You can call (800) 749-7424 ext 5-0254 to make a referral to the kidney transplant program at the Shands Transplant Center at the University of Florida.

What are the advantages of living donation?

The average long-term success rates tend to be higher with living donation than with cadaveric donors. In living donation, transplant surgery can be scheduled at a time that is convenient for both the donor and the recipient. The last advantage is that, in most cases, the transplant is much sooner with live donor than waiting for a kidney from the cadaveric waiting list.

What are the disadvantages of living donation?

The disadvantage is that the live donor must be in good health and will have to have surgery to remove that kidney that will be transplanted. This requires a hospital stay of two to five days, depending on the type of operation that is done to remove the kidney. The surgery has a small risk for the donor, but donors can usually return to their normal lifestyles in several weeks without any more risk of illness than the general population.

How are the kidneys selected for transplantation?

The first step is to check for compatibility. That is the ability of recipient's body to accept the new kidney. The donor and recipient must have compatible blood types. When a blood type-compatible donor is available, a blood test called tissue typing is done. This test identifies the transplant antigens in your body. Antigens are markers on your cells that tell your immune system that they are yours.

Who can be a donor?

Family members may donate because they are likely to share the same antigens. Success of the kidney transplant is better with a kidney from a closely matched blood relative, although any compatible live donor may be considered.

What is meant by matching?

A blood sample is taken from the potential kidney donor and the patient (recipient) to determine their blood types. At the same time, a test called tissue typing is done that identifies the different HLA (transplant) antigens in your body. Antigens are markers on your cells that are specific to you. A live donor must have a compatible blood type with the recipient.

Who may be a live donor?
A mother, father, sister, brother, son, or daughter (18 years or older) may be considered to be a live donor. In some situations, extended family members and non-related significant others may also be considered to be live donors. You must be emotionally and physically healthy to be a living donor. Any major medical or psychological problems will disqualify living donors. This includes persons who have a history of high blood pressure, cancer, urinary tract infection, diabetes, kidney stones, alcoholism, drug abuse or positive blood test for hepatitis or AIDS.

Who pays for the evaluation and hospitalization?
The evaluation and surgery are paid for by a variety of methods, including managed care, commercial insurance and Renal Medicare. A financial counselor will confirm insurance coverage before you are scheduled for evaluation. In most cases, all charges are billed to the kidney recipient's insurance. However, individual insurance policies may vary. If you receive any bills related to the donor testing, contact your coordinator.

What does donor evaluation involve?
To be considered as a donor, we must make sure that you are in good physical and mental health. If you live far away from Gainesville, Fla., it may be possible to arrange for your evaluation and follow-up care to be done in your local area. The surgery, however, must be done here at Shands at the University of Florida. Your coordinator will discuss this with you.

The donor evaluation consists of:

Tests
UF physicians perform a complete a medical and psychological evaluation on the living donor candidate. These tests may be done at Shands at UF or in your local area.

A renal ultrasound shows the size, shape and location of your kidneys by using sound waves. The technician will apply special jelly to your abdomen and moves a wand around over the jelly to generate pictures from the sound waves. There is no pain or discomfort from this test, and it takes about an hour to compete.

Several blood tests must be done to check your blood count, blood chemistry and immune system. You will also be tested for HIV (the AIDS virus) and hepatitis.

Fasting blood sugar is measured through the blood tests. Remember that you cannot eat or drink anything from midnight until after this test is completed the next morning. This includes gum, breath mints, coffee, juice, etc.

A chest X-ray is a picture of your heart and lungs. It is required before your surgery since you will receive general anesthesia.

An electrocardiogram (EKG) measures the electrical activity in your heart. An EKG can show if you have any abnormal heart beats or heart problems.

Three urine tests must be completed in the evaluation. For the first test, you will collect a 24-hour urine sample and bring it with you to your evaluation An instruction sheet will be enclosed in your evaluation packet. This test will check to see how well your kidneys work at getting rid of waste products. On the day of your evaluation, two more urine samples will be taken. A urinalysis is a general exam of your urine's appearance and chemistry. The other test is a urine culture to check for infection. For females, the clinic nurse will collect this sample by placing a small, rubber tube in the bladder for a few minutes to allow urine to drain into a sterile jar.

