Living KidneyDonation

k i d n e y a n d pa n c r e a s t r a n s p l a n t p r o g r a m

1 Introduction2 What are the treatment options for someone with kidney failure?2 What are the advantages of having a living donor transplant?3 Who can be a kidney donor?4 If I decide to be a donor, what should I do?4 What does the evaluation process include?6 What happens during surgery?6 What is laparoscopic kidney removal surgery?7 What is recovery like?7 What are my health risks?8 Who pays for my medical costs?8 Will I need follow-up care after I donate?

Contents

On the cover: Gary, kidney transplant recipient, with his donor and wife, Susan.

Knowing that the gift of one’s kidney can help end dialysistreatments and enable an individual with kidney failure toenjoy more freedom and energy prompts many to considerliving kidney donation.

In fact, in 2006, nearly 7,000 individuals in the UnitedStates acted as “living donors,” accounting for almost 40 percent of all kidney transplants.

At California Pacific, we have been performing living donorkidney transplantation since 1973. To date, we have hadmore than 800 living kidney donors who have graciously provided the “gift of life.” Our Kidney Team works closely withall donors, beginning with the initial evaluation and continuingthrough surgery and follow-up visits.

While donating a kidney can be one of life’s greatest experiences, it should be entered into with a completeunderstanding of the living donation process. This pamphletprovides an overview of what you can expect as a livingdonor and addresses frequently asked questions.

Introduction

What are the treatment options for someone with kidney failure?

A patient with kidney failure can choose among two forms of treatment for this condition:

• Dialysis

° Hemodialysis uses a machine to filter one’s blood and temporarily remove waste products, extra salt and extra water from the body.

° Peritoneal Dialysis uses the lining of one’s abdomen to remove waste products, extrawater and chemicals from the body.

• Kidney Transplantation is a surgical procedure that involves the replacement of a diseased, damaged or missing kidney with a healthy donor kidney. The donated kidneydoes the work of the two failed kidneys. There is no need for dialysis with this surgicaltreatment. Although most patients receive kidney transplants after starting dialysis, patientsmay also choose transplantation before starting dialysis. For many patients, kidney trans-plantation has become the preferred treatment for kidney failure.

What are the advantages to having a living donor transplant?

Living donor transplantation provides some major benefits forpatients. First, patient outcomes are much better than forthose who receive a transplant from a deceased donor.Second, the waiting time before transplantation is usually veryshort. The current waiting time in California for a deceaseddonor organ is five to seven years, while with a living donor, atransplant could occur within a few months. Third, the opera-tion can be timed to meet the patients’ needs, allowing themto prepare both physically and mentally for surgery.

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Living donors are usually between the age of 18 to 60 and in excellent health.One cannot donate a kidney if he/she has suffered from diabetes, hyperten-sion, heart disease, cancer or chronic kidney disease. A kidney donor andrecipient do not need to be the same race or blood type.

There are two types of living donors:

• Living Related Donor: Refers to a living donor who is a healthy blood relative of the person awaiting transplant. This includes a sibling, parent,child, aunt, uncle, cousin, etc.

• Living Unrelated Donor: Refers to a healthy person who is emotionally close to, but not blood-related to the person awaiting transplant. This includes one’s spouse, in-law relatives and close friends.

Who can be a kidney donor?

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Breyon (left) donated her kidney to friendand neighbor, David Jacobs (seen hereenjoying a baseball game). Of the experi-ence, Breyon says, “I was pretty shockedthat we were compatible, me being anAfrican-American 20-year old female andhim being a 50-year old Jewish male. I amamazed at that connection and how biologically we are all the same.”

If I decide to be a donor, what should I do?

Individuals who want to donate to someone who is clearedfor kidney transplantation at California Pacific Medical Centercan start the process by calling our Living Donor TransplantCoordinator at 415-600-1718 (toll-free: 1-877-427-6289).This will begin the evaluation process. Individuals who pursuekidney donation should remember that they can stop theprocess or change their mind at any time.

What does the evaluation process include?

Potential kidney donors undergo a medical evaluation and screening tests to determine if theycan donate a kidney. Throughout this process, all communication between the donor andtransplant center remains confidential.

The steps involved in becoming a living kidney donor are as follows:

1. Call our Living Donor Coordinator: Any potential donors should first call our LivingDonor Transplant Coordinator at 415-600-1718 (toll-free: 1-877-427-6289). The nurse will discuss their general medical history and inquire about conditions that may rule them outas a donor.

2. Undergo a Screening Blood Test: Donors next have blood studies done by CaliforniaPacific’s Histocompatibility Lab to determine compatibility between the recipient anddonor. (If necessary, the transplant coordinator can help make arrangements for the bloodto be drawn locally). We give the result of this test to the donor confidentially.

° Blood Compatibility Work-Up: A potential donor will have blood drawn for ABO bloodtyping, crossmatch testing and HLA testing. Crossmatch testing involves mixing donorand recipient blood in our laboratory. A “negative” crossmatch means a potential donorcan donate to the recipient. A “positive” crossmatch means there is a high rejection riskand the transplant should not take place. In this case, the potential donor and recipientare offered participation in our Paired Donation Program.

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3. Medical Work-Up: If the donor is compatible and wishes to proceed, we will schedule afull medical work-up at California Pacific Medical Center in San Francisco with a transplantnephrologist and a psychosocial evaluation by a transplant social worker. If a potentialdonor lives out of state, the medical work-up may be completed by a recognized trans-plant center locally. The steps to complete the medical work-up include:

° Medical and Psychosocial Exam: A potential donor will undergo a medical and psychosocial evaluation. This involves a visit with a physician and social worker or psychologist, and a number of medical tests.

