Kidney Donation

When an individual's kidneys fail, three treatment options are available: hemodialysis, peritoneal dialysis and kidney transplantation. Many patients feel that a successful kidney transplant provides a better quality of life because it allows greater freedom and often is associated with increased energy levels and a less restricted diet. In making a decision about whether this is the best treatment for you, you may find it helpful to talk to people who already have had a kidney transplant.

Donating one's kidney to a loved one in need of a transplant is an important decision and a unique gift. Kidney transplantation enables a patient suffering from kidney disease to stop dialysis treatments, and to enjoy a life filled with more freedom, energy and productivity. Donating a kidney can be one of life's greatest experiences, however it should be entered into with a complete understanding of the living donation process.

Are there different kinds of kidney transplants?

There are two types of kidney transplants: those that come from living donors and those that come from unrelated donors who have died (non-living donors). A living donor may be someone in your immediate or extended family or your spouse or close friend, and in some cases a stranger who wished to donate a kidney to anyone in need of a transplant. There are advantages and disadvantages to both types of kidney transplants.

Can I donate a kidney?

The short answer is you need to show three things: (1) you have blood and tissue types compatible to the recipient, (2) You are generally healthy, and (3) you have two healthy kidneys. You might also undergo psychological and financial assessments. For more information, check out this page.

Long-term effects of kidney donation

Research has shown there are few, if any, long-term effects on a living kidney donor. There are small possibilities of high blood pressure and elevated levels of protein in the urine. The decision whether or not to donate ultimately is yours. So, the first thing is not to let people pressure you. Next, make sure you have all the information you need to make an educated decision.

Kidney donation to unrelated recipient.

In the past, the conventional wisdom was that close tissue typing was necessary for a successful donation, and close tissue typing implied blood relationships. But anti-rejection drugs are so powerful now that close tissue typing is less important. Consequently, unrelated living donation has increased dramatically over the last 10 years. You will still need to go through the normal evaluation of donors.

Donated kidney's outcome

In fact, living kidney donation has the best track record of all forms of donation. Statistics from United Network for Organ Sharing show that the kidney donated from living donors is still functioning in 97% cases after one year and 85% of cases after four years. Even so, you should be prepared mentally for the possibility of rejection.

Kidney donation effect on pregnancy

The presence of a solitary kidney does not appear to pose a significant risk during the course of a normal pregnancy. Be sure to talk with your obstetrician or gynecologist about your interest in donation and the effect it could have on future pregnancies.

How will the surgery affect the donor's life?

The surgical procedure to remove a kidney from the donor is called a nephrectomy and takes approximately two to three hours. After donation, a healthy person can lead a normal life with only one kidney. Living donation does not affect the ability of women to have children. Most donors are able to return to their former level of activity within 3 to 6 weeks.

What is laparoscopic nephrectomy?

Laparoscopic nephrectomy is a minimally invasive surgical procedure for obtaining a kidney from a living donor that can make the process easier. In comparison to the standard operation, it results in a smaller incision, lessens recuperation time and usually shortens hospital stays. Many donors are discharged from the hospital after approximately four days.

Not all donors can undergo laparoscopic nephrectomy. One or two radiologic tests will be performed to see if a laparoscopic nephrectomy is a possibility for any particular donor. Other living donors undergo a conventional nephrectomy.

Types of living donors

In general, most living donors are between the ages of 18 and 60 and in excellent health. Anyone from the groups below can be evaluated as a potential donor. There are two types of living donors:

Living Related Donors

Living related donors are healthy blood relatives of patients awaiting a transplant. They can be:

• brothers and sisters
• parents
• children over 18 years of age
• other blood relatives (aunts, uncles, cousins, half brothers and sisters, nieces and nephews)

Living Unrelated or "Emotionally related" Donors

Living unrelated or "emotionally related" donors are healthy individuals emotionally close to, but not blood related to patients awaiting a transplant. They can be:

• spouses
• in-law relatives
• close friends

Donor evaluation process

It is very important that all potential donors be genuinely willing to donate, in excellent health, of a compatible blood type and immunologically compatible with the recipient.

The initial screening process involves some questions and a general health review by a nurse coordinator. Routine blood tests are also drawn to determine the potential donor's compatibility with the patient awaiting a transplant.
After these initial screening tests, a final donor candidate undergoes further evaluation consisting of:

• Laboratory and radiological tests
• An evaluation by a physician and social worker
• Possibly other tests depending on specific circumstances

KIDNEY DONATION AND REWARDED GIFTING: AN "IRANIAN MODEL"

At present, Iran is the only country that has been able to abolish waiting list for kidney transplantation by adopting techniques that all together is called "Iranian Model" that I will describe them in detail.

