Living-Donor Transplant Procedure

Overview

Beginning the Living Donor Assessment

Anyone interested in becoming a living kidney or liver donor must start by completing a health questionnaire. This step checks if a person is healthy enough to safely donate. It collects information about medical history, current health conditions, and lifestyle.

After completing the questionnaire, health professionals review the answers and may request additional tests, such as bloodwork or physical exams. These tests help confirm the donor is a suitable match and has a low risk of complications. The evaluation protects both the donor and the recipient to ensure the highest level of safety.

Typical steps in the assessment process:

Fill out a health and medical history form.
Go through physical exams and blood tests.
Assess psychological health.
Meet transplant team specialists, such as social workers and doctors.

The transplant team aims to protect the donor’s well-being while helping the patient in need.

Types of Living-Organ Donation

Living-organ donation can be grouped into two main types: matched (directed) donation and altruistic (non-directed) donation. These types differ in how the donor and recipient are linked.

Matched Living-Organ Donation

In a matched or “directed” donation, the donor gives an organ to a specific person. Usually, donors are family members, such as parents, siblings, or adult children. They can also be other relatives or close friends or acquaintances, like coworkers. Sometimes, people become donors for someone they have only heard about who needs a transplant.

Altruistic Living-Organ Donation

Altruistic, or “non-directed,” donors decide to give an organ to someone they do not know. The recipient is selected based on medical need and compatibility. Sometimes, these donors and recipients remain anonymous, but in some situations they may meet if both agree and the center allows. Donation types can be summarized:

Donation Type	Donor Relationship	Recipient Selection
Directed	Family, friends, or known	Specific named recipient
Non-directed	No relationship	Based on need and compatibility

Most living-donor transplants involve kidneys or a portion of the liver. A person can live normally with one kidney, and the liver can regrow after part is removed. Tissue donation, such as bone marrow, is also possible.

Kidney Exchange and Donation Networks

Paired-organ donation and donation chains provide more solutions for people with incompatible donors.

Kidney Exchange Donation

If a person wants to donate a kidney to a loved one but they are not a match, both can join a kidney exchange (also called paired exchange). In this process, two or more pairs are matched so each recipient gets a compatible kidney from another donor in the group.

Donation Chains

A non-directed living donor can start a donation chain by giving an organ to anyone in need. This donation triggers a series of transplants involving several pairs of incompatible donors and recipients. Each donor gives to a stranger, and each recipient gets a compatible organ. This way, one donation can lead to many lives being improved. Key points about paired and chain donations:

Increases access to transplants for people with rare blood types or antibodies.
Helps recipients who have a willing but incompatible donor.
Utilizes donations from both directed and non-directed donors.
Allows for multiple transplants from a single act of kindness.

Living-donor transplantation, including kidney paired exchanges and liver donation, provides more opportunities for patients compared to waiting for an organ from a deceased donor.

Reasons for Choosing This Option

Living-donor transplants allow transplant candidates to avoid long waiting times on the national transplant waitlist. This method helps when quick action is needed, such as for patients on dialysis. Organs from living donors often last longer and may have better genetic matches for the transplant recipient.

Potential Health Concerns

Health Considerations for Donating a Kidney

Donating a kidney can lead to both short-term and long-term health challenges. Surgical risks include pain, bleeding, injury to nearby structures, infection, blood clots, hernia, and rarely, death. Doctors recommend thorough screenings to rule out any hidden illnesses or conditions that might raise these risks. Long-term effects may include:

Slightly higher chance of developing high blood pressure.
Increased protein in urine.
Reduced kidney function compared to before surgery.

A small number of donors may later develop kidney failure. However, research shows most kidney donors have a life expectancy similar to people who have not donated, as long as they stay healthy.

Kidney donors also undergo tests for transmissible diseases and cancer, so hidden health risks are checked before surgery. Mental health concerns after donation can include anxiety, depression, and even regret if complications occur or if the transplant does not succeed for the recipient.

Quick Reference: Kidney Donor Possible Health Risks

Risk Type	Examples
Surgical Risks	Bleeding, pain, infection, blood clots, hernia
Long-term Risks	High blood pressure, kidney function drop, increased urine protein
Emotional	Anxiety, depression, worry about health

Safety Issues Linked to Liver Donation

Liver donation involves removing a portion of the donor’s liver, which brings its own risks. Surgical problems can include infection, bleeding, pain, or problems with wound healing. Some donors may also experience bile leaks or narrowing of the bile duct. Other issues that may arise after donating part of the liver are:

Bleeding within the abdomen
In rare cases, the remaining liver portion does not regrow enough

Like kidney donation, mental health concerns can affect liver donors, including symptoms of depression or stress. This type of donation is newer, so doctors are still learning about long-term effects, but most donors recover well.

Checklist: Liver Donor Health Concerns

Surgical pain and infection
Bile duct problems (leak or narrowing)
Intra-abdominal bleeding
Rare: insufficient liver tissue regrowth
Possible emotional effects

Both types of living organ donation carry some risk, so donors must have complete evaluations to confirm they are healthy enough to donate.