° Chart Review: The kidney team conducts a thorough medical chart review before determining if an individual can become a living donor.

4. CT Scan: A final study—the CT scan—is scheduled once the donor is determined to bemedically acceptable. The CT scan is a type of X-ray that enables the physician to viewone’s kidney and surrounding blood vessels from many different angles. The scan takesabout one hour and is usually performed at California Pacific in San Francisco unless thedonor lives far away. Immediately after this test, the donor and transplant surgeon meet to discuss the findings. If there are no abnormalities, the surgeon and donor will discussthe surgery.

5. Arrange a Transplant Date: The last step in the living donation process is scheduling adate for the transplant surgery. This timing is based on the donor and recipient’s sched-ules, as well as the operating room and surgeon’s schedules.

What happens during surgery?

The surgical procedure to remove a kidney from the donor is called a nephrectomy and takesapproximately 2 to 3 hours. There are two options for kidney transplant surgery: either laparo-scopic kidney removal or open surgery. Most nephrectomies are now done with the laparo-scopic technique.

Prior to surgery, the nurse will start an IV in the donor’s arm. Once the donor comes to theoperating room, he/she receives a general anesthetic and quickly falls asleep. The surgeonthen removes one of the donor’s kidneys. The donor and recipient surgeries are staggered sothat immediately after the donor’s kidney is removed, the surgeon transplants it into the recipi-ent, who is in an adjacent operating room.

What is laparoscopic kidney removal surgery?

Laparoscopic kidney removal surgery, also known aslaparoscopic nephrectomy, is a minimally invasive surgical procedure for obtaining a kidney from a livingdonor. In comparison to open surgery, laparoscopicnephrectomy results in a smaller incision, lessens recuperation time and shortens one’s hospital stay. In1998, California Pacific was the first kidney transplantprogram in the San Francisco Bay Area to perform alaparoscopic nephrectomy.

During the procedure, small incisions (~ 1 cm inlength) are made at three key points in the abdominalarea to enable insertion of instruments and a miniaturecamera. The camera is attached to a monitor that thesurgeons view to guide their work. A slightly larger incision (~ 8 cm in length) just above the pubic bone isused to remove the donor’s kidney for transplantation.

Typically, laparoscopic nephrectomy patients(donors) spend 2 to 3 days in recovery before being discharged, compared to an average of 5 days with thetypical open donor kidney transplant surgery.

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During laparoscopic kidney removal surgery, three small incisions below the ribs allow the surgeon to insert instruments and a miniature camera. The kidney is removed through an incision above the pubic bone. Medical Illustration Copyright © 2007 Nucleus Medical Art,All rights reserved. www.nucleusinc.com

What is recovery like?

Living donors typically spend 2 to 3 days recovering in the hospital and can return to their nor-mal level of activity within 4 to 6 weeks. The first few days after surgery, kidney donors aremade comfortable with patient-controlled pain medicine.

Because the kidney donor operation is a major surgical procedure, donors find they haveless energy and need about 4 to 6 weeks to return to their full pre-surgical activity level. Fordonors who worked prior to surgery, disability coverage allows 6 weeks off for recovery; how-ever, some donors return to work before this time. Frequently, disability does not cover all of adonor’s salary. Other options may need to be pursued such as using vacation or sick time.Sometimes a donor’s co-workers will donate their vacation time.

Before leaving the hospital, the transplant staff will schedule a 2-week follow up visit. This appointment is necessary to check the donor’s surgical incision, blood pressure andoverall health. Additionally, California Pacific offers a Living Donor Wellness Clinic following kidney donation.

What are my health risks?

Typically, there is little risk to a living kidney donor. Of course there is the usual risk and painassociated with any surgery, but they are usually minimal due to the excellent health of thedonor. Our team will discuss medical and psychosocial risks associated with kidney donationduring your evaluation. However, if you have any questions regarding the specific risks apotential donor may face, contact our Living Donor Transplant Coordinator at 415-600-1718(toll-free: 1-877-427-6289).

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Who pays for my medical costs?

All expenses for the medical work-up and transplant surgery are covered by the recipient’shealth insurance. In considering donation, candidates need to consider additional expensessuch as:

• Travel to California Pacific Medical Center in San Francisco• Parking, lodging, gas, bridge tolls and other incidentals• Lost wages if sick time or short-term disability from work is not available

Our transplant financial coordinators and social workers can discuss your specific circum-stances in more detail.

Will I need follow-up care after I donate?

Kidney donation should not affect the donor’s life span or lifestyleonce he/she has healed from the surgery. For health maintenance,the kidney team encourages regular yearly visits with your primarycare physician.

Additionally, California Pacific offers a Living Donor WellnessClinic, which gives donors the opportunity to see a transplantteam member and have an annual health evaluation following kid-ney donation. This visit is covered by a donor’s primary insuranceor, if insurance is unavailable, by California Pacific Medical Center.

Clinic visits are available at sites throughout Northern California.Approximately 3 to 6 months following donation, the kidney team will contact you to

schedule an appointment which includes a focused physical exam, weight and blood pressurecheck, and blood and urine tests. For more information about our Living Donor WellnessClinic, or to schedule an appointment if you have been a living donor at California PacificMedical Center, call 209-238-9132.

Kidney and Pancreas Transplant ProgramCalifornia Pacific Medical Center2340 Clay Street, 4th FloorSan Francisco, CA 94115415-600-10001-877-4-CPMC-TX toll free(1-877-427-6289)www.cpmc.org/kidney

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Copyright©California Pacific Medical Center. All rights reserved.TRANKID-livingdonationbk-2007

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Notes