The Gift that Keeps on Giving: Northern Sydney Living Kidney Donors offer support to those contemplating kidney donation
Living donor kidney transplantation remains the best modality for renal replacement therapy. The statistics are well defined for the kidney transplant recipient, however what are the risks for the living donor? and what is the responsibility of the GP when a patient comes into the surgery and states they want to donate a kidney?
“Primum non nocere” is the mantra central to all of medicine. Yet contrary to this the living kidney donor undergoes a surgical procedure they do not need that reduces their glomerular mass by 50%. The sole benefit is psychological. When the donor is altruistic and non-directed, these psychological benefits become more obtuse and are based on “ the greater good”. Hence how best to advise and assess these patients is key. Following GP assessment the potential donor then undergoes an intensive education and workup assessment at a transplanting unit.
Living Donors Support Volunteers
A number of living kidney donors from Royal North Shore’s (RNSH) Renal Transplant service, have formed the “www.livingkidney.org.au” that aims to inform and support those contemplating donation and hence is a useful resource for patients and GPs to access.
These volunteers provide phone support, attend education days and run a visitation programme for donors postoperatively. Their personal practical experience is invaluable. They aim to increase awareness of the positive benefits of living kidney donation to the general public and medical community.
What facts are useful to the GP when discussing living kidney donation.
Kidney Health Australia has also compiled information for a potential kidney donor.
Who can be a donor?
Not everyone can be a living kidney donor, the main exclusion criteria are:
- Diabetes mellitus
- Significant obesity
- Significant hypertension (>2 medications)
- Inadequate GFR<60-90 ml/min dependant on age
- Significant albuminuria
- Recurrent kidney stones
- Risk of infection transmission
- History of cancer
The risks are twofold: standard surgical risks coupled with living with a single kidney.
- Estimated risk of death is 1 in 3000
- The occurrence of peri/post operative complications is up to 10% and include: bleeding, infection, hernia, veno-thromboembolism and anxiety and depression
The recovery period is at least 6 weeks and patients are unable to drive for up to a month
The long term risk associated with living with single kidney
- Overall the life expectancy of living kidney donors is the same as their matched individuals who have not donated.
- The loss of renal mass overall sits around 20-30%. The remaining kidney undergoes hypertrophy in the first 12 months post donation.
- There is a small increased risk of hypertension, proteinuria and cardiovascular disease.
- However the health of those that complete the living donor assessment is better than the general population, long term the cardiovascular health of living donors post donation equates to the general population long term.
Financial Impact of Donation
The Australian Government has a “ Supporting Living Organ Donors Program” which aims to reduce any financial stress. Payments are based on up to 9 weeks leave and are equivalent to the national minimum wage. Learn more.
Psychological Impact of Donation
Up to 30% of living kidney donors manifest symptoms of anxiety/depression through the process. Psychological assessment and support is available for all donors.
The donors from Living Kidney have a high retrospective satisfaction with their decision to donate and represent the “gift that keeps on giving”. They provide faith that the living kidney donation assessment is robust and the experience a positive one.