A Guide to Living Kidney Donation

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1 A Guide to Living Kidney Donation A Living Donor can give life a second chance. 1

2 Thank you for choosing Baylor St. Luke s Medical Center Deciding voluntarily to donate a kidney to someone is an important decision and can be an extremely rewarding experience. Transplantation of a kidney from a living donor has a 90 to 95 percent rate of success. For someone with chronic kidney disease, it s the best hope for good health and a normal lifestyle. Since 1986, the Kidney Transplant Team at CHI St. Luke s Health has performed more than 600 transplantations. Annually, kidney transplantations are performed one third are from living donors. This Guide will introduce you to CHI St. Luke s Kidney Donor Program. By understand and knowing the facts, you can make an educated decision that you can feel comfortable with, now and in the future. Kidney Transplant Team The material is provided as a service to CHI St. Luke s Health patients and their families. The information herein is intended to help you become better informed, and is not meant to take the place of advice from a physician. This Guide provides general recommendations and should be followed only with the consultation of the living donor coordinator and under the direction of a physician. 2

3 Contents 2 Living Donation Q&A 5 Characteristics for Living Donors 6 Medical Evaluation 7 Kidney Paired Donation 10 Day of Surgery 13 Recovery 14 Discharge Instructions 15 Post-Donation Follow-up 16 Important Hospital Locations 18 Public Transportation & Parking 19 Phone Directory

4 Living Donation Q & A What is living donation? Living donation occurs when a living person donates an organ or part of an organ for transplantation to someone in need. What are the advantages of living donation? Compared to a deceased donor, a living donor kidney transplant has a number of advantages: Higher success rate and longer life span Surgery can be scheduled ahead of time Kidney usually begins to function immediately after the transplantation, while deceased donor kidneys may take longer to function normally Offers other transplant candidates on the waiting list to receive their kidney transplant sooner What determines who can become a living donor? Acceptable living donors must be 18 years or older and specific testing blood work, urine test, chest X-ray, ECG, kidney function test, and a CT angiogram is performed to determine a suitable donor. Who is my healthcare team? Living Donor candidates are given a thorough physical examination by a nephrologist, including consultations with a social worker, living donor advocate, pharmacist, dietician, and transplant coordinator. The results from these interviews and tests are presented to the Medical Review Board, which meets weekly. Candidates will be notified of the Board s decision. Can someone who is not a close relative be a living donor? Yes. Living unrelated kidney transplantation has an estimated success rate of about 90 percent one-year graft survival. How does living donation affect the donor? Studies have shown that one kidney functions adequately to remove waste and excess fluid from the blood in healthy adults. After donating one kidney, the remaining kidney grows bigger and takes over the work of both kidneys. Living donation does not change your life expectancy. The usual recovery time after the surgery is short, and you can generally resume normal home and working activities within four weeks. 2 A Guide to Living Kidney Donation

5 What if I decide against becoming a living donor? The decision to become a living donor should be voluntary and free from internal and external pressures. You have the right, to decide that kidney donation is not right for you. Your decision as the potential donor must be respected. Likewise, individuals who have kidney failure have the right to decide if they don t want a transplant. What is involved in the surgery? Once the evaluation is completed and you are deemed acceptable for donation, the surgery is scheduled. During surgery your kidney will be carefully removed and transplanted into the recipient. The hospital stay for donors is usually 2-3 days following donation. You will follow-up with the surgeon within two weeks after discharge from the hospital. Post-donation, you should visit our clinic or with your primary care physician at: six months, one year, and two years. There visits will include lab work urine test, blood pressure, and weight readings. We recommend that after the two-year follow-up you continue to see your personal physician annually. What happens to my kidney once it s donated? Your kidney is inserted into the recipient s body. The kidney is then connected to the recipient s artery and vein, and the ureter is connected to the bladder. Who pays for the kidney evaluation and the surgery? The costs of the donation, which includes laboratory, X-rays, physician fees, and hospital charges, are paid by Medicare or the recipient s insurance. There is no cost to you as the donor. However, if you decide to donate, you are not reimbursed for missed days at work, travel, or lodging by CHI St. Luke s Health. We encourage living donors to learn if their short-term disability insurance covers kidney donation recovery. The National Living Donor Assistance Center may provide financial support to individuals who want to donate, but cannot otherwise afford travel and subsistence expenses associated with donation. For more information on how to apply, visit livingdonorsassistance.org or call Are transplants from living donors always successful? It s important to realize that, although living related or non-related kidney transplants are highly successful, with a percent one-year graft survival, problems may occur. Sometimes, the kidney is lost to rejection or other complications. In certain cases, the original disease that caused the kidney failure may re-occur in the recipient causing the donated kidney to fail. 3

