Bringing together altruistic donors and patients in need

Although more than 70,000 people in the United States are on waiting lists for a kidney transplant, only 4252 cadaveric donor and 3750 living donor transplants were performed nationally in the first 7 months of 2006. To help ease a growing shortage of organs, UAB has established the Nontraditional Kidney Donation Program. Individuals desiring to donate a kidney to an unrelated or unknown recipient at UAB now can be evaluated, and, if they are suitable donors, participate in the program.

UAB transplant surgeon Carlton J. Young, MD, says, “There are almost 2500 people on UAB’s waiting list for kidney transplants; however, because of a nationwide donor shortage, only 129 kidneys were transplanted from deceased donors in Alabama, while living donors donated another 176 kidneys in 2005. With local prevalence of diabetes and hypertension leading to high renal failure rates, we do not have enough cadaveric and living donors to keep pace with demand,” he says. “Using donor kidneys offered by altruistic individuals with no genetic or personal relationship to the recipient can help fill the need for organs.”

An article in the American Journal of Transplantation (2004;4[7]:1110-1116) on nondirected kidney donors at the University of Minnesota transplant center notes these individuals have a history of performing humanitarian acts, a desire to give back to society, a religious motivation, and an emotional response to organ shortages. Postprocedure feedback from donors reported they were grateful for the opportunity and experience and had a feeling of fulfillment without regrets.

Rigorous evaluation begins with a telephone interview to determine candidates’ overall health. The interviewer also educates donors about risks, defines their responsibilities, and informs them about all aspects of the process. “People with hypertension, diabetes, heart disease, or any major illness are eliminated,” Young says. After donor candidates meet preliminary criteria, arrangements are made for blood testing.

The medical evaluation begins with a physical examination, a neuropsychologic assessment, and a meeting with social services. “Candidates who do not pass the neuropsychologic assessment or have unethical donation motives are not permitted to donate,” he says.

After passing initial screening requirements, candidates are admitted to the hospital for 2 to 3 days so the transplant team can complete evaluation and testing. Laboratory testing and procedures include urinalysis, renal scan, helical computed tomography scan, chest X-ray, electrocardiogram, and exams by a urologist, nephrologist, and transplant surgeon. The team can then determine if the candidate is a suitable donor.

Kidneys are removed laparoscopically. Patients typically recover from this minimally invasive approach after 2 to 6 weeks. As with any major operation, there is a small risk of infection, although the procedure should not affect long-term health and physical capacity. All costs associated with donor evaluation, surgery, and follow-up are paid by the recipient’s insurer.

“Nontraditional donor kidneys benefit recipients on UAB’s waiting list,” Young says. “Adults aged 18 to 65 years who are medically and psychologically fit and who have altruistic motives have an opportunity to explore kidney donation as an option to help address the critical need for more kidneys.”

For more information
Dr. Carlton Young
1.800.UAB.MIST
mist@uabmc.edu