Directed donation occurs when a donor and recipient know each other. The donor and recipient may or may not be related. In the past, for best results, donors and recipients needed to have matching blood types and the recipient’s body needed to be unsensitized. If a recipient is not sensitized, it means that the recipient’s antibodies should not attack blood and tissue from the donor, leading to organ rejection.

However, donors and recipients do not have to be an exact match. The Johns Hopkins Comprehensive Transplant Center developed a method, called plasmapheresis, that allows for a “non-matching” donor to still provide a kidney to a recipient. Through our Incompatible Kidney Transplantation Program (InKTP) and our Highly Sensitized Patient Protocol, more options are available for non-matching, directed donors and recipients.

Another directed donation option is to participate in a kidney swap, or exchange. Through this type of donation, a donor and recipient may trade kidneys with another donor/recipient pair. For example, if there were two donor/recipient sets, A and B, Donor A’s kidney would go to Recipient B, while Donor B’s kidney would go to Recipient A. When multiple donor/recipient pairs are used, this type of matching is called a Paired Kidney Exchange. 

Non-directed donors, or altruistic donors, are individuals who choose to donate a kidney to an unknown recipient. This kind of donation has the potential to start a domino effect of kidney donations.

The criteria for live donation of a kidney: 

• Must be in good physical and mental health
• Must be at least 18 years old
• Must have a body mass index (BMI) that is less than 35

Must be free from the following:

• Uncontrolled high blood pressure in certain individuals
• Diabetes
• Cancer
• Hepatitis
• Organ diseases
• Infectious diseases

Become a living donor

The evaluation helps determine if, as the donor, you match the recipient. In the first stage of evaluation, you’ll undergo tissue typing and lab screenings. Blood and tissue typing checks to see if you and your recipient are compatible, and how well the kidney will be accepted by the recipient.

Comprehensive lab testing may include, but is not limited to, the following:

• Blood test
• Urine test
• Pap smear / gynecological exam
• Colonoscopy (if over age 50)
• Cancer screening
• Antibody screen

If these lab results are satisfactory, you’ll next meet with transplant physicians to discuss the procedure and its risks. The physicians and surgeons will review your results and will require additional testing, such as x-rays, electrocardiograms, or radiologic testing.

This testing will including a full day of appointments and diagnostic testing. During this time, you will also meet with our psychologist, Donor Advocate, and nurse coordinator. Further testing may also be required.

Once the work-up is completed, your case will be presented to the multi-disciplinary transplant team. This team includes surgeons, nephrologists, psychologists, donor advocates, and nurse coordinators. They represent you and make decisions that are in your best interest regarding the transplant.

It is important to note that, as a donor, you will have a different transplant team from your recipient. Your team cares for you exclusively. It is a common fear that donors are viewed as a kidney and not as a person; however, at the Johns Hopkins Comprehensive Transplant Center, organ donors are given the same considerations and respect as all of our patients.

Note: At any time during the evaluation process, up until the moment of surgery, you are entitled to change your mind about the donation. This decision is made with your physicians and is kept completely confidential.

If you are approved for the donation after all of the tests are completed, the surgery will be scheduled. The surgery is usually scheduled four to six weeks in advance. Typically, a living kidney transplant donor spends two days in the hospital, and will have an additional four to six weeks of recovery time. Donors who are from out of town should plan on spending an extra week in town after they discharged from the hospital.

During recovery, you will experience some pain and discomfort. This should be easily relieved with either a prescribed medication or over-the-counter pain relievers. For two weeks, you should avoid driving, and you should avoid picking up anything that weighs more than ten pounds for six weeks following surgery. You are encouraged to walk several times a day. If you have children, you may need initial help in caring for them.

Depending on the type of work you do, you may be able to return to your job as soon as two or as long as eight weeks after surgery. There will be follow-up tests to monitor your health.

As with any surgery, live kidney donation has its risks:

• Anesthesia, and possible allergic reaction to anesthesia
• Pain and discomfort
• Infection
• Bleeding and blood loss which requires transfusion
• Blood clots
• Fever
• Nausea
• Urinary tract infection
• Pneumonia
• Injury to surrounding tissue and other organs
• Scarring
• Death

A Johns Hopkins transplant surgeon led a study to monitor long-term survival among live kidney donors and found that long-term mortality was similar or lower for live kidney donors than their counterparts in the general public.

Donors should not take non-steroidal anti-inflammatory drugs (NSAIDS). Tylenol is the only over the counter pain reliever that should be used post donation.
Download this alphabetical list of common NSAIDS to avoid. This list is not all-inclusive.

As a living donor, you should be aware of the financial aspects of donation.
Covered by Recipient’s Insurance: 

• Screening tests
• Surgery
• Some follow-up care

Not Covered by Recipient’s Insurance:

• Time off of work
• Travel expenses
• Expenses for treatment of unrelated conditions (For example, if a screening test shows cancerous cells, treatment for this condition would not be covered by the recipient’s insurance).

Donors should check with their own insurance prior to donation. Although unlikely, the act of donating a kidney could possibly affect future insurance coverage. We recommend that you have insurance prior to donating a kidney.

For travel expenses and other funds, the National Living Donor Assistance Center (NLDAC) offers a grant to donors. There are income qualifications that both the donor and the recipient must meet in order for the donor to be eligible.

If you are interested in becoming a living kidney donor, call 410-614-9345.