Iran has reported the largest experience of living unrelated donor transplants. We started the first living unrelated renal transplantation from a spouse and since then 2630 kidney transplantation is done in our department 2273 of them were living unrelated donors, with results superior to cadaveric transplantation and  similar to living related. This was the first step taken in building Iranian Model.

Our promising results with living unrelated transplantation motivated other centers in Iran to use living unrelated donors as a potential source for kidney transplantation. This led to more than 17000 kidney transplantation performed in Iran by the end of 2004. Meanwhile, we started laparoscopic donor nephrectomy (LDN) in Iran with a cost effective approach in the year 2000 and since then we have performed 713 LDNs, the largest number in the Middle East and one of the largest numbers done in a single center in the world. Undoubtedly, performing nephrectomy by laparoscopy, opened new horizons for donors and encourage them efficiently for their act. It should be mentioned that in "Iranian Model" all other potential sources for kidney graft such as living related donors and especially cadaveric transplantation are well appreciated 6.

The second step to build Iranian Model was the establishment of its infrastructures as an efficient, dedicated and wide spread Society for Supporting Dialysis and Transplantation (SSDT) with its branches all over Iran consisted of over 180 transplantation clinics nationwide. This is a charity foundation run by dialysis and transplanted patients and other volunteers for referring the patient and donor to the transplant centers and to help patients with end stage renal disease (ESRD).

This society registers donors (mainly unrelated volunteers) and introduces them to transplant candidates. Recipients are helped by the society to do their pre operative evaluation mainly reimbursed by insurance companies.
The third important part of Iranian Model is governmental help and involvement to promote renal transplantation since our governmental officials prefers it to dialysis both socially and economically.

Governmental aid has been done by covering the expenses of the operation done in public university hospitals through insurance system. The government also pays a sum of money (about $1200) to each donor after his donation as a gift. Donors also receive a rewarded gift directly from the recipient usually with the SSDT coordination but no one intrudes into their privacy. Transplantation teams and hospitals are not involved in the act of donation at all. The whole procedure is arranged so that majority of patients even with poor socioeconomic status can afford the operation and many generous people and charity foundations also participated in this regard. Therefore, in Iranian Model almost all patients with ESRD have the same chance to benefit from transplantation operation regardless of their economical class.

We believe that the involvement of both governmental and NGOs by providing money for the obviously humanitarian act of unrelated donors significantly improves their incentives and facilitates the process of finding an appropriate kidney graft for ESRD patients in a timely manner. Based on this system, pre emptive transplantation is now a routine strategy for many recipients especially for children 7.

To reduce the expenses for transplantation, our transplantation teams have a crucial role. They have accepted this challenging operation as a humanitarian rather than a financial act. From financial point of view, the fee for the surgeon to perform transplantation is very low compared to other operations done in private practice (about $200 for one kidney transplantation in comparison with about 1000 dollars for simple prostatectomy). This is an outstanding achievement for medical teams.

The fourth important aspect of Iranian Model is the establishment of a law according to it, each citizen can only receive kidney from his or her own citizen. Thus, Iranian kidneys may only be transplanted in to Iranian recipients. If any foreigner decides to perform kidney transplantation in Iran (due its cost effectiveness, patients recently refer to Iran more commonly), he or she should bring the proper donor (related or unrelated) from his or her own nation; therefore, this law prevents rampant commercialization.

In summary, kidney donation and rewarded gifting called "Iranian Model" has made a breakthrough and has revolutionized the transplantation process by eliminating the long waiting lists and is based upon these issues:

1. 1- Starting living unrelated transplantation (wife to husband) as a planned program is the cornerstone of the model.
2. Act of donation is regulated by charity foundation run by dialysis and transplanted patients (SSDT)
3. Government incentive as a gift for donation encourage act of donation and surgery is mainly done in university hospitals making transplantation possible for patients in poor socioeconomic condition. Very low surgeon fee, making transplantation a reality for both government and patients.
4. A law is in act that each citizen can donate his or her kidney only to his or her own citizen; this prevents commercialization in Iranian Model.
5. Charity foundations help the system running securely between recipients and donors.
6. Medical teams and hospitals are not involved in the act of donation. 
7. Education of all members of transplantation including transplant surgeon, its associated nephrologists and nursing staff inside the country helps the system to run efficiently.