There are two different types of kidney transplant:
Deceased donor transplant: using a kidney from someone who has died and donated his or her organs.
Living donor transplant: using a kidney donated by a living person. This is usually a relative, partner or friend, but occasionally is someone unknown to the recipient.
Are all deceased donors the same?
No. Just like everything in life, donors can vary in age, size, gender, medical problems and how the kidney was retrieved.
The doctors should be able to tell you some information about your donor and whether there are any potential issues with the kidney you are being offered.
There are two main types of deceased donors — Donors after Brain Death (DBD) and Donors after Circulatory Death (DCD). Up to one third of transplants at the Royal Free Hospital are carried out using DCD kidneys.
Donor patients classified as DBD have had a significant injury to their brain (usually due to a stroke) and tests have shown that their basic brain-stem functions (for example their ability to maintain spontaneous breathing) are not functioning.
There are strict neurological criteria to define brain-death. The patient cannot survive without a machine to help them breathe and they have lost all sensation.
The organs are retrieved while the heart is still beating (which is why they were previously known as ‘heart beating donors’) and the organs are well flushed through with storage solution during the surgery to clear them of blood.
Donor patients classified as DCD (previously known as ‘non-heart beating donors’) are patients who have either had a significant injury to their brain or heart or lungs; retrieval of organs is performed once death is diagnosed and confirmed using cardio-respiratory criteria.
Most DCD donation in the UK is controlled, ie it takes place after planned withdrawal of life-sustaining treatments that have been considered to be of no overall benefit to a critically ill patient in the intensive care unit or emergency department.
The organs are retrieved after the heart has stopped beating (‘asystole’) and the organs are flushed through with storage solution.
In the long term, there is no difference in the function or survival of the kidneys from DBD or DCD, but the kidneys from DCD often take longer to start working (which means you may be in hospital longer), during which time you may require sessions of dialysis to maintain some kidney function.
All types of donors may be variable in their suitability to you and the doctors will discuss any issues about the donor.
Access to both types of donors will increase the chances of you having a transplant and your doctor can discuss the potential benefits with you.
Receiving a kidney from someone you know (living donor) is the best and most reliable way to receive a kidney transplant.
There are many potential benefits of a live donor kidney transplant. These include better long-term outcomes and having a kidney transplant at the right time for you.
If someone offers to give you a kidney, please contact the live donor nurses on 020 7317 7604. You have to be suitable to receive a kidney.
Anybody you know can give you a kidney. The donor does not have to be a relative, but you have to prove that you know the person giving you a kidney.
Once a live donor has been deemed medically and clinically suitable to donate by their medical practitioner, the donor will be required to attend an independent assessment.
An independent assessment is an interview which is carried out by an independent assessor who is trained and accredited by the Human Tissue Authority.
The purpose of the interview is to ensure donors are not forced to do something against their wishes, that no reward has been sought or offered and that the donor has the capacity to make an informed decision.
It is a criminal offence to carry out a transplant operation between two living people if the conditions of the Human Tissue Act are not met. This means valid consent must have been given. It is also an offence to be involved in the buying or selling of human organs.
All donors are asked to provide a signed declaration confirming there is no reward associated with the organ donation and transplantation.
All donors will have to go through a thorough screening process to make sure they are fit enough to give a kidney.
We would not take a kidney from anyone with diabetes, high blood pressure on more than one tablet or anyone with serious heart or kidney problems.
A serious medical condition or previous cancer would usually rule a person out from being a donor.
Before a kidney is removed from the donor, we check very carefully the donor is fit enough to give a kidney and that they have sufficient kidney function to be left with one kidney.
We do not allow donors to give a kidney if they do not pass these tests.
There are long-term studies of patients who have given kidneys to other people or patients who have had a kidney removed for other reasons. These people manage well with a single kidney and giving a kidney does not increase their risk of having kidney failure themselves.
Large studies have been performed on people who have given one kidney to someone else. There does not appear to be any significant risk of serious problems from having donated a kidney.
There is a slight increased risk of raised blood pressure and protein in the urine after donation. Therefore, there does not seem to be any serious long-term problems from donating a kidney, but we monitor all donors in the long term to make sure they remain healthy.
This depends on the individual’s employer. They are not obliged to pay the donor sick pay while they are off work. Most employers are understanding, so it is not usually a problem.
If the employer will not pay, we can claim for lost earnings up to £5,000 from the health authority, but the donor has to be able to prove they have lost money while donating.
The claim must be submitted before the transplant operation and the live donor nurses can help direct you to the correct person to make the claim.
No. The donor has to give you the kidney without any condition attached, and it is illegal to pay your donor for their kidney or provide any incentive for them to donate.
Your donor needs to be matched with you to make sure they are a suitable donor.
The live donor nurses will arrange an appointment for you and any potential donors to come to the Royal Free Hospital for blood tests for blood type and tissue matching.
We can consider donors from outside the UK (or far away inside the UK) by asking them to courier their blood to us for matching. Please ask the live donor nurses for details and a posting pack.
If the donor is a suitable match to you, we will ask them to provide some basic medical details and have blood tests and an examination by a doctor in the country where they live.
If these tests are all satisfactory, we can write to the home office for a visa to allow your donor to come to the UK for a further assessment at the Royal Free Hospital prior to donating a kidney.
You will have to look after your donor while they are in the UK and provide their travel expenses and accommodation.
A donor with the same or compatible blood group is likely to be your best option for a transplant, but if you do not have a donor with a compatible blood group, we can consider a blood group incompatible transplant.
You will have to have suitably low levels of antibodies to your donor’s blood group and be strong enough to manage the extra treatment and immunosuppression involved. Your doctor or the live donor nurses can discuss this option with you.
Not all donors are compatible with their potential recipient and not everyone wants to have a blood group incompatible transplant.
In this case, you can consider the national paired exchange programme. This is a national scheme where kidney patients with incompatible donors can be matched with other incompatible donors and recipient pairs.
The matching happens four times a year and if you get a match, your donor will be asked to give a kidney to someone else and you will receive a kidney from a suitably matched donor.
The operations all take place at the same time and your donor will still donate their kidney at the Royal Free Hospital.
Please ask the live donor nurses about paired exchange if your donor is not compatible with you.
We would not advise having a kidney transplant abroad.
Although some patients have received a kidney transplant from abroad, the overall risk of complications and rejection is higher, and the life span of the kidney is often less.
In our experience, the risk of infection after the transplant is higher, with half the patients developing a resistant infection and a quarter developing hepatitis from their overseas donor.
Why might I be offered two kidneys?
There is a limited supply of kidneys for transplantation and there are not enough kidneys for everyone on the waiting list.
We try to utilise all offers of deceased-donor kidneys, even from donors who may have had medical problems themselves, to maximise the number of patients who can have a transplant.
Occasionally, we are offered kidneys from a DCD or DBD donor where one kidney would not provide enough kidney function for a patient.
In this case, we may offer the kidneys to you as a ‘dual transplant’ and both kidneys would be transplanted to you.
This would mean a bigger operation, but may provide you with a transplant you might not otherwise receive and overall better kidney function.
All donors are thoroughly screened for cancer and infection (particularly hepatitis and HIV) to reduce any risk to you following transplantation.
Although we cannot guarantee the screening 100%, it is very rare for the screening to miss any potential problems.
If there are any potential risks to you from the donor, the doctors will discuss this with you and ask whether you want to receive the kidney.
Only patients with hepatitis will be offered kidneys from donors with active hepatitis.
If you would like to know more about donors, speak to the pre-transplant nurse on 0207 794 0500 ext 34084.