REQUIREMENTS FOR A LIVING DONATION

 An organ donation from a living person is basically only possible if the procedure does not endanger their health in the long term. Therefore, a live donation is only an established method for the following organs:

  • Kidney: A kidney transplant
  • Liver: transplantation of parts of the liver

In 2013, 2,272 kidneys were transplanted in the USA, 725 of them (32%) after living donation. Living donations of the liver are rarer: of 970 liver transplants, 83 (8.5%) were performed after living donation.

REQUIREMENTS FOR A LIVING DONATION


Legal Requirements

In order to avoid organ trafficking and the associated crime, strict requirements for living donation are made by kidney Clinical Consultation. Another goal is to protect the donor, who exposes himself to a health risk (albeit a very small one).

The donor must

  • Be of legal age
  • Be capable of giving consent.
  • Be suitable as a donor, i.e., in good health so that the operation does not pose a great risk for him.
  • Be related to the recipient or have a special personal bond with him (first- or second-degree relatives, spouse, registered life partner, fiancé, or close friends).
  • Be informed by a doctor (e.g., about the purpose and type of the procedure, the examinations to be carried out, the risks of the procedure, measures to protect the donor, the expected success of the transplant)
  • Be voluntarily consent to the removal.
  • We agree to participate in medically recommended follow-up care.

The transplant should be an appropriate treatment to save the recipient's life and to cure or alleviate the underlying disease. At the time of organ removal, no suitable organ from a post-mortem donation must be available. Because of the long waiting times for the organs, this is almost always the case. The donor must be informed in the presence of another doctor who may not be involved in removing or transferring the organ. A commission responsible under state law ("living donation commission") must approve the transplantation in an expert report. This commission checks whether the donor and recipient are actually close and really consent to the procedure.

Medical Requirements

The blood groups of the donor and recipient should match or be "compatible." Sometimes, blood group, incompatible donations are also carried out. 

For kidney transplantation, in particular, it is important that certain tissue characteristics (HLA antigens) match as closely as possible. This reduces the risk of later rejection reactions against the organ. An important test for assessing tissue compatibility is the cross-match. If no suitable donor is found among those close to you (tissue or blood group incompatibility), in very rare cases, a "cross-over transplantation" can be carried out between two donor-recipient pairs. The donor must, of course, be in good health. This is checked with a series of medical examinations.

AB0 Incompatible Donations and Cross-Over Transplants

According to nephrology physicians, living donations are only allowed if the donor and recipient are related (1st and 2nd degree) or are very close. Unfortunately, it is not always possible to find a suitable donor among this group of people (tissue or blood group incompatibility). In the case of a blood group incompatibility, an AB0-incompatible living donation or a cross-over transplant can be considered as a way out of this situation. In the case of tissue intolerance (positive crossmatch), a cross-over transplantation can make a living kidney donation possible.

While a cross-over transplant is currently still an "exception to the rule" in Germany, the number of AB0-incompatible living donations is increasing. In the case of living kidney donations, the proportion of AB0-incompatible donations was already 18% in 2012. The ABO-incompatible living liver donation has so far rarely been practised in Germany and Europe. Nevertheless, worldwide there has been a very good experience with this method. Since infants and toddlers hardly develop antibodies against other blood groups, an incompatible liver donation is possible for this group.

AB0-Incompatible Living Kidney Donation

In the case of blood group incompatibility ("AB0 incompatibility"), a transplant is only possible if the blood group antibodies are removed from the recipient's blood beforehand. Various measures are necessary for this

  • Four weeks before the transplant, the administration of a certain drug suppresses the formation of new blood group antibodies.
  • One week before the transplant, the recipient must start taking immunosuppressive drugs. In addition, remaining blood group antibodies are removed from the blood with a kind of "blood wash" (immunoadsorption or plasmapheresis).

Without this pretreatment ("conditioning"), the recipient's blood group antibodies would attack the transplanted kidney and the risk of a rejection reaction would be very high. The blood group antigens (A, B, AB, or 0 (no antigen)) are not only on the surface of blood cells but also on the surface of cells in various organs, such as B. the kidney and live. Further treatment - i.e., surgery and follow-up care - hardly differs from living kidney donation that is compatible with blood groups. However, complications are somewhat more common, and the dose of immunosuppressants after AB0-incompatible living donation is usually somewhat higher than after other forms of kidney transplantation.

              The risk of rejection and infection is only slightly higher in the early phase after the transplant compared to a blood group-compatible transplant. There are no long-term results from Germany so far. From Japan, where more than 1,000 AB0-incompatible living kidney donations have already been carried out, we know that even 10 years after the transplant, the organ function of the kidney and the life expectancy of the transplanted are just as good as after a blood group-compatible living donation. The number of AB0-incompatible living kidney donations is increasing in Germany: of the 600 living kidney donations carried out in 2009, 15% were AB0-incompatible donations.

The Cross-Over Transplant

In the case of tissue or blood group incompatibility, a "cross-over living donation" between two donor-recipient pairs can be useful.

However, a high organizational effort is necessary for a cross-over transplant: First, a suitable couple has to be found, then legal hurdles have to be overcome. The two couples have to get to know each other personally and give a credible assurance to a living donation commission that they are willing to donate the kidney to the other recipient. The transplant itself is more complex for the transplant centre since four people have to be operated on at the same time or in quick succession. From an ethical point of view, one would have to carry out the organ removal at the same time, so that a partner does not jump off "at the last minute".


Dr Q Khan is the best Nephrology Physician in Riverside.

 

Location: United States

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