What you can expect
Before the procedure
If possible, bring a family member or friend with you for your evaluation. It may be helpful for you to discuss your decision to donate with a family member or friend.
Living-organ donors are generally between the ages of 18 and 60 and in good physical and mental health. Specific living-donor eligibility standards vary by organ and transplant center.
The donor evaluation process usually includes the following steps:
- Initial screening. The first step in living-donor evaluation is usually an initial screening, which may be completed online, in person or over the phone. The transplant center staff will ask for your consent to begin a medical screening and ask several questions about your health and medical history.
- Blood tests. The next step is usually a blood test to determine if your blood type is compatible with the recipient's. If your blood type does not match your intended recipient, there may be specialized medical treatment alternatives that still allow you to donate.
Physical examination and psychological evaluation. At the transplant center, a transplant team will evaluate your general physical and mental health to make sure that undergoing living-donor surgery will pose minimal risks to you.
Doctors will perform tests to look for preexisting conditions that may disqualify you from being a donor, such as diabetes, cancer, some infectious diseases, heart diseases or other conditions.
If you are participating in directed donation, different transplant team members will perform evaluations and surgeries for you and your recipient. Your evaluation is confidential.
Also, during the evaluation the team will check to ensure that the organ you're planning to donate is healthy and that removing either one of your kidneys or a portion of your liver is unlikely to cause health problems later in life. This may include laboratory and imaging tests.
Consent and final review. If you meet eligibility requirements to be a living donor, the transplant center is required to inform you of all aspects and potential results of organ donation and receive your informed consent to the procedure.
Transplant staff will discuss with you and your family the benefits and risks of donating a kidney or a portion of your liver and answer your questions. Staff will also discuss the importance of maintaining a healthy lifestyle before and after donating an organ.
During the procedure
Most procedures to remove a living donor's kidney for a transplant are done through minimally invasive surgery (laparoscopic nephrectomy). Laparoscopic nephrectomy involves less pain and a shorter recovery than traditional open surgery to remove a kidney (open nephrectomy).
In a laparoscopic nephrectomy, the surgeon makes two or three small incisions close to the bellybutton and uses a special camera called a laparoscope to view the internal organs and guide the surgeon through the procedure.
In some cases, donors may not qualify for minimally invasive surgery, and may need to have an open nephrectomy. This may be the case if you have had multiple abdominal surgeries or if you are significantly overweight. In open nephrectomy, a 5- to 7-inch incision is made on the side of the chest and upper abdomen. The surgeon then uses a surgical instrument called a retractor to spread the ribs to access the donor's kidney.
Both open and laparoscopic nephrectomy last about two to three hours, and are performed using general anesthesia, which means you'll be asleep during the entire surgery.
During living-liver donation, surgeons remove a portion of your liver through an incision in the abdomen.
Either the left or right lobe of your liver may be used in donation, depending on the size of the recipient.
About 40% to 70% of the donor's liver is removed for transplantation. The donor's liver begins to regrow almost immediately after surgery, reaching normal size and volume again within about two months after donation.
The surgery is performed under general anesthesia and can last up to 10 hours.
After the procedure
- Hospital stay. You'll stay in the hospital for a few days after kidney donation and up to seven days after liver donation.
Care after your surgery. If you live far from your transplant center, your doctors will recommend that you stay close to the center for a few days after you leave the hospital so that they can monitor your health and remaining organ function.
You'll likely need to return to your transplant center for follow-up care, tests and monitoring several times after your surgery. Transplant centers are required to submit follow-up data at six months, 12 months and 24 months after donation. Your local health care provider may conduct your laboratory tests one and two years after your kidney or liver surgery.
- Recovery. Depending on your living-donor procedure and overall health, doctors will give you specific advice on how to take care of yourself and reduce the risk of complications during your recovery, including caring for your incision, managing pain, limiting strenuous activities and returning to a normal diet.
Return to normal activities. After donating a kidney, most people are able to return to normal daily activities after four to six weeks.
The recovery process takes a little longer for liver donation, and most people are able to return to work and other normal activities two to three months after donation.
Pregnancy. Kidney donation normally does not affect the ability to become pregnant or complete a safe pregnancy and childbirth. Some studies suggest kidney donors may have a small increase in risk of pregnancy complications such as gestational diabetes, pregnancy-induced hypertension, preeclampsia and protein in the urine.
It's usually recommended that women wait at least six months after living donation before becoming pregnant.
Little is known about pregnancy after living-liver donation since the procedure is newer and less common.