Can a kidney from a relative, partner or friend be used for a transplant?
Can a kidney from a relative, partner or friend be used for a transplant?
Even though a cadaveric transplant is by far the most common type of kidney transplant in the UK, it is possible to receive a kidney from a living relative. A growing number of renal units now have a Transplant Co-ordinator whose main job is to organise living related transplants (LRTs).
A living related transplant is ‘better’ than a cadaveric transplant in that it is more likely to work. The best donor is an identical twin, as the tissue type is identical. Unfortunately, most people do not have an identical twin waiting to give them a kidney! However, a kidney from another relative may be suitable.
If a kidney patient has a relative who is at least 18 years old, healthy, and willing to give them a kidney, they should speak to the Transplant Co-ordinator (or senior nurse or doctor) at their unit. The most suitable donor is usually a brother, sister, father, mother, son or daughter, but other more distant relatives are sometimes suitable.
It is up to kidney patients to ask their relatives to see if they are willing to donate a kidney. Doctors will not usually ask a patient’s relatives for them, but they will talk to anybody who is willing to donate a kidney.
Sometimes a relative is very keen to give a kidney, but the person on dialysis does not want to put their family member through the operation, or perhaps to feel under an obligation to them in the future. As many as 20% of living related transplants are ‘blocked’ in this way. If this happens, the person wanting to donate should not feel rejected – their relative on dialysis is being selfless, and wants to protect their family against harm. They may be putting their family’s interests higher than their own, which is to be particularly respected if dialysis is causing complications or hardship.
Refusing the offer of a transplant when you are on dialysis is one of the most generous things anyone can do. However, in making a decision to turn down a transplant, someone should realise that a donor ‘gains’ an awful lot from giving a kidney to a relative. People do want to be generous to others, particularly in their family. Giving a relative a transplant may take a burden of worry or care away from someone that quite outweighs the risk or pain of an operation.
To find out if a relative is a suitable donor, it will be necessary for them to have the some blood tests, including blood group, tissue type and virus tests. If they ‘pass’ this hurdle, they will then need to have further tests to check that their own kidneys are working perfectly. These include an ultrasound (a sound-wave picture) of the kidneys. The final test is usually an arteriogram (also called an angiogram) of the blood vessels of the kidneys. The angiogram is performed with a CT or MR scanner. This involves an injection into a vein in the arm, and them lying under a machine that takes the images.
Either of these types of scan are suitable, depending on the local preference. These ‘non-invasive’ scanners have replaced angiograms, where long tubes were placed into the artery in the groin and Xray contrast was injected into the artery of the kidney.
LRTs can be arranged before a patient starts dialysis. The tests described above can be organised in less than three months. But both sides – patient/donor and renal unit – need to move quickly to do this. Both the patient and the donor must make a lot of time available to get all the tests done, even if it means taking time off work. After the tests have been done, the donor and recipient are reviewed by someone on behalf of a Government body called the Human Tissue Authority (HTA). The assessor is independent of the transplant unit, and makes sure that the donor is not being coerced or paid to give the transplant, and also has been informed of the risks of kidney donation.
It is not essential for a person who donates a kidney to be related to the patient. Kidneys may also be donated by someone close to the patient, such as a husband, wife, partner or good friend. This is called a living unrelated transplant.
Before a living unrelated transplant can take place, agreement must be obtained from a government body called ULTRA (Unrelated Live Transplantation Regulatory Authority). This process can slightly delay the transplant arrangements, which may therefore mean that they take longer than those for an LRT.
Kidney patients and potential donors are both advised to think very carefully before going ahead with transplantation from any living person. They need to consider very carefully what the emotional consequences might be if the transplant is not successful.
As human beings do not need two kidneys to be healthy, the donor is unlikely to come to any harm by losing a kidney.
This does not mean that there are no risks to the donor. One research study showed that there were the following risks to the donor:
However, even if a kidney comes from a close relative, it is important that both the donor and the patient understand that the kidney is not guaranteed to work.
Adapted by Rob Higgins, Renal Consultant, Walsgrave Hospital, Coventry, From ‘Kidney Failure Explained’ by Janet Wild and Andrew Stein, published by Class Publishing.
NKF Controlled Document No. 255, Can a kidney from a relative, partner or friend be used for a transplant?, written 1 May 2000. Last reviewed 28 January 2010.
The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.
The National Kidney Federation is registered in England and Wales as a Company limited by guarantee (Company No 5272349) and awarded charitable status (Charity Number 1106735). Give as You Earn contributions No. CAF GY511.
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Page created: 1 May 2000
Last updated: 28 January 2010