Kidney Transplant: Donate Alive

By far the most famous transplant is the one with a kidney from a deceased donor, the so-called post-mortem donation. But because there is a great shortage of postmortem organ donors, nowadays even more kidney transplants are performed per year with kidneys from a living donor than with a kidney from a deceased donor.

Living donors can be partners, friends or relatives, as well as strangers. A living person can become a kidney donor, because kidneys have considerable overcapacity. A healthy person can live without problems with one kidney. That does not alter the fact that it is a big decision to donate a kidney.

The benefits of living kidney donation

• The time of the transplant can be planned. As a result, donor and recipient are in optimal condition at the time of surgery.
• The waiting time for a kidney is significantly shortened, so that the recipient has to dialysis less or not at all.
• A living donor’s kidney is in better condition than a deceased donor’s kidney. The organ is outside the body for a shorter time and less storage and transport damage occurs.
• When it comes to family transplantation, an additional advantage is that the tissue characteristics of the donor kidney often match those of the recipient. However, this is not always the case and should be confirmed by research beforehand.

Tissue typing

A major advantage of family or relationship transplants is that the tissue characteristics of the donor kidney often match those of the patient very closely. But family ties do not automatically make someone a suitable donor. In addition, partners and friends are increasingly acting as donors, meaning that the increased chance of correct tissue typing is not present.

Pre-emptive transplant

An important reason for choosing living donor transplantation is the possibility to dialysis treatments and shorten the waiting time for transplantation. Recent research has also shown that transplantation, preferably before someone has started dialysis – a pre-emptive transplant – produces the best results for patients. The donor and recipient are operated on on the same day and in the same hospital. The kidney is then only briefly outside the body and the results of this form of transplant are therefore better. The harmful effects of years of dialysis are avoided by pre-emptive transplantation.

Crossover transplant

Sometimes a donor cannot donate directly to the desired recipient because their blood groups do not match or because the cross match shows that the blood of the donor and recipient ‘clots’ when it is brought together. In such a case ‘cross-over transplantation’ or exchange transplantation can be an alternative.

In a crossover transplant, a different couple of donor and recipient is sought and both donors donate a kidney to the recipient of the other couple. The Dutch Transplantation Foundation ensures matching of transplant pairs four times a year. A crossover transplant is of course the donor’s own choice; you are not obliged to donate a kidney to a stranger.

Extra chance

The program means an extra chance. However, there is no guarantee that a good match can be made in the short term. If no suitable exchange pair is found for a couple, they will automatically participate in the next search round. It often happens that not two, but three or even four pairs are linked together.

In a cross-over procedure, the recipients are always operated on in their ‘own’ transplant centre. The donor travels to the new recipient’s hospital. So there is a good chance that you will be treated in another hospital. The operations take place simultaneously. In principle, there is no contact between you and the couple you exchanged with.

Samaritan donation

A final form of living donation is the so-called ‘Samaritan donation’, sometimes also called altruistic donation. Here, someone anonymously donates his kidney to a stranger. In order to be able to donate a living kidney to a kidney patient, someone must meet a number of conditions.

Conditions for living donation

• You are of age
• Your blood group matches the recipient’s blood group. For some time now, there has also been the possibility that the recipient is prepared with medicines, so that the transplant can be carried out through the blood group.
• The tissue characteristics of the kidney are not objectionable to the recipient.
• Your physical and psychological condition is such that you can safely undergo an operation.
• The results of the blood test and other medical examinations are in order.
• You do not have a kidney disease and no disease that could worsen kidney function in the future (for example diabetes mellitus or a strong raised blood pressure).
• You dispose of the kidney of your own free will and without external pressure.
• You donate the kidney free of charge (so there is no financial compensation in return).

What does the law say?

Living donation of organs and tissues is regulated in the Organ Donation Act (WOD). It emphasizes that the decision to donate while living must be made in complete freedom and without any moral pressure. The donor therefore donates a kidney entirely of his own free will and without external pressure. It should not be thought lightly, after all it is an operation and that makes it a major event, both physically and emotionally. The financial and social consequences must also be considered. For people considering a living donation, the Kidney Foundation has the brochure ‘Living kidney donation’ released to aid in an informed decision.