What to Expect as a Living Donor
A step-by-step process on how you can help save lives.
Every 10 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 — more than 4 out of 5 — are made possible through deceased donors. Still, 20 people die each day waiting for a transplant.
Living donors offer the potential to help close the gap. They can donate a kidney or a portion of their liver, and in rare cases, a portion of their pancreas.
Before becoming a living organ donor, it’s important to know what to expect. Here, Health Matters talks to the experts at NewYork-Presbyterian about the steps involved in becoming a living organ donor.
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.”
Meet the Team
Your donor team includes key contacts such as a transplant coordinator, your donor surgeon, a social worker, and a donor advocate who keeps in contact with you throughout the process. For liver donors, the team also includes a hepatologist, financial coordinator, and psychiatrist.
It’s also important 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 Santamour-Saab, “and to make sure you have that time available and you’re not going to go into financial hardship due to the donation.”
While the evaluation process is extensive, it doesn’t mean prospective donors are committing to donate, Boyd says.
“This is really kind of just an education for them to get more information,” she says, “and for us to take a look and make sure that we think it’s safe for them. At any time, they can choose to stop the process, even if they’re cleared.”
Receiving Your Evaluation
After a prospective donor’s assessment is completed, a selection meeting occurs during which “the team all meets within a formal committee to determine whether the donor is suitable to proceed with the donation,” says Boyd. The committee checks for contraindications, reviews the potential donor’s medical information, hears from the team psychiatrist, and discusses any lingering concerns before giving the living donor the green light.
Preparing for Surgery
Living donors undergo further blood work one to two weeks ahead of their surgery, says Boyd. Women on estrogen birth control need to cease taking it six weeks before their surgery to decrease the chance of a blood clot. The use of aspirin or ibuprofen must cease one week before surgery. Starting the night before surgery, patients must not consume liquids or solids, says Boyd.
A donor is typically hospitalized for five to seven days after a hepatectomy. On day one, donors experience soreness, nausea, and grogginess. Pain will still be present on days two to three as patients switch from IV to oral pain medication and begin to slowly walk.
By day four, pain subsides and patients may drink clear liquids. Bowel function will start to return. Discharge from the hospital occurs after the patient has a bowel movement, is able to eat regular food, and has a drainage tube removed from the abdomen. Patients will be given a prescription for oral pain medicine to take as needed, and can expect to be moderately fatigued for several weeks.
Patients are encouraged to slowly resume normal activity, walk daily, and avoid lifting anything greater than 15 pounds for four weeks and anything heavier than 30 pounds for 12 weeks.
“We encourage donors to slowly work back to their normal exercise routine and that it may take a few months to get back to baseline,” says Santamour-Saab.
They may return to work one to two months after surgery; liver donors who undergo laparoscopic surgery are often able to return earlier. Alcohol and any medications or herbal remedies that can be toxic to the liver should be avoided for six months and pregnancy for one year.
After either laparoscopic or single-site surgery, donors stay in the hospital for about two days. The morning after the surgery, patients receive IV pain medication, are on a clear liquid diet, their bladder catheter is removed, and they are encouraged to begin to slowly walk.
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.
“Our team members often hear comments from patients’ families the morning after a kidney transplant about how well the transplant recipient looks and that the patient has color back in their cheeks that they hadn’t seen in a long time. The families are amazed at how quickly it happens,” Dr. Kapur says.
On day two, donors receive solid food, transition to oral pain medication, and are discharged in the afternoon.
People who work in an office setting usually return to work in two to three weeks. People with physically demanding jobs may need to recover for four to six weeks.
Both kidney and liver donors return to the hospital 10 days after release “to make sure they are healing nicely,” says Boyd. “Then we do a six-month, one-year, and two-year follow-up. Patients don’t need to physically see us for these assessments. Instead, we send them a prescription for blood work.”
For more information about becoming a living organ donor, visit nyp.org/transplant.