The gift of life – the journey of an organ donor

Choosing to be an organ donor can be more than checking the box on your driver’s license. Traditionally, organs used for transplant come from a deceased donor. But with advances in surgical capabilities, it’s a choice you can make now – and it can provide the gift of life to a recipient who may be waiting a long time for a match.

You may have a loved one in need of a transplant or you may want to give an organ to any matching recipient in need, which is becoming increasingly more common. If you do decide to be a living donor, you are able to donate one of your kidneys or a portion of your liver.

“Last year, out of the 36,000 transplants done throughout the country, 21,000 of them were kidney transplants,” said Dr. Richard Migliori, retired chief medical officer, executive vice president, UnitedHealth Group. “And of those, 6,000 were transplants from a live donor.”

Yet, there are more than 113,000 people currently waiting for a transplant. Even with roughly 170 million people registered as a donor, an average of 18 patients die each day waiting for a transplant.

Living donors are preferred for two reasons. First, organs coming from a living donor don’t spend any time in storage, which eliminates the chance for any delayed function. Secondly, the recipient is able to schedule their procedure and may be able to spend less time on dialysis or avoid it completely.

“Someone who goes through dialysis only has about a 40 percent chance of being alive after five years,” Dr. Migliori said. “The data shows people who go right to transplantation, or are only on dialysis for a short period of time do better after transplant.”

A living donor kidney transplant performed before initiation of dialysis (pre-emptively), will last on average 15-20 years, whereas a deceased donor kidney transplant, after dialysis has started, typically lasts 7-10 years.

If you are considering becoming a living donor, the typical journey is as follows:

• The donor must be evaluated as a fit donor. “Organ donation is only appropriate when three things are happening. Number one is that the individual is healthy and is predicted to stay healthy after donation. Second, the individual has to be clearly willing to voluntarily donate. And the final piece is that the individual themselves is of sound mind and body,” Dr. Migliori said.
• After the evaluation from the psychologist or psychiatrist, there’s a physical evaluation and a series of tests, like an imaging screen, to make sure you have two kidneys. If you are trying to donate to a specific person, the recipient center will run testing to see if you are a match, which involves:
  • A blood type test: The donor and recipient must have matching blood types. 
  • Genetic testing: This looks at the human leukocyte antigen (HLA) system to see if there is fairly natural alignment. The HLA system is responsible for the regulation of the immune system in humans.
  • Mixing of donor cells with the recipient’s blood to make sure there isn’t a reaction. “What they are looking for when mixing cells is to see if the donor has an antibody sensitivity that will attack the cells of the donor because the biggest problem you face after transplantation is rejection,” Dr. Migliori said. “Sometimes you have what’s called incompatibility.”
• If there is incompatibility, a paired kidney donor program may be considered. These programs search for cases where the donor in each pair is compatible with the recipient in another pair. Then by exchanging donors, a match for both recipients is found. UnitedHealthcare helped the American Society of Transplant Surgeons and United Network for Organ Sharing (UNOS) build a database to track potential paired donation opportunities. 
  
• After you are matched, the surgery will be scheduled and performed. With any surgery, there are risks. But liver and kidney transplant surgery are minimally invasive and most people are able to return to their normal activities in two to four weeks. 
  “Surgery recovery is tracked by the transplant center for at least a year. Going beyond that, they have to have good follow-up care to check ongoing kidney function, because now the donor only has one kidney,” Dr. Migliori said.
  

Becoming an organ donor is a big decision, but can have a huge impact on someone’s life. April is National Donate Life Month, so if you are interested and committed to becoming a living donor join the registry.

“It’s the greatest gift people can give,” Dr. Migliori said, “because you save a life.”