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Living donation is the best method of treating kidney failure. People who gave their loved ones such a gift emphasize that they never regretted their decision and if they were to take it again, they would do the same.
In recent years, approximately 50 kidneys have been transplanted annually in Poland from living donors, which constitutes 5% of all kidney transplants – from living and deceased donors. Meanwhile, in the EU countries, an average of 20 percent. According to the transplantologist, Dr. Piotr Domagała from the Clinic and Department of General and Transplant Surgery of the Medical University of Warsaw, Poles are not less willing to make the greatest sacrifices for their loved ones. We simply lack awareness, both broadly understood in society, but also among medical personnel.
Why is a living donor more valuable?
The survival rate of recipients 10 years after transplanting a kidney from a living donor is approximately 87%, and that of a deceased donor is 74%. The average lifetime of a transplanted organ from a deceased donor is 9 years, and 15 years for a kidney donated by a living donor. Before such a procedure, the donor is thoroughly examined, so the recipient receives a functioning kidney from a completely healthy person. Surgery is planned and controlled in advance, and the ischemic time of the retrieved kidney is much shorter, thanks to which it begins to function immediately after transplantation. Many patients decide to undergo dialysis in the hope that they will have a kidney from a deceased donor and will not put their loved ones at risk. Unfortunately, 50% of dialysis patients die within 5 years.
It should also be remembered that each month of dialysis treatment shortens the working life of the kidney after transplantation – says Dr. Domagała. In addition, transplantation in women increases the chance of having children, because the dialyzed person will not give birth to a child. Besides, hemodialysis disrupts normal life. The patient has to come to the dialysis center for five hours three times a week, practically every other day. If we add the travel time, it is approximately 7 hours. Many patients feel very tired after this procedure and need a lot of time to regenerate. More convenient for the patient, peritoneal dialysis, which is done at home, is associated with strict rules of sterility, even disinfecting the room, otherwise the risk of life-threatening peritonitis increases.
How is the decision to donate an organ made?
It is difficult for a sick person to ask their loved ones for such a gift. Ideally, it should come from the family who should make such a decision among themselves. Therefore, a regular educational campaign is needed, both in schools and in the media.
Dr. Domagała says that donors do not regret their decisions and often stress that if they made them a second time, they would do the same.
Such a gift usually deepens and cemented relationships. The donors live with the conviction that they have done something good, which gives them a lot of satisfaction. Recipients, on the other hand, often say that the moment of transplantation is a second birthday for them, that having received such a gift, they will take care of themselves more and enjoy life. And it changes dramatically, because the lack of compulsion of dialysis allows you to return to professional activity. Many people start traveling abroad. Comfort is really increasing – says the transplantologist.
Who can donate a kidney?
The kidney donor can be a relative of the recipient, such as a parent, brother, sister, or adult child, as well as a distant relative or unrelated person who has a personal or social relationship with the recipient, such as a spouse, friend or colleague. In the case of further family relationships, e.g. cousins or emotional relationships – partners, friends, after obtaining a positive opinion of the Ethical Committee of the National Transplantation Council, it is necessary to obtain the consent of the district court in non-trial proceedings.
The kidney donor must be an adult, physically and mentally healthy, which is confirmed by appropriate laboratory and diagnostic tests carried out in transplant centers. Contraindication to kidney donation are uncontrolled hypertension, diabetes, cancer, heart disease, chronic obstructive pulmonary disease, hepatitis B or C, mental illness, obesity, kidney disease and borderline kidney function.
Safety of the procedure
A significant psychological barrier for the donor may be the fear of surgery and the awareness of the removal of a healthy kidney.
Organ removal and implantation have been safe procedures performed in the world for over 60 years. Transplantation is therefore no longer an event like a medical experiment, but a routine operation with a risk close to zero – says Dr. Domagała.
Thanks to the advances in surgery in recent years, many kidney donations are performed using minimally invasive techniques – laparoscopically or with the use of manual assistance.
This form is less invasive than the open method, requiring much smaller incisions. This means a shorter hospital stay and faster recovery and recovery from daily activities. Serious complications after surgery are very rare, while less serious complications, such as postoperative pain, are more common. As Dr. Domagała emphasizes, donors after kidney transplantation are still healthy people.
They don’t live shorter than people with two kidneys. And thanks to transplantation, they care more about their health and have better access to a doctor, because the living donor care program includes an annual medical check-up. Even if they have other health problems, we can advise them on where to seek help, he explains.
Eligibility for surgery
The qualification of a potential living kidney donor consists of several stages and takes from several to several weeks, sometimes several months. It includes the performance of specialized blood and urine tests as well as ultrasound, X-ray and computed tomography imaging tests, which aim to assess, among others, the work of the kidneys, heart, lungs, or the risk of thrombotic or hemorrhagic complications in the perioperative period. Both the donor and recipient are labeled HLA antigens.
The recipient is tested for possible anti-donor antibodies (DSA) and a test is performed for the presence of any antibodies in the recipient’s serum, ready to react with the donor’s cells and activate mechanisms that destroy the donor’s cells. Its result is very important and determines the success of the transplant operation performed. A positive result disqualifies a potential donor from further qualification procedure. Then the donor and recipient can be enrolled in a pair exchange program. Then the kidney transplant can take place between unrelated people.
Donor Privileges
Donating a kidney is voluntary and the donor cannot, and should not, count on any material benefits. In some countries, he or she is compensated, for example for lost earnings while he is away from work or reimbursement of travel expenses for qualifying and screening examinations. In Poland, a kidney donor is awarded the title of a Distinguished Transplant Donor along with a badge and ID card, which entitles to use out of order outpatient health care and pharmaceutical services in pharmacies. Additionally, in some Polish cities a Meritorious Transplant Donor is exempt from fees for using public transport.