to a patient waiting on the list for a deceased donor kidney. This takes a patient off the waiting list, allowing more transplants to occur.

While a potential donor is participating in a registry and waiting to be matched with a compatible recipient, he or she will be contacted periodically by the Transplant Coordinator.

 It is extremely important to notify the Transplant Coordinator in between these points of contact if you develop any medical conditions, if your personal situation has changed, or if there are any other issues that could impact your ability to serve as a donor.

Donors who choose to enter a KPD registry are not obligated to sign an agreement. However, potential donors must sign a consent form indicating their willingness to participate in a KPD program.

 Due to the nature of KPD programs, the medical information of potential donors is entered into the registry and thus may be shared with other transplant centers that are participants in that particular KPD program, so potential donors must agree to have their medical information shared with the KPD program. Only medical information needed to match a potential donor with a recipient is entered into the registry. 

One risk of KPD programs is that donors back out of the program after the person they originally wanted to donate to receives a transplant.

 At times, this is due to the donor being a bridge donor whose personal situation changes (such as getting a new job that prevents them from taking the required time off to donate, or developing a medical issue of their own).

 Due to the way the KPD registries work, one donor backing out can cause numerous transplant chains to fall apart. This is why donors are asked to make a firm decision to participate so that logistics can be confirmed and there will not be a last-minute change of mind.

 If a donor were to back-out at the last minute, this would "break the chain", which could impact the ability to transplant many patients who have already been scheduled to receive a transplant.

Once a potential match is found through a kidney paired donation registry, the crossmatch process is initiated between the matched donor and recipient.

 The crossmatch is a test where the donor and recipient blood are mixed together to see if the recipient's immune system has any reactivity against the donor. Reactivity signals that the recipient has antibodies against the donor, which are caused by previous exposure to human genetic material through blood transfusions, prior transplantation, and/or pregnancy.

 The presence of antibodies can increase the risk of acute rejection and graft loss after transplantation. However, this depends on the strength of the reaction.

In order to perform the crossmatch, the matched donor and recipient will each receive a kit in the mail containing blood tubes that need to be drawn and then shipped to a specified tissue typing laboratory.

 All donors and recipients involved will be notified within a few days of the results of the crossmatch. If the crossmatch results show compatibility, the transplant will then be scheduled as long as all donors and recipients are medically cleared for transplantation. 

If a pancreas transplant fails, the patient will need to return to managing their diabetes with insulin injections and intense blood glucose monitoring. It may be possible to receive another transplant, however, this depends on many factors such as number of previous transplants, levels of antibodies in the body, and whether the patient was adherent to their medication and follow-up schedule. 

Living with a transplant is a life-long process. Medications must be given to suppress the immune system so it will not attack the transplanted organ. Other medications must be given to prevent side effects of the anti-rejection medications, such as infection. Frequent visits to and contact with the transplant team are essential. Knowing the signs of organ rejection and watching for them on a daily basis are critical. 

Unfortunately, pancreas transplants do not last forever. If a transplanted pancreas fails, the decision to give a person another pancreas transplant is decided on a case-by-case basis and requires consideration of many different factors.