Kidney Transplantation Living Donors
In addition to waiting for a kidney from a deceased organ donor, patients of Northwestern Medicine in need of a kidney transplant may want to consider living donation. Living donation is a transplant surgery performed between two living adults or an adult to child. Although most of us are born with two kidneys, only one working kidney is needed to sustain a normal life. This allows a healthy person the opportunity to donate a kidney to someone with kidney failure.
There are many benefits to receiving a kidney from a living donor, including:
- No waiting period, and the surgeries can be scheduled at a convenient time for both the donor and recipient
- A kidney from a living donor often works sooner than a kidney from a deceased person and typically lasts longer
Due to the length of the kidney waiting list, the waiting period for a deceased donor kidney can be many years. Thus, having a living donor can decrease your waiting time for a kidney transplant, allowing you to avoid dialysis or stop it earlier. This also helps reduce the number of patients on the national wait-list and allows those patients without a living donor option to receive a deceased donor kidney sooner.
Who can be a living donor?
A living donor can be a blood-related family member or a non-blood-related individual such as a spouse, friend or acquaintance. Potential donors must be in relatively good health, both physically and emotionally, and over the age of 18.
All potential living donors must:
- Be in good health
- Undergo a thorough evaluation process
- Understand and accept the surgery and its risks, including medical, pychosocial and financial implications
- Volunteer to be a transplant donor
- Understand and accept that the outcome of the transplant might not be as expected
- Be able tell the team clearly their reasons for donating once they are aware of all of the benefits and risks
An increasingly popular form of living donation is called altruistic, non-directed organ donation, in which people donate organs as a humanitarian gesture, without a specific recipient in mind. These organs are distributed to patients on the Northwestern Medicine list using the UNOS priority system or as part of a kidney paired donation.
The goal of the Northwestern Medicine Living Donor Kidney Program is to make every effort to ensure that a transplant takes place when a medically viable living donor steps forward.
Blood type and immune incompatibility
Approximately one-third of living donors who come forward are not matches for their intended recipient due to incompatible blood type and immune system differences. Most blood types form antibodies against the other blood types, meaning most patients cannot get blood transfusions or organ transplants from donors with blood types different from their own. This is called blood-type or ABO incompatibility. In the past, a blood type or immunological incompatibility would have ruled out a donor and recipient pair. Now there are two options: desensitization treatment and kidney paired donation.
Kovler Organ Transplantation Center at Northwestern Memorial Hospital is one of only a handful of centers in the country offering these pairs desensitization treatment that will allow the donor’s kidney to be placed in the intended recipient.
A week or two before surgery and a week or two after the transplant, these patients undergo a variety of treatments tailored to the recipient’s antibody titers. Treatment may include plasmapheresis (plasma exchange), intravenous immunoglobulin (medication to prevent antibodies from returning) and/or monoclonal antibody treatment such as rituximab (Rituxan®). These levels are checked frequently to determine if additional treatments are needed.
Typically, three to five treatments are required before transplant. At the start of the plasmapheresis treatments, the patient receives anti-rejection medications to help prevent production of new anti-HLA antibodies. These anti-rejection medications are the same medications that the patient will continue to use after transplantation. Plasmapheresis treatments may be necessary following transplantation to reduce the risk of rejection. The number of treatments will depend on antibody levels. The majority of patients receive three to six treatments.
The goal is to reach acceptable antibody levels with the least amount of immunosuppression. Long-term outcomes of kidney transplants following desensitization have been excellent and comparable to compatible donor transplants.
Kidney paired donation
Another option for donor and recipient pairs who aren’t compatible is kidney paired donation (KPD). KPD transplants are made possible when a kidney donor who is incompatible with the intended recipient is paired with another donor and recipient in the same situation.
Northwestern Medicine Kovler Organ Transplantation Center team has performed more than 200 KPD surgeries to date, the largest of them being an eight-way paired exchange that involved eight donors and eight recipients. KPD exchanges are becoming more common and signal a trend in the field of organ transplantation. They have the potential to dramatically increase the number of patients who receive transplants, and reduce or eliminate time spent on the waiting list.
About the surgery
When a living person donates a kidney, the donor and recipient surgeries are done on the same day. The operation performed to remove the healthy kidney from the donor is called a nephrectomy. These surgeries are done using a laparoscopic, or minimally invasive, approach. Patients undergoing laparoscopic kidney removal have significantly less pain, a shorter hospital stay and return to normal life much faster than those who undergo the more traditional “open” procedure. Bear in mind that this is still a major surgery and there are some risks involved.
Why Northwestern Medicine?
Northwestern Medicine Kovler Organ Transplantation Center continues to be the largest living donor kidney transplant program in Illinois, and a leader nationally, performing more than 300 living donor kidney transplants over the last three years. Not all transplant centers have the expertise to perform laparoscopic donor surgery. Northwestern Medicine is fortunate to have specially trained transplant surgeons who have successfully performed more than 2,000 laparoscopic donor surgeries since 1997, using video technology to allow the kidney to be removed safely through small incisions on the abdomen.
Convenient satellite clinics
In addition to the downtown campus, we are available to see patients at any one of our transplant outreach clinics:
- Oak Brook: Serving the western suburbs
- Glenview: Serving northern and northwestern suburbs
- Crest Hill/Joliet: Serving the southern and southwestern suburbs
- Portage: Serving northern Indiana and southwest Michigan
Our focus on community outreach benefits patients and their physicians by providing pre-kidney transplant services closer to home.