6 LifeGift LifeGift is a local, federal-designated, non-profit organization that serves Houston, Forth Worth, and Lubbock to promote organ donor awareness. Individuals who have a family member or friend with kidney disease are usually more aware of the need for organ donors than the general public. If you or anyone you know want more information about organ donation, call LifeGift at UNOS The United Network for Organ Sharing (UNOS) provides a toll-free patient service line to help transplant candidates, recipients, living donors, and family members understand organ allocation practices and transplantation data. For more information, call National Kidney Foundation of Southeast Texas The National Kidney Foundation of Southeast Texas offers general information and assistance to kidney transplant patients, donors, and their families. For more information, call A Guide to Living Kidney Donation

7 Characteristics for Living Kidney Donation One of the primary reasons people don t consider living donation is due to a lack of knowledge. The following is a summary of the necessary characteristics of a potential living donor: Willingness to donate a kidney without monetary gain or psychological coercion Willingness to donate with full knowledge of risks and complications associated with kidney donation Willingness to accept all blood products the physician feels medically necessary Age 18 or older No evidence of: Malignancy HIV Hepatitis B Sickle cell anemia disease or trait Diabetes Uncontrolled hypertension Kidney disease Active mental illness Blood type compatibility with the recipient: Recipient O A B AB Compatible Donor O A or O B or O A, O, B, or AB Negative cross-match (blood test required) Medical Evaluation 5

8 If you are interested in donating a kidney, you will undergo a thorough evaluation as an outpatient to ensure that you will not be harmed by donating. The results of the medical workup will help the Kidney Transplant Team in making a final decision regarding your suitability to donate a kidney. Evaluation Three Blood Pressure Readings (including date and time) will be provided by you once a day for three days. Blood Test to determine blood type compatibility to the recipient. Finance Coordinator Consultation to address any questions regarding financial matters. You will not be billed for any charges related to donation. If you received a bill, please contact the financial coordinator. Living Donor Coordinator Consultation provides education regarding the donation evaluation process, patient responsibilities before and after transplant, and answer to any questions about kidney donation and the transplant process. Living Donor Advocate Consultation will assist you with any needs or questions you may have during the evaluation. Social Worker Consultation provides an opportunity to discuss your feelings about donation, and how it will affect your life, and help determine if kidney donation is the best decision for you. Psychiatry/Psychology Consultation may be recommended to conduct a more in-depth evaluation of your psychosocial/psychiatric history and your readiness for kidney donation. Nutritional Consultation provides education and best practices by a dietitian on how to maintain a heart healthy life including dietary recommendations, as needed. Nephrology (kidney specialist) Consultation is a thorough physical examination and review of your medical history to assess your kidney function and the safety of your donation. Pharmacist Consultation will advise which medications you need to avoid after kidney donation. Diagnostic Tests will be performed as a part of your evaluation: Collect a 24-hour urine specimen to assess the function of the kidneys. Instructions on how to collect this specimen will be provided to you. The Glofil, an indicator of the health of your kidneys, may be performed to evaluate the GFR (the amount of blood filtered by the kidneys each minute). It involves an injection of Glofil-125, which is an agent with a small amount of radiation (smaller than what you are exposed to during a chest X-ray). This test also involves a collection of small blood samples during a period of 3-5 hours. 6 A Guide to Living Kidney Donation