A Renal CT scan uses X-rays and a computer to get a three-dimensional view of your kidneys to look for anything abnormal. It will take about an hour. If you allergic to iodine or shellfish, you must contact your coordinator at least one week before your evaluation. The technician will start an IV to administer dye during the scan. When the dye is injected, you may experience flushing, a metallic taste, headache or a burning at the IV site. You must stay still during the scan because motion will change the picture. After the test, you will be watched for signs of an allergic reaction to the dye. If you have any flushing, nausea, itching or sneezing, tell a staff member immediately.

A renal arteriogram may be ordered if the CT scan cannot be done or does not provide enough information. It permits the doctor to see arteries and veins of your kidney. This is another X-ray that uses dye. An area in the region of your upper thigh will be numbed. Then a doctor will place a small, plastic catheter into one of your arteries to instill the dye. You might have a warm, flushed feeling when the dye is injected. You will be given medication during the test to help you relax. After the X-ray pictures are taken, the catheter will be removed and pressure will be applied to the site for about 15 minutes to prevent bleeding. You must keep your leg straight for 6-8 hours, and a nurse will check your blood pressure and pulse frequently during that time. You will not be allowed to drive yourself home after the arteriogram, and you will be told to avoid long walks or drives and to "take it easy" for the first 24 hours after the test.

A physical exam records your height, weight, temperature, pulse and blood pressure. You will be seen by a surgeon who will ask about your past and present health, examine you and explain further about kidney donor surgery.

Psychological testing is done to make sure that you are in good mental health and that you understand that kidney donation is done from true commitment and without any guarantees. There are no guarantees on how long or how well the donated kidney will function or what your course of recovery will be like after donating a kidney. Both the donor and the recipient must understand this and be able to deal with anything that happens.

When will I know the results of the evaluation?
Two or three weeks after your evaluation, all of your test results will be presented before the Transplant Committee. The committee is made up of your coordinator, UF physicians and other staff who help in the care of both kidney donors and recipients. After the Transplant Committee meets and makes its decision, your coordinator will contact you and discuss the results of all your tests.

What happens after a donor is accepted?
After you have completed the donor evaluation and have been accepted as a kidney donor, we will notify you and schedule a date for the surgery. Because you will be admitted to the hospital after your surgery is done, you will be seen the day before the surgery in the anesthesia and urology clinics to have your final testing done. The surgeon will examine you again, explain the procedure, and get your permission to do the surgery. An anesthesiologist from the surgical team will get your permission to give you anesthesia during the surgery and talk to you about what kind of pain control is available for you after surgery. You will have a urine sample checked and blood drawn in the lab. You may need to have a chest X-ray and an EKG if it has been several months since your evaluation. You will get specific written instructions about checking in when your surgery date is scheduled.

What will happen the day of the surgery?
On the day of surgery, you will report to Ambulatory Surgery Waiting Area at the scheduled time. You will be admitted to a room after your surgery. In most cases, you will be taken to the Pre-Operative Holding Area from the Ambulatory Surgery Waiting Area. If you have family or friends who would like to visit before you go to the operating room, they should meet you in the Ambulatory Surgery Waiting Area.

The actual surgery will last between three to six hours. Your family can wait in the surgery waiting room and the surgeon will notify them when you are out of surgery. You will be in the recovery room for two to three hours of observation after surgery.

When you are ready, you will be taken to a hospital room. Your family will be able to visit you after you are in your room, but we suggest that only your immediate family visit for short periods of time for the first 24 hours. You will tire easily and you need to rest to heal.

What does the surgery involve?
There are two types of surgery to remove a kidney. One is a laparoscopic procedure and the other is called open surgery. The surgeon will describe both types of surgery to you. The type of operation that is done will be based on the result of your tests.