Getting Ready for Donation

Thinking Through Your Choice

Deciding to become a living donor requires careful thought. Potential living donors should take their time and look at all sides of this important step. It’s important to ask questions and talk to friends, family, and other trusted people for guidance. Living donors should never feel rushed or forced—choosing to donate is always a voluntary act, and the decision can be changed at any stage. Here are helpful points that donors should consider:

Personal Feelings: Are you comfortable with the idea of organ donation?
Medical Risks: What are the possible health risks or complications?
Insurance Coverage: Which costs will your insurance handle, and what might you need to pay out-of-pocket?
Work and Finances: Will donating affect your job or your ability to earn income during recovery?
Knowledge: Do you feel fully informed about what the process involves?
Pressure: Is anyone pushing you to be a living donor, or is the choice truly yours?
Relationship Changes: How might your relationship with the recipient change if you do or don’t donate?
Alternative Options: Are there other possible donors? If so, how will the final donor be chosen?
Religious Concerns: Does your faith or spiritual practice have guidance on living donation?
Health or Medical History: Do you have any medical conditions that could cause issues with donation?
Support: Is there someone available to help you during the donation and recovery period?
Emotional Readiness: How will you feel if you are not approved as a living donor, or if the transplant does not help the recipient?

The transplant center keeps all private health information confidential. If someone is not approved to donate, the recipient is only told that the donor was not matched—details are shared only if the donor chooses to explain.

The transplant program introduces you to an independent advocate—usually a counselor or social worker—whose job is to defend your interests and make sure you clearly understand what giving consent means. The advocate can answer your questions, offer reading materials, and help talk through any feelings or worries about becoming a living kidney or living liver donor.

Picking a Transplant Hospital

Choosing the right transplant hospital is an important step for all living donors. You can go with a center suggested by your health care provider or pick one yourself from a list covered by your insurance. When looking for a transplant center, consider making a table to compare:

Transplant Center	Number of Transplants/Year	Donor Survival Rates	Recipient Survival Rates	Support Services	Location
Example Center 1	150	98%	95%	Yes	City A
Example Center 2	100	96%	93%	Yes	City B

Key Things to Look At:

The number and types of organ transplants the center handles each year.
Patient and donor survival rates, which are available through resources like the Scientific Registry of Transplant Recipients.
Whether the center uses up-to-date transplant technology and methods.
Extra services such as housing during the recovery period, help with travel and logistics, support groups, and referrals to extra resources.

A good transplant center provides educational materials about the process and supports you every step of the way. The staff arranges important tests, such as blood tests, chest X-rays, and electrocardiograms, as well as the full medical screening and psychological evaluation all potential living donors must complete. The partnership between the donor, their doctor, and the transplant program helps make the donation experience as safe and smooth as possible.

What You Can Expect

Steps to Take Before Surgery

Donors go through a careful screening before giving an organ. Most donors are between 18 and 60 years old and are in good health. The transplant center starts the process with a basic review of medical history, often using a phone call, online form, or in-person visit. At this stage, the center will ask for permission to begin a health assessment.

A key part of early testing is a blood test. This test checks if the donor’s blood type matches the recipient. Blood type compatibility is important because it reduces the risk of problems after surgery. Sometimes, if the blood types do not match, special options may still let someone donate.

After blood tests, the donor has a full physical exam and a mental health assessment. Doctors want to be sure the donor does not have major health problems. Common issues that may stop someone from donating include diabetes, cancer, or heart disease. Mental readiness is also checked to make sure the donor is making a well-informed and confident choice. A table below shows some typical steps in donor evaluation:

Step	Purpose
Initial Screening	Gather medical background
Blood Compatibility Test	Check blood type and tissue match
Physical Exam	Assess donor’s overall health
Mental Assessment	Review psychological readiness
Detailed Testing	Scan organs with imaging/labs

The transplant team reviews the donor’s lab results and scans the organ to be donated. They want to be sure taking out the organ is safe for the donor and will not lead to health problems later.

Consent is another key phase. Before surgery, the center provides a full explanation of risks and benefits to both the donor and their family. Donors have a chance to ask questions and must agree to the procedure by giving informed consent.

Doctors also talk with donors about ways to stay healthy before and after surgery. Eating well, avoiding smoking, and staying active help prevent problems during and after surgery. Donors are encouraged to bring a trusted friend or family member to these talks for support.

What Happens During Surgery

The steps during donation differ based on the organ. For kidney donation, surgeons usually perform laparoscopic surgery. They make small cuts near the bellybutton and insert a thin camera and small tools through these incisions. Laparoscopic surgery causes less pain and leads to a shorter hospital stay compared to open surgery.