9 Series of laboratory tests: hepatitis, HIV, general chemistries, lipid profile, liver panel, complete blood count, and coagulation studies. Hemoglobin A1C and fasting glucose tests to evaluate the presence of diabetes. Urine test that includes two complete urine analysis and two urine cultures. Pregnancy test for women who are within child-bearing age. Pap smear for all women candidates, who are over the age of 40 are required to have a mammogram through their primary care physician or gynecologist. PSA testing for men who are 50 years or older. Chest X-ray to detect lung abnormalities. Electrocardiogram (ECG) to measure the rhythm and regularity of your heartbeat. CT angiogram to identify the blood supply to and from your kidneys and to assist the surgeon in determining your candidacy for laparoscopy versus open nephrectomy surgery. Medical Review Board Results from your evaluation are presented to the Medical Review Board, which usually meets once a week. This Board consists of a Transplant Surgeon, Nephrologists (kidney specialists), Living Donor Coordinator, Living Donor Advocate, Registered Dietician, Pharmacist, and a Social Worker. Based on the information presented, the Board and Transplant Team will decide if you are an acceptable candidate for donation. You will be notified of the Board s decision by the Living Donor Coordinator and a mailed letter. Kidney Paired Donation If you are a willing, but incompatible living kidney donor, you and your recipient can participate in a Paired Donor Exchange Program. A kidney paired donation matches one incompatible donor/recipient pair to another pair the two pairs swap kidneys. This program is sponsored by the Alliance of Paired Donation, which uses a computer database to locate other registered pairs who might be a match with you and your recipient. To register for this program and more information, contact the Living Donor Coordinator at CHI St. Luke s Health. The Living Donor Coordinator will need a signed consent form stating that you understand this program, agree to participate, and schedule you for an evaluation. Visit paireddonation.org to learn more. 7

10 Scheduling the Kidney Transplant Once you are approved for donation, the Living Donor Coordinator will contact you to schedule the surgery. Preparing for Surgery As an acceptable donor, the following steps are required for surgery: A fresh blood sample will be drawn at your pre-op visit for a final cross-match with the recipient. Occasionally, recipients will have a positive cross-match (not compatible) at this time, even though their stored blood from a previous cross-match was negative (compatible). If this occurs, surgery must be cancelled. Occasionally, an infection or other medical conditions may be identified that can cause the surgery to be cancelled. It s imperative that the Living Donor Coordinator is informed of any signs and symptoms of infection as soon as possible prior to surgery. You and the recipient will be scheduled to meet with the team for pre-op. A surgeon is assigned to both you and the recipient. You, as well as your families, will have the opportunity to meet with the surgeons prior to the day of surgery to review and sign the surgical consent, the consent for a blood transfusion, and to discuss the risks associated with the surgery. Blood transfusions are given at CHI St. Luke s only when absolutely necessary. The surgeon will address this with you prior to surgery. Your family and friends may want to consider donating blood in case you need a transfusion. For more information about blood donation, contact CHI St. Luke s Blood Donor Center at Additional chest X-ray and ECG will be performed. The Living Donor Coordinator will prepare you for surgery through further education. You and the recipient, will meet with anesthesiologist. 8 A Guide to Living Kidney Donation

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12 Day of Surgery On the day of surgery you and the recipient will arrive at the hospital as instructed by the Living Donor Coordinator. You will move from one area to another during various times that you are in the hospital, therefore, your family and friends will be responsible for your personal belongings. The hospital will not be responsible for your belongings, so please bring as little as possible with you. We highly recommend that you leave any valuable items at home. Two operating rooms will be assigned to you and the recipient. You will leave for surgery first and the kidney recipient will follow. While you and the recipient are in the operating room, family members may wait in the Surgery Waiting Area. Two teams of physicians will perform the surgeries, one team for you and the other for the recipient. The anesthesiologist will administer the anesthesia. After you are completely asleep, a breathing tube will be inserted to help you breathe during surgery, and a Foley catheter will be placed in your bladder to monitor your urine output. The surgeons will decide on how to remove the kidney based on the information obtained during your evaluation. There are two different techniques to remove one of your kidneys, artery vein, and ureter. Open Nephrectomy An Open Nephrectomy is the removal of the kidney using the Flank Approach. The surgeon will make an incision in the side or the flank area to remove the kidney. The incision will be stitched closed. The recovery period is approximately 4-6 weeks. Right Kidney Incision site 10 A Guide to Living Kidney Donation

13 Laparoscopic Nephrectomy Both approaches for Laparascopic Nephrectomy Multi-Port and Single Site the kidney is removed, through the incision. The abdomen will be stitched closed. The recovery period is approximately four weeks. Occasionally, the laparoscopic technique may be converted into open nephrectomy for patient safety, thus, increasing the recovery period to approximately to six weeks. Some donors may not be candidates for laparoscopy nephrectomy due to a prior history of abdominal surgeries causing extensive scar tissue. In other cases, the donor s complex anatomical characteristics may not be suitable for this technique. Currently, across the country, more donor kidneys are removed laparoscopically than by open nephrectomy. Multi-Port-Approach is performed through three small (1cm) incisions made in the abdomen for a camera and surgical instruments. Midline incision for removal of kidney (handassisted) Small incisions for laparoscopic instruments and camera Single-Site-Approach is performed through one central incision in your belly button for a camera and surgical instruments. Incision site 11

