for live donor transplantation. Kidneys are the
organs most commonly transplanted in the United
States (other than SKINand corneas). At present,
people waiting for donor kidneys outnumber
available kidneys nearly four to one. Between
50,000 and 60,000 people currently await donor
kidneys in the United States. A person becomes a
potential candidate for KIDNEY TRANSPLANTATION
with the onset of END-STAGE RENAL DISEASE(ESRD), a
permanent state of renal failure in which the kid-
neys cannot perform their functions at a level that
sustains life.
The donor and the recipient must match in
BLOOD TYPEand human leukocyte antigen factors
and be negative for antibodies (negative cross-
match). HUMAN LEUKOCYTE ANTIGENS(HLAS) are six
inherited proteins (three from each parent) on the
surfaces of leukocytes (white BLOODcells). The
more HLAs that match, the greater likelihood the
recipient’s body will accept the donor kidney.
Even with blood type match and good HLA
matching, some people’s immune systems produce
antibodies in reaction to the donor’s blood. A neg-
ative crossmatch mixes small amounts of the
prospective donor’s blood and the recipient’s blood
to confirm that there is no ANTIBODYreaction.
Living DonorA living donor may be a relative or a stranger to
the kidney recipient. In general a living donor
must be in overall good health and have two nor-
mally functioning kidneys. Some health condi-
tions, such as HYPERTENSION(high BLOOD PRESSURE),
chronic LIVERdisease, and DIABETES, preclude a per-
son from donating a kidney because the risk is
high for developing kidney disease as a conse-
quence of these conditions. People with chronic
health conditions generally are not eligible to
donate a kidney. There is no greater likelihood of
developing kidney disease with only one kidney,
and a single kidney can more than adequately
accommodate the body’s needs.
The transplant team selects a living donor on
the basis of the match between the donor and the
recipient. Typically, the recipient’s health insur-
ance pays for the donor’s medical expenses related
to the kidney donation, including surgery, hospi-
talization, and follow-up care. Once selected, the
living donor undergoes NEPHRECTOMY, an OPERATION
to remove a kidney. There are two options, open
nephrectomy and laparoscopic nephrectomy.
Either procedure is a major surgery that requires
hospitalization and postsurgical recovery time.
Though recovery is uneventful for most donors
whether they undergo laparoscopic or open
nephrectomy, donating a kidney does require time
off from work and regular activities.
Laparoscopic nephrectomy requires several
small incisions through which the team uses
laparoscopy to remove the donor kidney. Though
technically more challenging for the transplant
team, laparoscopic nephrectomy significantly
reduces scarring and recovery time for the donor.
Laparoscopic nephrectomy takes three to four
hours, with two to three hours in the recovery
room while the person returns to full conscious-
ness. Most people who undergo laparoscopic
nephrectomy stay one to three days in the hospi-
tal after the surgery and require four to six weeks
for return to regular activities. Within a year or
two, the small scars remaining from the incisions
are nearly invisible.
Open nephrectomy requires a single large inci-
sion and takes two to three hours, with two to
three hours in the recovery room to return to full
consciousness. Most people who undergo open
nephrectomy stay three to five days in the hospi-
tal after the surgery and need six to eight weeks
for return to regular activities. The SCARfrom the
incision begins to fade in about a year.
The transplant team immediately performs the
transplantation surgery to place the donor kidney
into the recipient. Only the intended recipient
may receive the living donor kidney; there are no
waiting list requirements for live donor kidney
transplantations. Living donor kidney transplants
have a higher long-term success rate than cadaver
donor kidney transplants.Cadaver Donor
Cadaver donor kidneys come from the bodies of
deceased persons who died of causes not related to
kidney function, had healthy kidneys at the time
of death, and signed documents affirming their
desires to donate their organs after their deaths.
Family members may make the decision about
organ donation when the person dies without
organ donor documentation. Organ donation can200 The Urinary System