What to Expect as a Living Donor

Every 8 minutes, someone is added to the national transplant waiting list, joining more than 100,000 others hopeful for the gift of life.

Most organ transplants each year are made possible by deceased donors and their families. But living donors make a tremendous impact — in 2023, more than 6,900 transplants were made possible by living donors in the United States.

If you’re considering becoming a living organ donor, it’s important to know the steps in the process. Here, Health Matters talks to the experts at NewYork-Presbyterian about what’s involved when giving the gift of life.

Living donors can donate a kidney or a portion of their liver, and in rare cases, a portion of their pancreas. Donors don’t have to be related to their recipients.

In making the decision to help save a life, evaluate your personal situation and potential risks. Then consider the different types of living donation. They include:

• A directed donation (donating to a family member or friend who is a match)
• A non-directed donation (donating to someone anonymously)
• A kidney or liver paired donation (involves multiple living donor/transplant pairs who “swap” donors to make compatible matches)
• An advanced donation (a voucher program through the National Kidney Registry)

After completing an online questionnaire from their living donor transplant program to assess basic health, potential donors go through an evaluation that includes consultations with the donor team.

Living donors also go through both a psychosocial and a medical evaluation.

Psychosocial evaluations are performed by a psychiatrist, psychologist, or social worker, covering 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. It’s important to have a caregiver attend this portion of the evaluation, as they will also be learning their role in supporting the donor, says Jennica Kim, living donor specialist at NewYork-Presbyterian’s Center for Liver Disease and Transplantation.

It’s also recommended to disclose your plan to be a donor to your employer to understand how they will handle your absence and whether you have vacation time or qualify for the Family and Medical Leave Act.

“Let them know your intentions,” says Kim, “and make sure you have that time available and you’re not going to go into financial hardship due to the donation.”

At this stage, team members will evaluate whether potential donors are eligible to receive any financial assistance.

Medical evaluations include disclosing general medical history before undergoing a number of tests, depending on the type of donation. Testing can include:

• Pre-cancer screenings
• Blood and urine samples
• Nuclear medicine test to measure kidney function
• Chest X-ray to check lung functionality
• EKG or stress test to measure heart function
• CT scan of the abdomen and pelvis
• Other exams depending on medical history and overall health

Living kidney donors, for example, undergo 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, and screening for transmissible diseases (such as HIV and hepatitis).

Liver donors, says Kim, receive an abdominal MRI where the surgeon looks at their liver’s anatomy and fat content and determines if their liver size and split are appropriate.

Your donor team includes key contacts such as a transplant coordinator, your donor surgeon, a social worker, a psychiatrist, a financial coordinator, and an independent living donor advocate who keeps in contact with you throughout the process. Depending on the organ, the team can also include a hepatologist and a nephrologist.

Remember, while the evaluation process is extensive, it doesn’t mean potential donors are committing to donate, says Brian Runge, chief living donor transplant coordinator at NewYork-Presbyterian/Columbia University Irving Medical Center.

After a potential donor’s assessment is completed, a selection meeting occurs during which the team meets within a formal committee to determine whether the donor is suitable to proceed with the donation. The committee reviews the potential donor’s medical information, test results, psychosocial and any other necessary clearances, and discusses any concerns.

Living donors undergo additional bloodwork one to two weeks ahead of their surgery. Medications such as aspirin, ibuprofen, and estrogen birth control may be halted weeks in advance. Starting the night before surgery, patients must not consume liquids or solids, says Runge.

If you’re donating a portion of your liver, the surgery is either fully laparoscopic, a minimally invasive procedure that involves a 3-inch horizontal incision above the pubic bone, or partially laparoscopic, with a vertical midline incision above the belly button, depending on liver anatomy, size, and shape.

A living liver donor is typically hospitalized for five to seven days after a partial hepatectomy.

“Both the donor’s and the recipient’s livers will mostly regenerate in the first three months post-donation,” Kim says.

If you’re donating your kidney, after either minimally invasive laparoscopic or single-site surgery, donors stay in the hospital for about two days.

Dr. Sandip Kapur, chief of transplant surgery and director of the Kidney and Pancreas Transplant Programs at NewYork-Presbyterian/Weill Cornell Medical Center, can attest to the near-immediate difference a kidney transplant makes.

“Living kidney donation improves the recipient’s quality of life, but there are immense benefits for the donor too,” says Dr. Kapur, who is also a professor of surgery at Weill Cornell Medicine. “Many express that they have a renewed sense of purpose in their life.”

Both kidney and liver donors return to the hospital 10 days after release for a checkup, and come back for six-month, one-year, and two-year follow-ups. They are encouraged to follow up with their primary care physician on an annual basis, Dr. Kapur says.