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15 Recovery Immediately after surgery, you will be taken to a recovery area, and then to your hospital room. The length of time varies to the care you may need and your progress. While in recovery, visitation will be established on a per patient basis and arranged by your nurse. After the surgery, you will use the following medical equipment: Oxygen Cannula or Oxygen Mask: Provides additional oxygen as needed once the breathing tube has been removed. Pulse Oximeter: Measures the saturation of oxygen in the blood. A sensor is placed on the finger or the toe. Incentive Spirometer: Helps to expand the lungs and prevent pneumonia. Foley Catheter: Placed within the bladder during surgery to drain urine from the bladder and remains in place for one day after surgery. After the tube is removed, you may feel some burning when you urinate. Intravenous Catheter (IV): This tube is placed in your vein to administer fluids and medications, as needed. ECG (Heart Monitor): An electronic device attached to the skin to record your heartbeat. During recovery, if you feel uncomfortable or have questions, let your nurse know. Pain relief allows for easier breathing and movement, which are both important for recovery. If coughing is painful, get your nurse or someone to support your abdomen and back with their hands or a pillow. The medical staff will continuously monitor your vital signs and progress. Your diet will be advanced as tolerated starting with ice chips and progressing to solid foods. The morning after surgery, your nurse will assist you getting out of bed. You will be encouraged to walk a good part of each day. This activity helps prevent the most common surgical complications by increasing circulation and promoting bowel function. Your nurse will encourage you to cough and take frequent deep breaths to avoid possible complications after surgery. 13

16 Discharge Instructions Always make sure every doctor who prescribes you any medications knows that you have donated a kidney. No heavy lifting greater than 10 pounds for four weeks. Increase fluid intake and walking to avoid constipation related to pain medications. You will be given pain medication and laxatives upon your discharge. You may shower the next day, pat incision dry. However, no baths for three weeks, lotion, powder, or perfume on your incision. No sexual intercourse for four weeks. Indefinitely avoid NSAIDs (Aleve, Ibuprofen, Nuprin, Advil, Motrin); take Tylenol as directed (no more than 4,000mg/4g per day). Signs and symptoms to report immediately: redness, swelling, and/or bulge of the wound drainage from the wound wound opening or separation bleeding shortness of breath unexplained pain or swelling in the legs frequent urination or problems urinating burning during urination cloudy or bloody urine foul smelling urine temperature greater than 101 abdominal pain 14 A Guide to Living Kidney Donation

17 Post-Donation Follow-Up Two Weeks Post-Donation Your Living Donor Coordinator will schedule a follow-up appointment with your surgeon and possibly order labs in the donor clinic. Six, 12, and 24 Months Post-Donation: Blood pressure and weight readings Labs: serum creatinine and urinalysis It s imperative that the transplant team review these results. Please ensure these are forwarded to the Kidney Transplant office. We recommend that after your two-year follow-up visit that you follow-up with your primary care physician at least once a year. 15

18 Important Hospital Locations Throughout various stages of your treatment, you and your family will need to be familiar with the following areas of Baylor St. Luke s Medical Center: Outpatient Kidney Clinic (Baylor Clinic, 6620 Main Street, Suite 1450, Houston TX 77030) The Outpatient Kidney Clinic is where you can have your lab work completed and consult with the nephrologist, social worker, living donor coordinator, donor advocate, dietitian, and pharmacist. Most of the kidney donor work-up evaluation and surgery prep will take place in the Kidney Clinic. Clinic hours: Monday Friday, 7 a.m. 5 p.m. O Quinn Medical Tower at St. Luke s (6624 Fannin, Houston, TX 77030) Your chest X-ray, ECG, and CT angiogram will be completed on the 10 th and 11 th Floor in this building. For your pre-op visit, you will report to Pre-Admission on the 12 th Floor. To get to O Quinn from Baylor St. Luke s, take the Skybridge on the 2 nd Level of the hospital. 6 th Tower Outpatient Unit (Baylor St. Luke s Medical Center, 6 th Floor/Yellow Elevators) You and the recipient will be instructed to arrive to this floor for final preparation the morning of surgery. Main Operating Rooms (Baylor St. Luke s Medical, 2nd Floor Yellow Elevators) Your kidney will be removed in the operation room location on the second floor of the hospital. While in surgery, your family can wait in the Cardiovascular Surgery Waiting Area. Cardiovascular Operating Rooms (Baylor St. Luke s Medical Center, 2 nd Floor/Purple Elevators) Your kidney will be transported to the Cardiovascular Operating Room, where it will be implanted into your recipient. While in surgery, your family can wait in the Cardiovascular Surgery Waiting Area. Main Recovery Room (Baylor St. Luke s Medical Center, 2nd Floor/Yellow Elevators) After surgery, you will be taken to the Main Recovery Room before being transported to your hospital room for your recovery stay. 16 A Guide to Living Kidney Donation

