How to Become a Kidney Donor

Phase 1: The Telephone Interview

The first stage of the living donor process is for the potential donor to call the transplant coordinator. The transplant coordinator will need approximately thirty minutes of your time to complete a telephone interview and discuss the process for donation. This interview includes a medical screening in order to determine if you would be an appropriate candidate to continue to phase 2.

Phase 2: Blood Testing

The second phase involves blood testing. The following tests are completed: blood type, crossmatch and in some cases human leukocyte antigen (HLA) matching, which tests for the degree of genetic similarity between the recipient and the potential donor.

The first test, identifying your blood group, determines if your blood type is compatible with the recipient.

Blood Group: Compatible blood groups for living donor transplantation:

Recipient Donor
A A or O
B B or O
AB A, B, AB, or O

The second test is the crossmatch, which determines if the recipient has any antibodies or sensitivities to the donor. If the crossmatch test result is positive, this signifies the recipient has the ability to attack the donor's cells and the transplanted kidney. Therefore he/she could not donate. However, a negative crossmatch result signifies the recipient does not have antibodies against the donor's kidney and he/she could be a potential donor.

The third blood test, HLA typing, determines if the donor and recipient share any of the same genetic markers. This is sometimes referred to as the "HLA match". Six of your genetic markers are identified and compared with the recipient's. It is not necessary for the donor and recipient to share any of the same genetic markers. However, all other factors being equal, a better HLA match is one factor that may improve the long-term outcome of kidney transplantation. This information is one factor that may help families choose who will be tested to be a donor when there are multiple individuals considering kidney donation.

Once blood is drawn for HLA typing, it takes approximately 3-4 weeks for the results to be completed. You will be called by your coordinator and given the results. At that time the coordinator will answer questions and provide scheduling instructions if you wish to proceed to the third phase of inpatient evaluation for donation.

Multiple Donors:

Many times multiple donors have blood testing performed for one recipient. We cannot release information regarding who or how many donors were tested to the recipient or potential donors. In this situation, we give each donor his/her results and we ask all to talk to each other if they want to proceed. The potential donors should then choose one person for phase three, the detailed medical evaluation performed at the Emory Transplant Center. We can provide information that may help in making this decision. There is more involved in choosing a potential donor than simply considering the genetic match. For example, can the person take time from work and family necessary for surgery and recovery? Most importantly, the act of donation must be voluntary. After taking all factors into consideration, only one donor at a time will be medically evaluated in phase three. We ask the selected person for phase three to call his/her coordinator to arrange the hospital admission evaluation.

Phase 3: Donor Evaluation

There are two ways to complete the donor evaluation phase:

1. For most patients the evaluation requires a two day visit to the Emory Transplant Center. During this visit, we provide donation education and perform a thorough medical and psychological evaluation to determine donor suitability. The potential donor will have the opportunity to meet the members of the transplant team, which include the transplant surgeon, nurse coordinator, physician assistant, nurse practitioner, nephrologist, psychiatrist, and social worker. To determine the health status of the potential donor, the following medical tests are performed: medical history and physical examination, chest X-ray, electrocardiogram (EKG), and blood and urine tests. A CT angiogram or magnetic resonance angiogram (MRA) is also done. This procedure is a specialized X-ray, which enables the transplant team to determine whether there are any abnormalities in the kidneys or their blood vessels. If necessary, additional testing will be performed based on an individual basis. This may include additional heart tests such as an echocardiogram or cardiac stress test. The transplant team seeks to confirm that you are in good health for the surgery and that you do not have any associated kidney disease or medical conditions that may be associated with kidney disease in the future. If there are significant concerns over medical issues, the Emory Transplant Team will advise you not to donate. Once the evaluation is complete, it takes approximately 5 - 10 days to receive your results.

2. When a donor lives out of state and does not wish to initially come to Emory. We may be able to arrange blood work and pre-evaluation testing at a remote location. The recipient's insurance company must allow for this remote testing. The actual evaluation must be done at Emory Transplant Clinic.

Phase 4: Transplant

Since the fall of 1999 virtually all donor nephrectomies performed at the Emory Transplant Center have been done using the laparoscopic technique. This includes patients with extra blood vessels to the kidney and instances in which the right kidney was removed for transplantation. The laparoscopic technique offers the donor a more rapid and less uncomfortable recovery while providing the recipient a kidney that functions the same as a kidney removed through the much larger incision used for the open technique. To date, Emory surgeons have performed over 400 consecutive laparoscopic donor nephrectomies.

The transplant pre-operative workup is completed one to two weeks before the surgery. The workup may involve blood tests, EKG, chest X-ray, history and physical examination, and consultation with the anesthesiologist. The donor is admitted to Emory Hospital on the morning of surgery.

If you have any questions, please do not hesitate to contact an Emory Transplant Coordinator toll free 1-855-EMORYTX (366-7989).