After completing an online questionnaire to assess basic health and answer any questions, potential donors go through an evaluation that includes consultations with the donor team, tests including blood and urine, and procedures to determine the state of their health.
Testing: In addition to blood and urine samples, additional testing may include a nuclear medicine test to measure kidney function, a chest X-ray to check lung functionality, an EKG or stress test to measure heart function, a CT scan of the abdomen and pelvis, and other exams depending on medical history and overall health.
This stage also involves reviewing existing life and health insurance policies and “talking about adopting healthy lifestyles, seeing primary care physicians, [and] making sure [potential donors] are up-to-date on their annual testing,” says Darby Santamour-Saab, Living Donor Program coordinator at the Center for Liver Disease and Transplantation at NewYork-Presbyterian. What’s also important is “deciding on a care partner that is going to support them through the whole process.”
Living donors also go through both a psychosocial and medical evaluation before being cleared for surgery.
Psychosocial: Performed by a psychiatrist, psychologist, or social worker, the psychosocial evaluation covers issues such as one’s motivation to donate, the donor’s awareness of risks, availability of support during recovery, and how one’s finances and health insurance might be affected.
Medical: In the medical evaluation, clinical issues like donor health are addressed. The donor should be prepared to disclose his or her general medical history before undergoing a number of tests, depending on the type of donation. Living kidney donors, for example, are put through immunological testing (blood type and cross-match compatibility), metabolic-focused testing (to look for issues such as diabetes or high cholesterol), anatomic assessment of the kidneys and their blood flow, screening for transmissible diseases (such as HIV and hepatitis), and cancer screening.
Liver donors, says Santamour-Saab, receive a “full blood work-up, chest X-ray, EKG to check their lungs and heart, and the abdominal MRI. And I explain to them that the MRI is really what the surgeon is going to be looking at to determine if their liver is sized appropriately, split appropriately, and they’re going to look at its anatomy and its fat content to determine if they are an appropriate candidate.”
Gretchen Boyd, chief living donor coordinator at NewYork-Presbyterian/Columbia University Irving Medical Center, points out that for potential kidney donors whose blood types do not match that of the intended recipient, “we do have an exchange program where you could go into a database with your recipient where we identify a compatible donor for your recipient, and you would donate your kidney to a different recipient.”