One of the initial concerns of families with a member experiencing kidney or liver failure is which pathway of transplantation will be available to them, and the question of living donor vs deceased donor kidney transplant comes up almost immediately. Each family eventually asks how do living donor transplants and deceased donor transplants work and how kidney transplant donor eligibility affects who can actually help. To better understand this, we will examine what each of these pathways entails for the recipient and donor.
Living Donor Transplants vs Deceased Donor Transplants
A living donor transplant is the donation of a portion of an organ by a living person. Most commonly a living donor renal transplant or a partial living donor hepatic transplant is performed. A donor may be a relative of the recipient. A deceased donor transplant is of an organ which is donated upon the death of a person. Deceased donor transplants are distributed as per transplant waitlist priority for the recipient and, in some countries, as per the location of the potential donor.
For patients who are not nationals of the country where they are seeking a transplant, a living donor transplant is the only viable option. A clear understanding of the living donor transplant process, and of kidney transplant donor eligibility more broadly, is important in the initial stages of the search for transplant options.
Kidney Transplant Donor Eligibility: The Evaluation of Living Donors
Comprehensive medical evaluation of a potential living donor determines if the donor is healthy and can function with one less kidney (if the donor is considering kidney donation) or with a smaller liver (if the donor is considering a liver donation). Medical evaluation also rules out any conditions that can put the donor’s health at risk. Potential donors undergo a donor psychological evaluation to determine if the donor understands the consequences of donation and if the donor is voluntarily consenting to donation. The evaluation also rules out if the donor is being coerced to donate. Potential donors and recipients are also tested for blood group compatibility and donor tissue matching to determine if they are medically compatible. Specialized protocols can also extend compatibility to some previously untransplantable patients.
India’s Transplantation of Human Organs Act allows transplants for foreign nationals if their relatives donate organs to them and the foreign nationals’ relatives are proven to be related to the foreign nationals — a core part of kidney donor requirements India applies to any international family evaluating this pathway.
Living Donor Kidney Transplant Risks and Expected Consequences for Donors
Kidney donors are healthy for life after the donation and can function with only one kidney. However, kidney donation is a major surgery, and understanding the living donor kidney transplant risks involved is an essential part of informed consent for donors and their families. Compared to kidney donation, liver donation is safer for the donor because the liver can regenerate. The process of partial liver donation regeneration means the donor’s liver typically returns to most of its original size within months, though a partial liver donation still is a major surgery and has risks.
Long-term studies of kidney donors indicate no major changes in quality of life, and kidney function tests are within normal limits, similar to the general population. However, transplantation is an irreversible process and long-term consequences on the donated kidney cannot be fully ruled out. Therefore, health care providers recommend follow-up evaluations for kidney donors and encourage them to maintain a healthy lifestyle to delay the potential loss of kidney function in the donated kidney.
Recipient’s Viewpoint: Living Donor Transplantation
There are several benefits of a living donor transplantation. For international patients, a living donor transplantation is the only option. A planned, scheduled living donor transplantation is better for the recipient and donor psychologically, and can improve the functional outcome of the transplanted kidney. Often, a living donor kidney transplantation results in a better functional renal outcome when compared to a deceased donor kidney transplant — an observation borne out by nephrology teams managing both pathways.
A better functional renal outcome after a living donor transplantation and a long wait time for a deceased donor transplantation contribute to the perception that a living donor transplantation is a better alternative, especially for international patients weighing living donor vs deceased donor kidney transplant options from outside the country.
Legal and Ethical Aspects
There are strict laws that govern the transplantation of foreign nationals. These laws exist to protect potential donors from exploitation and to ensure the integrity of the transplantation system. In addition to providing the donor with health care benefits, it protects the Ethical Transplant System and ensures appropriate care to all the stakeholders of the transplantation process.
MediKaya Healthcare transplant coordination team assists and supports the transplant legal documentation related to transplantation. In fact, MediKaya Healthcare considers the legal requirements as protection and, therefore, part of a responsible transplant coordination service.
What happens if there is no living donor?
There are legal provisions if there is no living donor who is compatible with the patient. In such cases, transplantation coordinators assist the family to explore other blood relations to check if they are compatible. In some rare cases, a team of doctors may devise a medical protocol to safely override blood group and tissue incompatibilities between the donor and the recipient.
It is the responsibility of the transplantation team to be totally honest with the family if such medical interventions are not safe and probable.
Assisting and Protecting the Interests of All Parties
MediKaya Healthcare’s transplant coordinators are totally transparent to the donor and the recipient in evaluating the potential risks involved. MediKaya Healthcare’s team also reassures the recipient’s family of the potential positive outcome of the surgery, without misrepresenting the situation. Only then, according to MediKaya Healthcare’s team, a truly ethical transplant is performed.
Protecting all parties involved in the procedure is the focal point of MediKaya Healthcare’s team in the field of transplant medicine and surgery.
Frequently Asked Questions
Q. Can non-blood relatives and/or spouses donate kidneys in India?
Yes, spouses can donate with some additional documents. However, the easiest cases for transplants for foreign nationals are with first-degree blood relatives and are decided on a case-by-case basis, with the presence of proper legal documents.
Q. Is it safe to have just one kidney?
It is safe for the donor, especially if that donor is healthy and screened thoroughly. Healthy donors should be careful to maintain their health after donation.
Q. How long does it take for the liver to fully regenerate after a partial donation?
This is one of the most common questions around liver donor recovery. It takes less than a year for the liver to regain most of its size, a regenerative capability liver transplant specialists point to as a key reason living liver donation carries a comparatively better safety profile than many other living-donor procedures. The liver is able to fully regenerate, and other organs in the body are not able to do so.
Q. What happens if a living donor cannot be found?
The transplant team helps to expand the donor pool, especially to other blood relatives. There are also procedures that can change the blood type of the donor to make it compatible with the recipient.
Q. Do kidneys transplanted by living donors show better performance than those transplanted by deceased donors?
There are many factors that can influence the longevity of a transplanted kidney. Some of those factors can be controlled, like the overall health of the donor and the time it takes for the process to be completed.
Why is it that only blood relatives can be transplant donors for a foreign national in India?
It is to discourage human trafficking and organ trading.
Exploring living-donor transplant options with a family member? Speak with our transplant coordination team.