If you have attended a Transplant Companions workshop recently, you can refer to the Patient Workbook which you received at the workshop. It contains a wealth of information on all aspects of kidney transplantation. You should also feel free to ask your transplant team any questions you may have, as they will want to ensure that you are as informed as possible about the procedure.

If you know someone who needs a kidney, you may have thought about becoming a living donor. It can be an incredibly rewarding experience for both you and the recipient, but it's important that you fully understand the transplant process and that you look at your own individual circumstances so that you can make a fully informed decision. Your decision to donate a kidney (or not to) must be a completely voluntary act. You should not feel pressured or obligated to donate, and you have the right to change your mind at any time during the process.

Potential donors should be physically fit and generally as healthy as possible and free from high blood pressure, diabetes, cancer, kidney disease and heart disease. A potential living donor should also be emotionally and psychologically prepared for the donor evaluation process, the surgery and the recovery period. There are also financial considerations, such as costs for travel and accommodation, taking time off work or school for tests before the surgery to remove your kidney, and time off for a recovery period after the operation takes place.

Currently, many transplant centres will not consider an anonymous donor. There must be an established emotional relationship between the donor and the recipient. Kidneys from living donors usually come from immediate family members.

Living related donors can be:

• Siblings
• Parents
• Aunts and uncles
• Children over 18 years old
• Cousins

Living unrelated donors can also be a suitable match and include:

• Spouses
• Close friends
• In-laws
• Co-workers

It is against the law to buy or sell organs in Canada.

If a living donor wishes to donate a kidney, tests will be done to make sure the donor is both healthy and a suitable match. The potential donor must be in very good health and not suffer from major health problems. The following conditions may prevent donation:

• Diabetes
• Most types of cancers
• High blood pressure

Potential donors should contact the living donor coordinator at the transplant centre to discuss any questions or concerns.

Someone might not be able to be a donor if they also suffer from:

• Heart disease
• Hepatitis
• Crohn's disease
• Blood or protein in the urine
• Recurrent kidney stones
• Significant obesity
• Untreated mental illness
• Mental disability

More details on donor restrictions can be obtained from the transplant team.

You will undergo an extensive evaluation process to ensure that you are as compatible as possible with your recipient. Some of the tests you will undergo include:

Blood typing

Your blood type must be verified in writing. If you have a copy of a lab report showing your blood type, it can be sent to the donor coordinator at the transplant centre. If you don't know your blood type or don't have a written copy of it, a blood test can be done by your family doctor or arrangements to have the test done can be made with the donor coordinator. If your blood type is not compatible with that of your recipient, options such as paired exchange or special desensitization protocols might be possible at certain transplant centres.

Tissue typing

A blood test called "tissue typing" is performed on both the donor and recipient to determine how many tissue antigens - the substance which stimulates the production of antibodies - are shared. Matching is not as important as it used to be. Even living donors who share no antigens with a recipient can still be suitable donors.

Cross-match

The most important blood test involves testing how the recipient reacts to the donor's blood cells. A sample of blood from the donor is mixed with a sample of the recipient's blood. The recipient's blood must not react to the donor's blood. This test, called the cross-match, predicts how the recipient will react to the donor kidney. A negative cross-match means there is no reaction to the donor blood cells. In some transplant centres, special protocols exist which allow a recipient to proceed with a transplant from a donor even with a positive cross-match.

The list of tests may vary, so be sure to check with your transplant centre.

Blood tests:

In addition to the blood tests mentioned earlier, you will undergo a viral screen, where blood samples are screened for hepatitis, HIV, West Nile and other viruses that may harm the recipient.

Diagnostic Tests:

1. Chest x-ray
2. Abdominal ultrasound
3. Electrocardiogram
4. Blood pressure monitoring
5. Urine tests
6. CAT Scan or angiogram
7. Other tests may be added as needed (check with your transplant centre)

Psychiatric and/or psychological evaluation:

Both you and the recipient may undergo a psychiatric and/or psychological evaluation to determine whether you are mentally and emotionally prepared to proceed with the transplant process.

The screening tests may take a number of months to complete and involve travel to the transplant centre for 2 to 4 visits. Some of the tests may be able to be done locally through your family doctor and the results forwarded to the transplant centre. The transplant team can provide more information.

The surgery to remove the kidney generally takes about 2 to 3 hours. Donor kidneys can be removed using several techniques: traditional "open flank" surgery, open flank surgery with a small incision, or laparoscopic (minimally invasive or "keyhole") surgery. Your transplant team can give you more details on the type of surgery you would undergo at your centre.