If laparoscopic surgery isn’t possible—such as when a donor has had many earlier abdominal surgeries or is overweight—the surgeon may use open surgery. The surgeon makes a larger cut on the side, which may lead to more soreness and a longer recovery time. Here’s a side-by-side list to compare the two main types of kidney surgery:

Laparoscopic Kidney Removal
- Several small incisions
- Special camera for guidance
- Shorter recovery
- Less pain
Open Kidney Removal
- One larger incision (5-7 inches)
- Muscle and ribs spread with surgical tools
- Longer recovery
- More pain at first

Both methods take about two to three hours. The donor receives general anesthesia and sleeps through the entire procedure. For liver donation, the process is different. The surgical team removes a section of the liver using a single cut on the stomach area. They may take either the left or right lobe of the liver, depending on what the recipient needs.

The team decides the size based on the recipient’s size and the amount of liver tissue needed. Surgeons may remove up to 70% of the donor’s liver. The surgery for liver donation can last several hours—sometimes up to ten. The table below summarizes surgical options:

Surgery Type	Incision(s)	Recovery Time	Special Notes
Laparoscopic Kidney	Small, multiple	Faster (2-3 days)	Less pain
Open Kidney	Large, single	Slower (3-7 days)	More discomfort
Liver Donation	Large, single	5-7 days	Liver regrows

Before surgery, the team checks tissue typing to improve the match between donor and recipient and lower the chances of organ rejection. During the operation, the surgical team uses up-to-date tools to keep the donor safe and comfortable.

Recovery and What Happens Next

After surgery, the donor stays in the hospital for a few days. For kidney donation, this often means two to three days. For liver donation, the donor may need to stay up to a week, since the recovery process is more involved.

Once out of the hospital, the transplant team checks on the donor. If the donor lives far from the center, the team may suggest staying nearby for a short while, just in case there are issues or questions. Check-ups are frequent at first and then become less often over time.

Stages of Post-Surgery Follow-Up

A few days at the hospital, focusing on pain control and early movement.
Short-term housing near the center, if needed, for easy access to care.
Scheduled visits at 6 months, 1 year, and 2 years after surgery.

Doctors help donors understand when and how to get back to a normal routine. They give advice on caring for the surgical site, warning signs for infection, and steps for pain control. Physical activity is limited at first. Heavy lifting, running, or contact sports should be avoided until the doctor says it’s safe.

For kidney donors, most return to regular daily activities within a month or so. Work and exercise can restart in about 4 to 6 weeks, as advised by the medical team. Donors can usually eat the foods they did before the surgery, but a healthy diet is encouraged.

Liver donors often need more recovery time compared to kidney donors. On average, they return to normal routines after two or three months. The liver usually regrows to almost its full size within two months. Doctors monitor the liver’s health with blood tests.

Returning to Normal

Light Activities: Resume in 2 – 3 weeks (kidney), 3 – 6 weeks (liver)
Work: Most can return in 4 – 6 weeks (kidney), 2 – 3 months (liver)
Driving: As soon as no longer taking strong pain medicine and cleared by doctor

Studies show that living with one kidney or a smaller liver rarely causes lasting problems for most people. Those who donate a kidney can still have children, but doctors suggest waiting at least six months before becoming pregnant. Pregnancy is still possible, but there may be a slightly higher chance of blood pressure issues.

Living donors should take care of their bodies to keep the remaining organ healthy. Regular exercise, a balanced diet, and follow-up check-ups help maintain good health. The transplant center and donor’s local doctor can work together to ensure recovery stays on track.

Coping and Support

When someone chooses to become a living organ donor, they may experience a wide range of emotions and questions. Support groups from organizations like the National Kidney Foundation or the American Liver Foundation help donors share their stories and gain advice from those with similar experiences. Peer support can boost mental health and ease worries.

Donors may also find it helpful to talk openly with family, friends, and transplant teams about their feelings and any concerns about medical costs. Programs such as the National Living Donor Assistance Center provide resources for financial support.

Support Option	Benefit
Support Groups	Share advice and encouragement
Professional Counseling	Improve emotional well-being
Educational Resources	Increase knowledge and self-confidence

Diet and Nutrition

Most people can return to their usual eating habits shortly after a living-donation surgery. There are typically no special diet restrictions unless a person has other medical conditions. A dietitian from the transplant team is available to answer questions and help with nutrition goals. Balanced meals and good hydration support healing and overall health.

Exercise

Staying active benefits living organ donors, just like it benefits everyone else. Most people resume their regular activities a few weeks to a few months after surgery. Healthcare providers often suggest starting slow and discussing any new workout plans with a doctor first.

Some types of sports can put the remaining kidney at risk. Activities such as football, boxing, hockey, soccer, martial arts, and wrestling may increase the chance of injury. To help protect the kidney, wear padding or special vests under clothing. Here’s a quick guide:

Activity Type	Recommendation
Walking	Allowed, as tolerated
Swimming	Allowed after healing
Contact Sports	Use protection or avoid
Weight Training	Start with light weights

Always check with a health care provider before making changes to exercise routines.