The laparoscopic procedure involves using special tools that are put into the abdomen and a special video camera. You will have two or three small holes in your abdomen and a three-inch incision above your navel.

The advantages of this type of surgery include:

• Less post-operative pain
• Shorter hospital stay
• shorter recovery time
• Better cosmetic results

In the open procedure you will have an incision on either your left or right side. Your doctor will decide which kidney to remove based on your test results. One of your ribs may have to be removed during the surgery in order to get to the area of the kidney. The removal of this rib will not make you feel any differently after the surgery.

With either procedure, there are some risks associated with the surgery and a small chance that you may have complications. The most common risks are (but are not limited to) infection and bleeding. There is a small chance that you will need a blood transfusion. If you do receive blood, there is a very small risk of getting hepatitis or HIV.

Any blood that is given to you is tested to decrease the chances of this happening. If you are interested in storing your own blood in case you need a transfusion, contact your coordinator at least one month before the surgery date to get instructions. There is also a small chance of injury to the nearby organs, pneumonia, stroke, blood clots in the legs or lungs or a collapsed lung.

It is possible that when you wake up from the anesthesia, you will have a small tube in your chest to help re-inflate your lung. If this tube is needed, it will be removed before you leave the hospital.

There is a small (less than 1 percent) chance that you could have a major complication, either during your surgery or in the recovery period, that could be life-threatening. Although these are the risks associated with any major surgery, you must weigh these risks against the reasons that you are donating your kidney.

What can I expect after surgery?
For the first day or two, you will have:

• Foley catheter to drain urine from your bladder
• IV lines with pumps to provide fluid and medications
• Support stockings (TED hose) to help prevent blood clots in your legs
• Dressing over the incision site

You may also have a small tube in your back (an epidural catheter) and a pump if you have chosen that method of pain control. You will be encouraged to cough and use an incentive spirometer to help fully inflate your lungs. This will help prevent pneumonia and clear your lungs from the anesthesia.

You may have some pain or discomfort when you cough or move. The nurses will show you how to "splint" your incision site to decrease discomfort. You may also be given pain medication to keep discomfort to a minimum so that you can move about and walk in the hallway.

The most important thing after surgery is to get up and start moving as soon as possible. The sooner that you are up and about, the faster your recovery will be and there will be less of a chance for complications. The dressing over your incision will be removed in one to two days and allowed to shower with your doctor's permission.

You will not be allowed to eat until your bowels "wake up" after surgery. This will be decided by when you start feeling your stomach "growl" and you start to pass gas. When you do get food, eat slowly. If you feel nauseated or bloated, stop eating and tell the staff. The final goal for letting you go home will be when you are moving around well and after you have had a bowel movement. Usually this is accomplished one to two days after laparoscopic surgery and four to five days after open surgery.

What happens after I go home?
After you go home from the hospital, you will be expected to relax and give yourself time to heal. You will be seen in our clinic about two weeks after surgery for an exam to make sure everything is going well and that your body is adjusting to one kidney. You can't drive a car or lift anything heavier than 10 pounds for three to four weeks. If you have had the open surgery, this may take a little longer to fully recover. You will be seen in the clinic again about six weeks after surgery. That is the time to ask your doctor about when you can resume driving and return to work.

What long-range expectations can a donor have?
After a person donates a kidney, his or her life expectancy does not change. Donors return to their same lifestyles. In most cases, the donor's insurance coverage does not change after the surgery. A donor is not at any greater risk than anyone else for illness or accidents. However, we do recommend that living kidney donors see their local doctor one a year for a checkup.

Statistics
Success rate and various other statistics regarding the Shands Transplant Center at UF are available from the Scientific Registry of Transplant Recipients at ustransplant.org.

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Make an Appointment

To make an appointment or find out more information about transplant services offered at Shands at the University of Florida, please call 352.265.8000 or toll-free 1.800.749.7424

You may also email our Consultation Center (consult@shands.ufl.edu) or use our secure online form.