Living organ donation is on the increase

What the news
Dr. Johnston means for you

Thomas Johnston, MD
Transplant surgeon

Live organ donations produce better outcomes for recipients

The UK Transplant Center has been performing transplantation operations since 1964. UK surgeons perform around 150 transplants per year, one-third of which are live donors for kidney transplants.

The number of living organ donations has been continuing to rise in recent years. The last 10 to 15 years has shown a large increase in the need for organ donations. To combat the need for organs, more and more people are becoming living donors for a loved one in need of an organ. Around 50 percent of all organ donations are from living donors. Presently the majority are relatives.

"There is almost never a situation where it is more advantageous to wait for a deceased donor."

Who can donate?
It has only been in the last 10 years that physicians encouraged non-blood relatives or friends of a potential recipient to donate live organs. It was previously believed that matching blood relatives between the donor and recipient would result in the most successful transplant. Now, any living donor appears to be better than all deceased donors. There is almost never a situation where it is more advantageous to wait for a deceased donor.

Almost all of the potential donors that come to UK Transplant Center are a relative (including spouses) of a potential recipient. However, we will consider anyone's offer to donate an organ, including altruistic strangers.

Making a decision to donate an organ
We encourage all potential recipients to seriously consider living donation. It is by far the best option because the kidney tends to work better when it comes from a living donor and the waiting time is drastically reduced. It takes around three months from inception to surgery to go through the living donation process. In comparison, it takes one to three years for a deceased donor transplant.

When a potential donor recipient comes to the transplant center and living donation is decided, we encourage them to talk with family members about living donation. If a family member is interested in being a potential donor, we like to have the potential donor contact us. There is less pressure this way and the transplant center can provide them with all the information they need to make an informed decision.

The two main requirements considered for live organ donation are that the patient have a compatible blood type and be in excellent health. A good blood and tissue match is most likely with a blood relative, but people not related by blood may also be donors. If the potential donor meets these two requirements, they will begin the evaluation process.

Evaluating donor organs
First, a blood test will be conducted to determine compatibility. If the recipient and donor have compatible blood types, then additional tests are conducted for tissue typing. If compatibility is determined, the donor will then undergo a medical examination, including blood and urine studies, chest X-ray and electrocardiogram (ECG). Last, to ensure the donor has two normal kidneys, a computed tomographic scan (CT scan) is conducted to obtain a three-dimensional image of both kidneys and the surrounding blood vessels.

Surgery and recovery
Both the donor and recipient are admitted to the hospital for routine laboratory work, a chest X-ray and an ECG to ensure health status has not changed. The surgical procedure, called a donor nephrectomy, is preformed under general anesthesia and takes three to four hours. Most donors will undergo laparoscopic surgery. Laparoscopic surgery is a minimally invasive surgical technique intended to minimize postoperative pain and speed up recovery times.

Most donors are able to leave the hospital 24 to 36 hours following the surgery. The remaining kidney will grow until it is able to do the work of two kidneys. Typically, donors have no restrictions on their lifestyle and can resume normal activity one month after surgery.

Donors may have a brief course of pain medicine and preoperative antibiotics. Organ recipients are required to take an immunosuppressant for life.

Trends in live organ donation
There is a very clear trend toward longer and longer waiting times for deceased donors. The best long-term outcomes occur when a person can be transplanted as soon as he or she reaches kidney failure. As a result, living donation will more than likely replace deceased donation as much as possible.

To learn more about living kidney donation or to discuss becoming a kidney donor, please call the UK Transplant Center toll free, 1-866-474-6544.

Dr. Johnston is a general and transplant surgeon, the director of renal transplantation for UK HealthCare and professor of surgery at the UK College of Medicine.

Living organ donation is on the increase

In June 2006, CNN reported that a Baltimore hospital performed an organ transplant where a man in his early 30s, acting on his religious beliefs, gave one of his kidneys to a stranger. While this form of donation sparked a debate among the medical community as to its ethics, living donations are on the rise. Most transplant centers will accept altruistic donation if the donor passes all medical and psychological screening.

Living donations are on the rise ... [most] common are the organ transplants involving living donors who are relatives or friends of the recipient.

Only about 400 people nationwide are known to have donated an organ to a stranger; more common are the organ transplants involving living donors who are relatives or friends of the recipient.

Need for transplant organs outstrips donations
The United Network for Organ Sharing (UNOS) lists approximately 94,762 candidates waiting for an organ transplant in the U.S. as of December 30, 2006. Contrast that with the reported number of transplants completed (January - September 2006): 22,016. The numbers reveal there are far more patients in need of an organ than there are donors available.

As a result, there has been an increase in the need and occurrence of live organ donation. This year, more than 40 percent of organ transplants involved living donors. According to Organ Procurement and Transplantation Network (OPTN) data, 103,651 deceased donor transplants and 81,657 living donor transplants have been performed in the U.S. since transplantation surgeries began.

Live organ donation
The first successful living donor transplant was performed in 1954 by Dr. Joseph Murray in Boston, Mass., at Peter Bent Brigham Hospital (now Brigham and Women's Hospital). The surgery, a kidney transplant, was performed between 23-year-old identical twins. The brothers went on to live active, normal lives.

Today, a certification process for living donors, created by OPTN/UNOS, guides kidney and liver transplant programs. For a program to receive certification, a surgical staff with defined experience in living-donor procedures must be retained. OPTN/UNOS recommends that programs have potential living donors undergo a psychosocial evaluation and the organization offers a standard educational tool to inform potential donors and recipients about the process of living donation.

Organs to donate
The most common living organ donation is the kidney, followed by the liver. In kidney transplantation, there is little risk to the donor and the remaining kidney will compensate for the donated kidney. Individuals may also donate a segment of the liver, the only organ that will regenerate and regain full function. Although far rarer, living donors can also donate a lung or portions of other organs.

Becoming a living donor
The decision to become a living donor is a voluntary choice and should involve careful consideration. Those considering becoming a living donor are encouraged to talk with family members, close friends, former organ donors or recipients, or a counselor.

Donors are typically between 18 and 60 years of age. They must be genuinely willing to donate; be physically fit, free from high blood pressure, diabetes, cancer, kidney disease, heart disease; and in good general health. Physical and mental health tests are performed in addition to compatibility tests with the recipient. Transplant centers also have living donors go through an informed consent process.

For more information, or to make an appointment with a UK HealthCare physician, please call UK Health Connection at 1-800-333-8874