Educating, Evaluating, and Selecting Living Kidney Donors

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Comprehensive coverage of common surgical complications is presented including management of urinary strictures, urinary leaks, lymphoceles, vascular probl. Ramirez has vast experience in kidney and liver transplant surgery. He earned his medical degree at the University of Philippines and completed his internship and residency at Philippines General Hospital. Ramirez completed a fellowship at the University of Pittsburgh Medical Center, where he received extensive training in adult and pediatric abdominal transplant surgery at the Thomas Starzl Transplantation Institute.

An associate professor at Jefferson Medical College, he has authored more than 90 articles and abstracts on transplantation and serves as Director of the Transplant Fellowship Program at Thomas Jefferson University. JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser. Medicine Surgery.

Organ and Tissue Transplantation. Addresses organizational issues that are vital to the good performance of transplant programs Covers key controversies and administrative issues unique to kidney transplantation Includes detailed pictures and surgical technique sections see more benefits.


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Buy Print. FAQ Policy. About this book This book provides a comprehensive guide to successful kidney transplantation in the highly regulated environment of today. However, the donor of each pair is compatible with the recipient of the other pair. If both donors and recipients are willing, doctors may consider a paired donation. More than one pair of incompatible living donors and recipients may be linked with a nondirected living donor to form a donation chain in order to receive compatible organs.

Living donors often play an important role in paired donation and donation chains. Paired-organ donation also known as paired exchange may be an option when a donor and intended recipient have incompatible blood types, or when the recipient has certain antibodies that will react to the donor's cells, causing the transplant to fail. In paired donation, two or more organ-recipient pairs trade donors so that each recipient gets an organ that is compatible with his or her blood type.

Living Donor Kidney Transplant - University of Mississippi Medical Center

A nondirected living donor also may participate in paired-organ donation to help match incompatible pairs. In this scenario, multiple recipients benefit from a single nondirected living donor. Living-donor transplantation offers an alternative to waiting for a deceased-donor organ to become available for people in need of an organ transplant. In addition, living-donor organ transplants are associated with fewer complications than deceased-donor transplants and, overall, a longer survival of the donor organ.

The risks associated with living-donor organ donation include both short- and long-term health risks of the surgical procedure, organ function, and psychological problems following organ donation. For the organ recipient, the risk of transplant surgery is usually low because it is a potentially lifesaving procedure. But donating an organ can expose a healthy person to the risk of and recovery from unnecessary major surgery. Immediate, surgery-related risks of organ donation include pain, infection, hernia, bleeding, blood clots, wound complications and, in rare cases, death.

Long-term follow-up information on living-organ donors is limited, and studies are ongoing. Overall, available data shows organ donors fare very well over the long term. Donating an organ may also cause mental health issues, such as symptoms of anxiety and depression. The donated organ may fail in the recipient and cause feelings of regret, anger or resentment in the donor.


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The known health risks associated with living-organ donation vary according to the type of donation. To minimize risks, you'll need to have extensive testing to ensure you're eligible to donate. Living-donor kidney transplant is the most widely studied type of living-organ donation with more than 50 years of follow-up information. Overall, studies show the life expectancy for those who have donated a kidney is the same as for similarly matched people who haven't.

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Some studies suggest living kidney donors may have a slightly higher risk of kidney failure in the future. But this risk is still smaller than the average risk of kidney failure in the general population. Specific long-term complications associated with living-kidney donation include high blood pressure, elevated protein levels in urine and reduced kidney function. The risks of living-liver donation also are low, but experience with this procedure is more limited because it was introduced into medical practice more recently than kidney donation.

The first living-donor liver transplant was performed in As with any surgical procedure, living-liver donation may involve surgical complications, such as infection, bleeding, blood clots and, in rare cases, death. Living-liver donation may also cause bile leakage, narrowing of the bile duct, intra-abdominal bleeding and, in rare cases, inadequate growth of the remaining part of the liver. Making the decision to donate an organ is a personal one that deserves careful thought and consideration of both the serious risks and benefits. Talk through your decision with your friends, family and other trusted advisers.

Your medical information is kept confidential by the transplant center.

