An Overview of Living Kidney Transplantation

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Living donation occurs when a living person decides to donate one of their kidneys to someone in need of a transplant. This is referred to as a directed donation since the donor specifies the recipient. When donors decide to donate to anyone who needs a kidney transplant, this is commonly referred to as an altruistic or non-directed donation. They do not specify who should receive their kidney.
Donating a kidney is the most frequent type of living organ donation and living kidney transplants have the highest success rate of all transplant procedures. Other organs which can be donated via living donation include liver, lung, small bowel and pancreas.

Being born with one kidney is not unusual. About 1 in every 750 people is born with just one kidney and the life expectancy is the same as those with two kidneys.

Who Can Donate a Kidney?

A living kidney donation often comes from a family member (i.e. a parent, child, sibling or other relative). A donor can also be a spouse, friend or co-worker. Or it can be a stranger. A genetic link between donor and recipient, although beneficial, is not necessarily required. This is largely due to improved anti-rejection medications. These type of “non related” transplants are becoming more common.

A good living donor candidate is someone who is healthy, well-informed and makes a voluntary decision to donate one of their kidneys. Living donors must be over 18 and usually under 70 years of age. They must be in good general health with no evidence of significant high blood pressure, diabetes, cancer, kidney disease, heart disease or hepatitis.

Several tests are necessary to determine if the donor’s’ kidney will be compatible for the intended recipient.

The Different Types of Living Kidney Transplants are:

Related living donors are healthy blood relatives of transplant candidates. They can be:

  • parents
  • siblings
  • children over 18 years of age
  • other blood relatives (aunts, uncles, cousins, half brothers and sisters, nieces and nephews)

Unrelated living donors are healthy individuals emotionally close but not related by blood to transplant candidates. They can be:

  • spouses
  • in-law relatives
  • close friends
  • co-workers, neighbors or other acquaintances

Non-Directed (Altruistic)
Non-directed donors are living donors who are not related to or known by the recipient and make their donation purely out of selfless motives. This type of donation is also referred to as anonymous, altruistic, altruistic stranger, or stranger-to-stranger living donation.
Individuals who are interested in becoming non-directed donors should contact transplant centers in their area to discuss the possibility of becoming a donor. 

Paired Kidney Exchange Programs

Kidney paired exchanges are becoming very common and an exciting option for kidney recipient and donor pairs who are not compatible with each other. Previously, people with kidney failure who had an incompatible donor were not able to benefit from the transplant being offered to them. However, kidney paired exchange programs are having a significant impact on the expanding options of living kidney transplants. Paired exchanges are now allowing transplants to occur between incompatible donor pairs and in a few unique ways.

How Does a Paired Kidney Exchange Work?

A kidney paired exchange consists of two or more donor/recipient pairs who are not compatible with each other. Kidney paired exchanges are a major breakthrough in living donations and are revolutionizing living donor transplants by eliminating incompatibility as a barrier to donation and providing a way for recipients and their incompatible donor to be paired with another incompatible recipient and donor.

Paired kidney exchange

In Pair 1, Donor 1 is not compatible with Recipient 1. In Pair 2, Donor 2 is not compatible with Recipient 2. However, Donor 1 is compatible with Recipient 2 and Donor 2 is compatible with Recipient 1. If you, your donor and the other pair are willing to participate in this “exchange,” a comprehensive evaluation process begins. The medical team will complete final medical tests and schedule the transplant on a date that works with everyone. Both transplants usually occur at the same day. This example used 2 pairs, but in fact any number of pairs is possible.

Domino Kidney Paired Exchange

A domino kidney paired exchange starts with a non-directed or altruistic donor. Instead of just one person benefiting from their donation, this donor can allow many incompatible pairs to be transplanted. The difference in the example shown below from the “Kidney Paired Exchange” is that Donor #2 is not compatible with either recipient #1 or #2. As such, the altruistic donor allows the other pairs to be exchanged, and have the domino effect.

Ongoing donor chains

Ongoing Donor Chains (Also called Never Ending Donor Chains)

Most recently, altruistic or non-directed donors have begun initiating donor chains which have the
potential to facilitate thousands of additional living donor transplants.

In the example below, donor, #2 does not donate in this exchange. Donor #2 is referred to as the
“bridge donor” for the next “chain”. Donor #2 functions in the same role as the altruistic donor in this
example. This chain could continue, over and over again with a new bridge donor.This example uses 2
pairs and the altruistic donor, but any number of pairs could be transplanted.

Ongoing donor chains

Compatible Paired Exchanges

Compatible donor/recipient pairs are being used to facilitate transplants with incompatible
donor/recipient pairs. This benefits the compatible donor/recipient pair if the recipient receives a
better HLA matched kidney, a kidney from a younger donor, or kidney that is a better size. The goal is
to have all recipients benefit by participating in such an exchange. An ideal compatible
donor/recipient pair is one where the donor is a blood type "O", and the potential recipient is blood
type "A", "B", or "AB".

Kidney Paired Exchange Programs

Many hospitals have their own kidney paired exchanges that they arrange within the incompatible
pairs at their hospitals. The nature of kidney paired exchanges is that the likelyhood of finding a
compatible pair is increased when there are many incompatible pairs. There are organizations that
“co-op” with other hospitals to increase the likelihood of being “matched” with another incompatible
pair. The following organizations have agreements with many hospitals in order to increase that

National Kidney Registry Contact: Diane Zocchia (631) 560-6836
The Alliance for Paired Donation Contact: Laurie Reece 512-961-6199
The New England Paired Exchange Program Contact: Ruthanne (800) 446-6362

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Harvey Mysel, Founder & President

Harvey established the LKDN after recognizing the need for better resources while pursuing a successful living kidney transplant in 2006. Our purpose is to share knowledge and build the confidence to enable the life changing benefits of living donation. Click here to learn more about Harvey.

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