19 Cardiovascular Recovery Rooms 1 and 2 (Baylor St. Luke s Medical Center, 2 nd Floor/ Purple Elevators) After surgery, the recipient will be taken to Cardiovascular Recovery Room 1 or 2. During your recovery, family members can wait in the Cardiovascular Surgery Waiting Area. Visitation is restricted to two persons at a time for no more than 30 minutes Visiting Hours Monday Sunday: 5:30 6: 30 a.m. 10:00 10:30 a.m. 5:00 5:30 p.m. 8:15 8:45 p.m. Transplant Unit (Baylor St. Luke s Medical Center, 12 th Floor/Yellow Elevators) The recipient s room will be on this floor. All rooms are private with a bathroom and a day bed for a family member or friend to stay overnight. Family and friends can visit at any time. However, children, under the age of 10, and any persons who may have colds or other contagious illnesses are not allowed on this floor. Please inform your friends and family that live plants, flowers, and fresh fruit baskets also are not allowed. Silk flowers, balloons bouquets, or greeting cards are suggested items to give. 16 th Floor/Yellow Elevator (Baylor St. Luke s Medical Center) The Living Donor s room is on this floor. Immediately following surgery, the donor you will be taken to the recovery area in the ICU and will be moved to the 16 th floor once stable. 17

20 Texas Medical Center Parking Dryden O Quinn Medical Tower BRC $11 Marriot $9 University $9 The Methodist Hospital Travis Baylor Clinic CLINIC HERE! Baylor Faculty Center 1 Parking Garage $12 N $12 Skybridge Skybridge Texas Heart Institute at The Denton A. Cooley Building $8 Southgate BLVD $12 Best Western $5 Main Texas Children s Hospital Pavilion for Women $12 Fannin Baylor St. Luke s Medical Center Texas Children s Hospital (TCH) Bertner Avenue MD Anderson Cancer Center $12 Bates Entrance Texas Children s Hospital Clinical Care Center TCH Nutrition Research Center TCH Clinical Care Center Richard J.V. Johnson Avenue Skybridge Emergency Entrance Lower Ramp Parking Garage $12 Bates 2 Holcombe Boulevard Emergency Care Dryden/TMC/ METRORail Station to Loop 610 W Valet Parking Patient Drop-Off/Pick-Up to US 288 Public Self-Parking PUBLIC TRANSPORTATION & PARKING The Texas Medical Center offers 15 parking lots and garages for your use during your visit to Baylor St. Luke s medical Center. For more information, visit texasmedicalcenter.org or ask a member of our staff for a map. Maps for the Texas Medical Center are located on the METRO website, or you can contact the METROLine at The METRORail is also available as public transportaion. Visit METRO at ridemetro.org to learn more. 18 A Guide to Living Kidney Donation

21 Phone Directory Hospital Departments Main Number Information (Bates Lobby) Admitting/Discharge Services Day Surgery Admitting Dietary Services Gift Shop Infectious Disease Service Nursing Support Services or Nutritional Services Occupational Therapy Outpatient Clinic Parking (TMC) Spiritual Care Patient Services Patient Mail Pharmacy (O Quinn Medical Tower) Physical Therapy Respiratory Therapy Social Services Transplant Coordinators Transplant Financial Counselor Transplant Service Living Donor Coordinators Elizabeth Martin Priscilla Sloan Patient Areas & Waiting Rooms Transplant Unit (12 Tower) Transplant ICU, 8 Cooley A Cardiovascular Waiting Area Recovery Room Recovery Room Dialysis Unit, 7 South Tower

22 Names & Phone Numbers Date of Donation Surgeon Nephrologist Living Transplant Coordinator/Advocate Inpatient Coordinator Outpatient Coordinator Social Worker Finacial Counselor Dietician 20 A Guide to Living Kidney Donation

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