If you are rejected as a donor during the evaluation process, the donor is told only that your organ was declined. It is up to you whether you tell the recipient if known the reason if you choose to do so. This advocate is often a social worker or counselor who can help you discuss your feelings, answer any questions you have and assist in protecting your best interests throughout the donation process. Your physician or your recipient's physician may recommend a transplant center for your procedure.

You're also free to select a transplant center on your own or choose a center from your insurance company's list of preferred providers. If you're committed to donating an organ, your transplant team will partner with you and your doctor throughout the living-donor transplantation process. If possible, bring a family member or friend with you for your evaluation. It may be helpful for you to discuss your decision to donate with a family member or friend. Living-organ donors are generally between the ages of 18 and 60 and in good physical and mental health.

Specific living-donor eligibility standards vary by organ and transplant center. Physical examination and psychological evaluation.

The Role of a Living Donor Advocate - UPMC On Topic

At the transplant center, a transplant team will evaluate your general physical and mental health to make sure that undergoing living-donor surgery will pose minimal risks to you. Doctors will perform tests to look for preexisting conditions that may disqualify you from being a donor, such as diabetes, cancer, some infectious diseases, heart diseases or other conditions. If you are participating in directed donation, different transplant team members will perform evaluations and surgeries for you and your recipient.

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Discussing living donation with family and friends

Your evaluation is confidential. Also, during the evaluation the team will check to ensure that the organ you're planning to donate is healthy and that removing either one of your kidneys or a portion of your liver is unlikely to cause health problems later in life. This may include laboratory and imaging tests.

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Consent and final review. If you meet eligibility requirements to be a living donor, the transplant center is required to inform you of all aspects and potential results of organ donation and receive your informed consent to the procedure. Transplant staff will discuss with you and your family the benefits and risks of donating a kidney or a portion of your liver and answer your questions. Staff will also discuss the importance of maintaining a healthy lifestyle before and after donating an organ. In a laparoscopic nephrectomy, the surgeon makes two or three small incisions close to the bellybutton and uses a special camera called a laparoscope to view the internal organs and guide the procedure.

The donor kidney is then removed and transplanted into the recipient. Most procedures to remove a living donor's kidney for a transplant are done through minimally invasive surgery laparoscopic nephrectomy. Laparoscopic nephrectomy involves less pain and a shorter recovery than traditional open surgery to remove a kidney open nephrectomy. In a laparoscopic nephrectomy, the surgeon makes two or three small incisions close to the bellybutton and uses a special camera called a laparoscope to view the internal organs and guide the surgeon through the procedure.

In some cases, donors may not qualify for minimally invasive surgery, and may need to have an open nephrectomy. This may be the case if you have had multiple abdominal surgeries or if you are significantly overweight. In open nephrectomy, a 5- to 7-inch incision is made on the side of the chest and upper abdomen.

The surgeon then uses a surgical instrument called a retractor to spread the ribs to access the donor's kidney. Both open and laparoscopic nephrectomy last about two to three hours, and are performed using general anesthesia, which means you'll be asleep during the entire surgery. Within the first week after living liver donor surgery, the donor's liver starts to grow back to its normal size. Standard liver volume returns within about two months after donation.

During living-liver donation, surgeons remove a portion of your liver through an incision in the abdomen.

Educating, Evaluating, and Selecting Living Kidney Donors

Either the left or right lobe of your liver may be used in donation, depending on the size of the recipient. The donor's liver begins to regrow almost immediately after surgery, reaching normal size and volume again within about two months after donation. Care after your surgery. If you live far from your transplant center, your doctors will recommend that you stay close to the center for a few days after you leave the hospital so that they can monitor your health and remaining organ function.

You'll likely need to return to your transplant center for follow-up care, tests and monitoring several times after your surgery. Transplant centers are required to submit follow-up data at six months, 12 months and 24 months after donation. Your local health care provider may conduct your laboratory tests one and two years after your kidney or liver surgery.

Return to normal activities. After donating a kidney, most people are able to return to normal daily activities after four to six weeks. The recovery process takes a little longer for liver donation, and most people are able to return to work and other normal activities two to three months after donation.

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