Evaluations Phase I
Phase I is to determine whether you meet the essential requirements to be considered, so we’ll take basic blood and urine tests, and conduct an initial health screening.
The donor coordinator will play a video that will walk you through all the steps in the donation proces. The independent living donor advocate will make sure you’re well aware of all aspects of donating, then ask you to consent to the evaluation process. Should you change your mind, you are welcome to opt out at any time, without consequence, and with strict confidentiality.
Your muscles dump a waste product called creatinine into your bloodstream. A healthy kidney will filter and expel it through urine to keep the body relatively clean. We’ll measure the amount of creatinine in your bloodstream to learn whether your “glomerular filtration rate” is within normal range.
We’ll test your blood type to see if you’re compatible with the recipient. Use this chart to determine whether you're compatible with your intended recipient. If you’re not compatible, you may enter the national Kidney Paired Donation Program to perform a “swap” with another incompatible pair.
We’ll take a urine sample and inspect its appearance and composition to help us assess a wide range of conditions. For example, if your urine looks cloudy, you may have a urinary tract infection; high levels of protein are a sign of kidney disease; excess sugar in urine generally means you have diabetes. If we see any of these indications, we’ll need to pursue further tests to pinpoint the root cause.
Looking at your past will help us know if you suffer from a medical condition that may put you at future risk for kidney donation. You may be asked to obtain certain medical records from your local practitioner.
Our medical physician will conduct a typical physical exam that will include taking your vital signs, and listening to your heart and lungs. He or she will also review your health history for completeness.
You will need to go through a psychosocial evaluation with Lahey’s social worker. Due to the moral implications of living donation, the donor team will need to understand your motivation for donation. Certain categories of potential donors will also need a psychiatric evaluation.
Evaluations Phase II
Phase II consists of the more formal medical evaluations, including diagnostic testing and consultations with our donor team.
Our immune system works by destroying foreign bodies, and ignoring ones it recognizes. This recognition system occurs through six different proteins named ‘antigens’ that work like a lock and key mechanism. The more antigens that match between the donor and the recipient, the less likely the recipient is to reject the new kidney (a six-antigen match is ideal, but uncommon). If the antigen match is poor, the recipient will need to take more anti-rejection medications.
We’ll take X-rays to rule out lung diseases or tumors. We’ll check that your lungs are healthy enough to endure the strain of kidney donation surgery, since there’s a small risk of pneumonia.
Our technician will attach pads on your chest (electrodes) that measure the electrical activity of your heart over a period of time. This will help us find out if you have a normal heart rhythm or any cardiovascular problems.
You’ll have a consult with each member of our multidisciplinary team to guarantee that no detail has gone unnoticed. Visit the section Meet the Donor Team to learn about the members you’ll meet.
We’ll ask you to fast for 12 hours before this test so we may measure your baseline sugar levels. Then we’ll ask you to drink a large dose of glucose (sugar) to increase your blood sugar levels. A healthy body should produce insulin, which will signal your liver to bring your blood sugar levels back down. We’ll draw more blood after 2 hours; if your sugar is still high, we will know that you have diabetes.
Hemoglobin is the protein in your red blood cells that carries oxygen. This blood test will measure what percentage of your hemoglobin is coated with glucose (sugar), which will tell us your average sugar levels over the past three months. If you’re above 6.5%, it means you have persistently elevated blood sugar; an indication of diabetes.
We’ll ask you to collect and refrigerate your urine over a 24-hour period so we may track whether your urine volume is within normal range. We’ll also test the amount of protein that comes out in your urine; large amounts of protein could be a sign of kidney damage, possibly from hypertension or diabetes.
Evaluations Phase III
The last phase of donor evaluations consists of finalizing exams that will take place only after the donor candidate has been found acceptable to donate.
This is an imaging process (similar to X-rays) that will help us study the anatomy of your kidneys. We’ll inject you with a fluid that will make your kidney’s vessels contrast against the surrounding tissues. Then you’ll be asked to lie down on a bed that goes into a donut-shaped machine to perform the scan. Your surgeon will study this scan to decide which kidney he finds most suitable for donation.
This is another type of compatibility test. We’ll mix your blood with the recipient’s and observe; if the recipient’s cells coexist with your own, the two are compatible. If the recipient’s cells attack the donor’s cells, then they are not a match, and the donation may not proceed because the kidney is very likely to be rejected.
If you and the recipient are not compatible, we offer a Kidney Paired Donation Program, where the donor and the recipient perform a kidney "swap" with another pair.
After having cleared the evaluation process, we’ll show you a video and educate you on the details of the surgery, its risks, and expected recovery process. The living donor advocate will answer any questions that you may have, and ask you to sign a surgical consent form so we may schedule the operation.