Whether your surgeon plans to remove your kidney using an open flank incision or the laparoscopic approach, complications of kidney removal surgery can include and may not be limited to the following:

• Pain
• Infection of the wound
• Bleeding
• Blood clots
• Pneumonia
• Side effects or allergic reactions due to the anaesthetic
• Other potential complications

There can also be long-term complications to consider. Living donors may experience increased blood pressure, kidney failure or protein in the urine. You should discuss potential risks with the donor coordinator at your transplant centre.

You may be off work for an average of 4 to 6 weeks after surgery. The recovery time for laparoscopic and flank surgery with a small incision is generally 2 to 6 weeks. The traditional flank surgery requires a bit more time to recover, ranging from 4 to 10 weeks. Each person is unique in how quickly they recover from surgery. The type of employment you have may determine how quickly you are able to return to work. If you do physically demanding work, you will need to allow a longer period of time before returning to your job. The donor coordinator at your transplant centre can give you more information on potential recovery times.

The office coordinating the transplant will arrange follow-up appointments for you with the nephrologist (kidney specialist), nurse co-ordinator, social worker and surgeon. Your records will be sent to your family physician for ongoing follow-up. Some transplant centres may continue to follow you on an annual basis or as needed. Check with the donor coordinator at your transplant centre for more information.

Your medical costs will be covered by your provincial or territorial health plan, however, in most provinces travel, accommodation, meals and out-of-pocket expenses will not be covered. Governments are beginning to understand that living donors should not have to bear a financial burden in order to donate an organ for transplant and that donors need financial help to cover their expenses. The provinces of British Columbia and Manitoba, in partnership with the Kidney Foundation of Canada, will now reimburse living donors for pre-approved expenses related to the donation of a kidney to a resident of the respective provinces. The Ontario Ministry of Health and Long Term Care, through the Trillium Gift of Life Network, has established a similar fund with the potential to have the reimbursements retroactive to August 3, 2007, on a case-by-case basis.

Other provinces may also be evaluating the issue of financial support for living donors, so ask your donor co-ordinator for the latest information on available programs in your province or territory.

A friend or family member from another country may be considered as a potential kidney donor. Anonymous donors are currently not accepted by most transplant centres. Preliminary testing can be done in the potential kidney donor's country of origin. This information has to be reviewed and cleared by the living donor team before the potential donor can apply for a visa.

The country in which the potential donor resides may not provide coverage for these tests, in which case the costs must be assumed. Once the potential donor arrives in Canada, the remaining tests, hospital stay and surgery are covered by the provincial transplant program or health plan of the province in which the recipient lives. (Source: Kidney Foundation of Canada website)

The cost of the potential kidney donor's flight or other means of transportation is not covered. It is also recommended that the donor take out travel insurance to cover any potential accident or injury not related to the transplant surgery.

Many countries require a visa for travel to Canada. The transplant centre could provide a letter to support the donor's visa application. Potential donors should speak to the donor coordinator at the recipient's transplant centre for more details.

Living donors do not receive any financial or other compensation for donating one of their kidneys. It should also be noted that the purchase or sale of human organs is illegal in Canada.

Some transplant centres in the United States and Canada have started a new program for living donor transplants called paired exchange. If a potential donor has been found unsuitable because their blood type is not compatible with that of the recipient, then this new program could represent another option.

Paired exchange involves two separate, willing donors who are each unable to donate to their intended recipients due to blood group (ABO) incompatibility. In this program, a willing donor (Donor A) would donate their kidney to another blood-group-compatible recipient (Recipient B) in exchange for that recipient's donor (Donor B) donating a kidney to their recipient (Recipient A).

Most common donor/recipient exchange:

Donor ARecipent A
Donor BRecipent B

Paired exchange:

Donor ARecipent B
Donor BRecipent A

An anonymous kidney donor does not know the eventual recipient. Some donors wish to donate a kidney to someone on the transplant list in need of a living donor. Some programs have begun accepting anonymous (sometimes called altruistic) donors, but there are many legal, ethical and practical issues to be considered and only a few transplant centres will consider anonymous donors.

The donation of a kidney is a precious gift of life. Discuss organ donation with your friends and family. If you, or someone you know is, considering the donation of a kidney, attend a Transplant Companions workshop or contact your local branch of the Kidney Foundation of Canada for additional information and resources to help you make an informed decision.

(Source: Transplant Companions Program: Your Companion Workbook, 2008)