Kidney Transplant – Donor Matching

One thing I’ve certainly learned since I’ve been researching this whole kidney transplant thing, it’s certainly not like running out to the grocery real quick. It’s a long timely process, and if you’re very lucky it’ll work for you.  There are a ton of hurdles along the way, and even getting to the end game doesn’t promise you anything. So in short, any naive thoughts I had about being on dialysis for a short stretch then getting a transplant was quickly kaboshed with a little research and talking to my doctor. However, the good news is it’s totally doable with the leg work.

A few weeks back I received my initial Transplant packet from IU Health. I basically just filled out a bunch of paperwork and mailed it back in.  The letter inside mentioned several health screening tests I had to take, such as cardiac stress test, chest X ray, colonoscopy, etc.  They basically are checking me from head to toe to make sure I’m even eligible to be an organ recipient.   My doctor said I’m a very healthy guy so I’ll have no problems passing these tests, so I’m not worried about that.  I haven’t taken any of these tests yet, I’m still waiting on IU Health to set them up for me.

I talked to my nephrologist about the whole process, he told me it takes 2-5 years from start to finish to receive a donor kidney. There are a lot of things that have to happen your way in that time period, but it’s possible and happens.

The big “test” when finding a closely matching donor come from 3 areas.  Blood Type, HLA Testing, and Antibodies.

First, you must have a matching blood type.  Since I am “A negative”, my matching types are any “A” or “O”.

Next – HLA. The fancy word for HLA is “human leukocyte antigen”. We’ll just stick with calling it HLA. Anyway, this test identifies the major HLA genes a person has inherited from their mother and father, and the corresponding antigens (proteins) that are present on the surface of their cells. These antigens help your immune system determine which cells are “self” and which ones are “non self”.  Any cells that are considered “non self” can trigger an immune response against them.

Finally, there are Antibodies. Your immune system may produce antibodies that react specifically against something in the donor’s tissues. If no reaction occurs when combining them in a tube, you should be able to accept the kidney.

In other words, the antigens and antibodies in your body are the whistle blowers of the block – they are on the front line, and call for backup to ward off anybody trying to invade your turf.  This is a fantastic thing to have – as we’d all be sick or dead without it.  However this same defense system also tries to attack donor organs.  While our outer mind knows the organ is OK, our inner immune system sees it as an intruder.

This is why you need to find the closest matching Blood Type, HLA profile, and Antibodies to yours as you can. This, along with some Immunosuppressant drugs (drugs that reduce your immune system), allows you to put someone else’s organ into your own body.

How do you find the closest match to your own as you can?

My doctor broke it down into 3 categories, ranked by preference/odds of success:

  1. Living Related.  This is the most favorable kidney donor. This is from a parent, sibling, cousin, or other closely related person. Since your HLA profile combination is inherited from your mother and father, chances are better that a closely related person would be a better match for you.   Granted, nobody is going to be an exact match (the closest would be if you had an identical twin), but this is still the best category out there.

Key points:

  • more control over timing of transplant
  • tend to be better matches
  • waiting time reduced
  • however sometimes difficult because if it’s a genetic disease, other family members may be affected as well.

2. Living Not Related. The next best option is from someone who is not related to you, but still alive.  This could be anyone – from a neighbor, friend, coworker, acquaintances, or a good Samaritan who you don’t know at all.

Key Points:

  • more control of timing of transplant
  • waiting time reduced
  • genetic problems are less

3. Deceased. While this is least desirable, it doesn’t mean it won’t work. It can be from either a related or not related deceased person. Modern preservation techniques allow a deceased kidney to be preserved for up to 72 hours, so timing is short and fast. Quick decisions must be made.

Key Points:

  • most transplants come from deceased donors
  • timing is very short – it must happen very quickly once donor dies.
  • chances of post-surgery dialysis need are greater than that of Living donors.

Regardless of which of the three types of donors you go with, it’s a life changing procedure, and nothing is guaranteed.  The new organ may last you the rest of your life, or it may last just a few years, or it may not work at all.

As far as medical costs for the Donor,  all expenses are paid by the recipient’s insurance. The only thing the donor has to pay for is missed work time. A Living donor is usually back to work after a few weeks of post surgery rest and recovery.

Speaking of the living donor – on the surface it may seem like a no brainer decision for some people.  The person instantly wants to help and offers up a kidney and help the person in need. However, there are things to consider.

The donor must be prepared for emotional repercussions if their kidney fails to work in the recipient, or if it works for awhile then fails. Once it’s out of their body, it’s gone forever. The donor should be prepared for this scenario, as it’s a possibility.  But even so, it’s one of the most selfless attempts at a gift a person could ever bestow upon anyone.

The donor must also be prepared for physical repercussions. They will be sore for awhile, and will miss some work. There are chances of complications from the surgery (but very small chances). It also takes a month or two for the donor’s body to acclimate to only having one kidney.  The donor may feel fatigued or sluggish for a month or two while recovery is happening. But eventually the body recovers and is back to normal.

Other things to consider for the donor – if their remaining kidney ever becomes compromised – be it their own kidney disease, auto accident, any other disease that may affect it – they in turn would be in the kidney transplant line since they wouldn’t have a “spare” anymore.

All of these things and other things must be carefully weighed by the donor before making the decision.

As for the recipient, their life has changed for sure. Once the kidney is diagnosed as a success, they must take the anti rejection medications for the rest of their life. If they ever stop taking them, the chances of kidney failure are very high.  They must continue seeing their nephrologist regularly to monitor kidney function. If function starts to decline, medications and lifestyle changes must be taken to react to it.  The recipient must also be prepared for the possibility of the kidney failing and having to go back on dialysis.  The good news for the recipient – if they are healthy enough and approved, they can try for another transplant.

As for my search for a matching donor, I haven’t reached that part yet. I’ve yet to take my own tests to determine what people can match to. Once all that is done in the coming months I’ll report back, as I know some of you have expressed interest in seeing if you are a match to me.  I am forever grateful to each and every one of you for the kindest of all gestures!  I just ask that you consider all things I mentioned, and do more research on your own before deciding. It’s a huge deal.

All of this is a load to read – I hope it was educational.  I’m learning a lot myself about this so I love sharing what I learn in my own words to all of you who are awesome enough to care to read about my ramblings here.

Terry

August 2015

Resources:

Lab Tests Online

Kidney Link

 

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