People whose kidneys have stopped working may undergo dialysis or opt for a kidney transplant from either a living or deceased donor. Those who choose a live donor transplant must first undergo a medical assessment to ensure they are suitable candidates for the treatment. Once that determination has been made, patients are asked to inform any potential living donors to contact the Transplant Department. An individual must first volunteer to donate one of his or her kidneys to a family member or to someone with whom he or she has strong emotional ties. In certain circumstances, such as when a "Good Samaritan" donor or a "paired exchange" donor donates a kidney, there may be no emotional relationship between donor and recipient. A Good Samaritan donor refers to a person who wishes to donate a kidney anonymously and does not designate a particular recipient. A paired exchange occurs when each donor in two individual donor-recipient pairs is not compatible with their intended recipient, but is compatible with the recipient in the other pair. Potential donors who are identified must undergo testing to be sure their kidney function is normal so they can safely donate one of their kidneys. Living kidney donors must also meet the following criteria:
Potential donors then undergo further testing to be sure they are compatible with their recipient. This specialized testing is called histocompatibility testing, or "tissue typing," and checks that the recipient has not had an immune response to the donor's tissue type, which would result in the kidney being damaged or destroyed. It is done through a blood test in which the donor's white blood cells are mixed with the recipient's blood serum (the clear part of the blood) and checked to be sure no damage has occurred. This test is called a "crossmatch." Psychiatric evaluations are also conducted to ensure that the donor does not feel unduly pressured by the recipient or other family members and is truly willing to undergo the procedure, even if it should fail. After initial screening blood work is received and reviewed, a potential donor meets with a transplant nurse and surgeon to discuss the procedure itself and ask questions. Potential donors who remain willing to donate are then scheduled for a comprehensive evaluation by a nephrologist, internist, psychiatrist and social worker who have no ties to the recipient's care team. A CT scan to evaluate kidney structure and vascular anatomy is usually performed toward the end of the evaluation process. The results of the evaluation are presented to a multidisciplinary screening committee. If the donor candidate is found acceptable, surgery is scheduled and preoperative testing and final crossmatch are performed.
Health Resources and Services Administration (HRSA) Awards Lahey Clinic the Silver1 Medal of Honor for Organ Donation.