Living-Donor Kidney Transplantation
A living-donor kidney transplant may be an option that is offered to the parents of a child who requires a kidney transplant. Living donation, in general, will only be considered for recipients who weigh 10 kilograms. First performed in the United States in 1954, living-donor kidney transplants have steadily increased each year.
At Lurie Children’s, approximately 30% of all kidney transplants performed to date have been living-donor operations. Donors have included parents, cousins, aunts, uncles, grandparents and family friends. All donors are currently alive and well.
Selecting a Donor
The potential living kidney donor must meet certain age and health criteria, as well as have the same or compatible blood type as the recipient.
- The donor should be of overall excellent health without significant medical problems such as diabetes, heart disease, hypertension, asthma or a history of hepatitis.
- We generally do not consider individuals below the age of 18 or over the age of 50 as potential donors.
- Most importantly, the donor must be willing and able to withstand the stress of donation and recovery from major surgery.
We encourage parents to have their blood types checked to determine if one or both are a match. If both are a match, the family needs to decide who would make the most suitable donor. Some issues for consideration are: employment (who is the primary breadwinner), work demands (sedentary or physical), sick-leave limitations and available support systems.
The donor work-up is initiated when a suitable donor is identified. The donor evaluation will consist of:
- Laboratory testing
- Medical exam
- CT scan of the kidney to measure size and rule out abnormalities
- ECG, chest x-Ray
- The donor may donate at least two units of their own blood for the procedure
The testing is accomplished over three to four days, but can be compressed into one day in special circumstances. Because living donors are adults, all donor evaluation and testing procedures are performed at our adult partner hospital, Northwestern Memorial Hospital. Once the donor work-up is complete and the potential donor is deemed suitable, the transplant teams from Lurie Children’s and Northwestern Memorial work together with the family to select a date for the transplant.
Living-Donor Transplant Surgery
The infant or child is admitted to Lurie Children’s transplant unit the night before or the morning of the scheduled surgery, depending on the dialysis schedule, and the donor will report to Northwestern Memorial by 6 a.m. on the day of surgery.
The donor operation begins about 7:30 a.m., and the two transplant teams are in constant communication thereafter. Once the donor kidney is removed, the team at Lurie Children’s starts the recipient’s procedure. While the donor operation normally takes two to three hours, the recipient’s procedure may last approximately three to four hours.
Pros & Cons
The most important advantage to living-donor kidney transplant is the ability to schedule the surgery on an elective basis. This allows the transplant team, along with the family, to decide on the optimum time for the procedure. The recipients are usually healthier and stronger at the time of transplant as well.
Living-donor recipients may have shorter hospital stays and may have fewer episodes of moderate to severe rejection. On the other hand, the family must endure two procedures rather than one. The living-donor operation, while very safe, is a major surgery with significant risks. These risks include bleeding and infection.
Most donors are discharged from the hospital within two days and back to work within two weeks.