Renal Living Donor Transplantation

The Leeds Teaching Hospitals strive to ensure that all living donors receive streamlined, flexible and individually-tailored care intended to provide the best possible outcomes, and that all results are reviewed with a multidisciplinary team approach.

All our information about live donation can be accessed through our website:

Once you have read the information on our website, if you would like to pursue live renal donation please call the live donor team on 0113 206 6601. A donor health questionnaire will be issued via email or post following a screening telephone call.

Stage One

Once you have completed your donor health questionnaire a live donor co-ordinator will contact you to arrange for you to come for initial tests.

Our initial visit clinic runs on a Thursday and consists of a whole day of investigations. A video will be sent to you to watch before you attend this clinic. It will detail the live donor process, investigations and risks involved in being a live donor. On the afternoon of your initial visit clinic appointment you will meet with a kidney doctor who will take your full medical history and will medically examine you and answer any questions you may have.

Your initial visit will consist of

• Routine blood tests to check your general health status (kidney function, liver function, full blood count, clotting, inflammatory markers, glucose)
• Virology blood tests (HIV, Hepatitis B and C, Syphilis, Ebstein-Barr virus, Cytomegalo virus)
• Blood group check:

• Urinalysis – urine tests
• Chest x-ray
• ECG
• We will discuss your donor health questionnaire
• Tissue typing if appropriate (this is a blood test to check compatibility with the recipient)
• GFR test – this is the best test to measure your level of kidney function

Blood group incompatible

On testing of your blood group we may establish that you and your intended recipient’s blood groups do not match (see table above).

Within the live donor programme at Leeds Teaching Hospitals we do have a blood group incompatible transplant programme; this is based on each individual couple and requires further blood testing.

Tissue Type Incompatible

We may also find on testing of your tissue type that you and your intended recipient are tissue type incompatible. We do also have a transplant programme for live donors who are not a tissue match, this is based on each individual couple and your co-ordinator and consultant would discuss this with you in detail if this is the case.

UK Living Kidney Sharing Scheme (UKLKSS)

If you and your intended recipient are not able to donate directly because of blood group or tissue matching, there is a national kidney sharing programme, sometimes called the paired exchange. Your co-ordinator can give you some information about this scheme.

Donor Health Assessment with your GP practice

Please make sure that you are up to date with your national screening this will assist us with your live donor work up process.

• Cervical screening for those applicable aged:
  – 25 – 49 years every 3 years
  – 50 – 64 years every 5 years
  – 65 years plus need to be screened only if no screening performed since the age of 50 years or if abnormal screening
• Bowel screening (People aged 60 – 69 years every 2 years)
• Breast screening for those applicable age 50 – 70 years every 3 years
• Testicular examination

Based on the results of the discussed tests, your age and medical history, additional cardiac investigations may be required these will be explained to you by your live donor co-ordinator.

A referral to the renal psychology team may be required if there is a history of depression or psychological medical history. All altruistic donors will be referred to the psychology team.

If there are any abnormalities from your tests taken at initial visit clinic you will be asked to come in for further testing or consultations before proceeding to the next stage.

Stage Two

If there are no contraindications for you to proceed, the next stage of testing will be requested, these tests are:

• MRA – Magnetic Resonance Angiography to look at the kidneys and the blood vessels
• DMSA – This looks at the split function of your kidneys ie: are they working equally?

Once these tests are complete your case will be presented at the MDT (multi-disciplinary team) meeting to determine whether you are suitable to donate one of your kidneys.

If you are suitable to donate then the next stage is to attend an appointment to meet with a surgeon who will discuss the surgery and counsel you about the risks associated with kidney donation.

You are required by law to meet with an Independent Assessor – this is someone completely separate to the transplant service and therefore not biased in order to gain approval from the HTA (Human Tissue Authority).

You must be able to prove the relationship between you and your intended recipient for direct donation.

The Operation

The surgery is performed using a laparoscopic (keyhole) technique. The actual operation usually takes approximately 2 hours, but you are likely to be off the ward area for approximately 5 hours (this includes recovery time).

The average length of stay in hospital following a live donor nephrectomy is approximately one day. You will have three small cuts on your abdomen and one slightly longer cut just above the groin where your kidney will be removed. These cuts will be closed with dissolvable stitches.

You will be closely followed-up by the live donor team following your discharge home and you will receive an appointment to see the Consultant Surgeon who performed your surgery approximately 6 – 8 weeks following your donation to check you have recovered and your wound is healing well.

You will then be reviewed at 6 months following your donation by the live donor team who will perform a basic health check to monitor your on-going kidney health and then annually thereafter.

Risks

We know that living kidney donation is the ‘gold standard’ treatment for an individual with kidney failure, however the down side of living donation is the risk taken by the donor which is discussed in detail on our video ‘Live Renal Donor – Risk Discussion’ which can be viewed on our website:

Patient Information Videos – Leeds Teaching Hospitals NHS Trust

General Health Guidelines for Living Donation at LTHT

The following are generally-accepted requirements for living kidney donation:

• Good general health
• Normal kidney function
• Age 18 to 75 years (exceptions are made for the upper age limit)

Conditions that may exclude a person from becoming a
living donor:

• Hypertension (high blood pressure) requiring multiple medications
• Kidney disease
• Obesity (BMI > 30)
• Certain infectious diseases, such as hepatitis
• Most forms of cancer
• Some forms of heart disease
• On-going drug abuse
• Some forms of psychiatric problems
• Kidney stones

All of the above information can be discussed in detail when you meet the live donor transplant co-ordinators, the kidney doctors and the transplant surgeons.

Please feel free to ask questions at any time during your live donor work up process.

Social Media Appeals

If you see an appeal on social media and want to be tested to see if you can help, there is a separate email address you can contact directly with your enquiry which is:

[email protected]

this will then provide you with further information and what to do next.

Useful websites

• Leeds Teaching Hospitals
  https://www.leedsth.nhs.uk/services/kidney-renal-transplantation/
• Kidney Research UK
  https://www.kidneyresearchuk.org/health-information/living-donor-transplantation
• Give a Kidney
  http://www.giveakidney.org/the-donor-operation-before-during-and-after/
• Make Your Mark – Robert Dangoor Partnership
  https://www.donateakidney.co.uk/