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Organ Donation and Transplantation - Kidney transplants from relatives and friends

 

Key Points

  • Kidney transplants from a family member are usually very successful

     

  • DGF/sleepy kidneys rates are less than 5%

  • Even close relatives may be unsuitable as donors, for medical reasons
  • Both the kidney donor and the kidney patient must have a positive attitude to living related transplantation before any operation takes place

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Living related transplants – what are they?

Although many people receive kidneys from people who have died (deceased donors), a third of transplants in the UK are now performed from living donors. Many renal units now have a Transplant Coordinator whose job is to organise living related transplants (LRTs).

A living related transplant is ‘better’ than a deceased donor transplant in that it is more likely to work. The best donor is an identical twin, as the tissue type is identical. Unfortunately, most people do not have an identical twin waiting to give them a kidney! However, a kidney from another relative/friend may be suitable.

If a kidney patient has a relative who is at least 18 years old, healthy, and willing to give them a kidney, they should speak to the Transplant Co-ordinator (or senior nurse or doctor) at their unit. The most suitable donor is usually a brother, sister, father, mother, son or daughter, but other more distant relatives and friends are sometimes suitable.

It is up to kidney patients to ask their relatives/friends to see if they are willing to donate a kidney. Doctors will not usually ask a patient’s relatives for them, but they will talk to anybody who is willing to donate a kidney.

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Someone on dialysis may not accept a kidney offer

Sometimes a relative is very keen to give a kidney, but the person on dialysis does not want to put their family member through the operation, or perhaps to feel under an obligation to them in the future. As many as 20% of living related transplants are ‘blocked’ in this way. If this happens, the person wanting to donate should not feel rejected – their relative on dialysis is being selfless, and wants to protect their family against harm. They may be putting their family’s interests higher than their own, which is to be particularly respected if dialysis is causing complications or hardship.

Refusing the offer of a transplant when you are on dialysis is one of the most generous things anyone can do. However, in making a decision to turn down a transplant, someone should realise that a donor ‘gains’ an awful lot from giving a kidney to a relative. People do want to be generous to others, particularly in their family. Giving a relative a transplant may take a burden of worry or care away from someone that quite outweighs the risk or pain of an operation.

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Tests before a transplant

To find out if a relative is a suitable donor, it will be necessary for them to have the some blood tests, including blood group, tissue type and virus tests. If they ‘pass’ this hurdle, they will then need to have further tests to check that their own kidneys are working perfectly. These include an ultrasound (a sound-wave picture) of the kidneys. The final test is usually an arteriogram (also called an angiogram) of the blood vessels of the kidneys. The angiogram is performed with a CT or MR scanner. This involves an injection into a vein in the arm, and them lying under a machine that takes the images.

Either of these types of scan are suitable, depending on the local preference.

LRTs can be arranged before a patient starts dialysis. The tests described above can be organised in less than three months. But both sides – patient/donor and renal unit – need to move quickly to do this. Both the patient and the donor must make a lot of time available to get all the tests done, even if it means taking time off work. Most centres discuss all these results in their MDT (multi-disciplinary meetings)attended by surgeons, nephrologist and radiologist. After the tests have been done, the donor and recipient are reviewed by someone on behalf of a Government body called the Human Tissue Authority (HTA). The assessor is independent of the transplant unit, and makes sure that the donor is not being coerced or paid to give the transplant, and also has been informed of the risks of kidney donation.

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Living unrelated transplants

t is not essential for a person who donates a kidney to be related to the patient. Kidneys may also be donated by someone close to the patient, such as a husband, wife, partner or good friend. This is called a living unrelated transplant.

Before a living unrelated transplant can take place, an assessment must be obtained from a government body called the HTA (Human Tissue Authority). An independent assessor will interview the donor and recipient separately and together to check that they know each other and that there is no coercion or payment involved in the donation.

Kidney patients and potential donors are both advised to think very carefully before going ahead with transplantation from any living person. They need to consider very carefully what the emotional consequences might be if the transplant is not successful.

Altruistic donors are live donor where a person donates their kidney for a transplant to a stranger.

 

 

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Living related AND UNRELATED transplants – risks to the donor

As human beings do not need two kidneys to be healthy, the donor is unlikely to come to any harm by losing a kidney.

This does not mean that there are no risks to the donor. One research study showed that there were the following risks to the donor:

  • a 1 in 25 chance of long-term (possibly permanent) pain in the side of the abdomen/chest (ie, the area through which the kidney is removed)
  • a 1 in 200 chance of developing kidney failure themselves.
  • a 1 in 3000 risk of dying after the operation

     

  • a 1 in 100 risk of converting to open surgery from key-hole surgery

  • a 1 in 20 risk of major complication
  • a 1 in 5 risk of minor complication

However, even if a kidney comes from a close relative, it is important that both the donor and the patient understand that the kidney is not guaranteed to work.

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Adapted by Rob Higgins, Renal Consultant, Walsgrave Hospital, Coventry, From ‘Kidney Failure Explained’ by Janet Wild and Andrew Stein, published by Class Publishing.


The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.

NKF Controlled Document No. 255: Kidney transplants from relatives and friends written: 01/05/2000 last reviewed: 23/09/2016