Living kidney donation Normal Kidney Function

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1 Living kidney donation Normal Kidney Function The kidneys function is removing wastes and excess water from the blood. Many vital body functions are depend on the proper functioning of the kidneys. In order to proper filtering process, the blood pressure and blood flow to the kidneys must be adequate. If the arteries leading to the kidney are diseased, the filtering process will be affected. The nephrons, including the glomeruli and the tubules, must be healthy, and the path from the nephron to the urethra must not be blocked. There are normally approximately 1 million filtering units or nephrons in each kidney. Diseases that reduce the number of normally functioning nephrons and/or reduce the function of nephrons cause chronic kidney disease (CKD). When the kidney filters are working properly, the result is a proper balance of fluids and chemicals in the body. If an imbalance occurs, many critical bodily functions can be affected, possibly

2 producing symptoms associated with kidney disease(uptodate, 2017).

3 Chronic Kidney Disease Risk Factors Diabetes mellitus, high blood pressure, a family history of kidney disease, African-American and other ethnic minorities, obesity, smoking, older age, having protein in the urine, having autoimmune diseases such as lupus are some factors which can increase the risk of developing chronic kidney disease (Uptodate, 2017). How Many People Affect By Kidney Disease and Needing Donor Kidney? More than 2 million people worldwide are being treated for end-stage kidney disease (ESKD)(Robinson et al., 2016). The number of patients with kidney failure is on the rise in Canada, leading to a higher need for dialysis treatment and greater demand for kidney transplants, which have superior patient outcomes and lower healthcare system costs than dialysis treatments(terner, Redding, & Wu, 2016). The number of annual kidney transplants performed has increased along with the waiting list for a kidney transplant, resulting

4 in a persistent 2.5 times gap between patients on a waiting list for a kidney and the number of kidney transplants performed(terner et al., 2016). Symptoms of Chronic Kidney Disease Most people with CKD do not have symptoms until the kidney function is severely impaired. The problem is often discovered when blood or urine tests done for other reasons and showed an increased creatinine concentration in the blood and protein or albumin in the urine. Even when kidney failure is advanced, most people still make a normal or nearnormal amount of urine; this is sometimes confusing. Urine is being formed, but it does not contain sufficient amounts of the body's waste products. Edema (swelling of the feet, ankles, or legs), loss of appetite, increased sleepiness, nausea, vomiting, confusion, and thinking problems may develop with advanced. Patients often develop high blood pressure, blood chemistry (electrolyte) abnormalities such as a high potassium concentration, anemia (a decrease in red blood cells, which can cause fatigue

5 and other symptoms), and bone disease. Finally people with advanced kidney failure may develop a group of symptoms referred to as uremia. The symptoms of uremia include loss of appetite, nausea, vomiting, a build-up of fluid around the heart, nerve problems, and changes in mental status, including drowsiness, seizures, or coma(uptodate, 2017).

6 Who Need Kidney Transplantation Some people with CKD progressively worsen over time and will eventually need dialysis. Kidney transplantation is an option for some people with CKD. An important component of treatment for patients with CKD is planning for dialysis in advance(uptodate, 2017). Patients with CKD are at increased risk for cardiovascular events, hospitalizations, and mortality, and kidney transplantation is the preferred treatment for eligible patients with end-stage kidney disease (Parajuli, Clark, & Djamali, 2016). A successful kidney transplant improves the quality of life and reduces the mortality risk for most patients when compared with maintenance dialysis (Uptodate, 2017).

7 Kidney Transplant and Living Kidney Donation The number of patients awaiting kidney transplantation has steadily increased over time (Uptodate, 2017). The kidney transplants that most people are familiar with are those using a kidney donated by someone who has died which is known as deceased donation. It is also possible for a healthy living person to donate a kidney, a living kidney donation. In general, organs from living donors function better and for longer periods of time than those from donors who are deceased (Uptodate, 2017). The increased use of organs from living donors is one strategy that addresses the need for transplants(uptodate, 2017). Living kidney donation involves a surgery to remove the kidney from a living donor. The kidney is then transplanted into a patient who needs a kidney transplant, the recipient. Every year in the United States, approximately 6000 healthy adults accept the risks of donor nephrectomy to help family members, friends, or even strangers improve survival and quality of life(muzaale et al., 2014). The chronic shortage of kidneys for

8 transplantation has increased the number of living donations, but demand remains high, which has created a long waiting list of end-stage kidney disease patients(tsai et al., 2012). The increase in candidates for kidney transplant has led to growth in the number of living donor transplants(de Souza Rodrigues et al., 2017). Living donation takes place when a living person donates an organ (or part of an organ) for transplantation to another person. There are several different types of living donor transplant options: 1. The donor is a family member 2. The donor is not a relative, but is emotionally related to the recipient perhaps a close friend, spouse, or in-law 3. The donor is a stranger to the patient, often referred to as altruistic donation Only one kidney is required to survive (Uptodate, 2017), and Kidney donation is often a safe procedure(de Souza Rodrigues et al., 2017). Living donor transplants may be performed with minimal

9 delay and controlled scheduling, which permits preemptive transplantation (transplantation prior to dialysis) or transplantation early in a recipient s course of renal failure (Uptodate, 2017). Kidney transplantation with living donor organs is associated with longer graft and patient survival compared with deceased donor organs (Maggiore et al., 2017).

10 The Process of Being a Living Kidney Donor and Risks Many people are eligible to donate a kidney, and living kidney donors are a vital part of the kidney transplant process. Only candidates with an apparent low risk of kidney disease are accepted as living kidney donors (Steiner, 2016). Living kidney donors should meet these criteria: Be between the ages of 18 and early 70s Can include parents, children, siblings, other relatives and friends Have a genuine interest in donating Have a compatible blood type with the recipient Be in good general health Typically, a person cannot be a donor if he/she has: Cancer Diabetes Kidney disease

11 Heart disease Liver disease Sickle cell disease HIV or hepatitis In addition, donating a kidney is a major surgery. The risks include the possibility of infection, allergic reaction to general anesthesia, pneumonia, and the formation of a blood clot. The risk of dying from donating a kidney is 0.03%. The risk of serious complications is about 1-2%. Donors commonly have post-operative incision discomfort, constipation, abdominal discomfort, and nausea for the first week or two following surgery. Determining candidacy for live kidney donation among obese individuals remains challenging (Locke et al., 2017). However, living kidney donation benefits recipients and society but carries short-term and long-term risks for the donor. The health risks which donors face are minimal in the long term with respect to renal function, hypertension, and life span(soneji, Vyas, & Papalois, 2008). It should mention that donors in

12 developed countries have a similar life expectancy and quality of life as healthy non-donors. Living kidney donation is associated with an increased risk of end-stage renal disease, although this outcome is uncommon (<0 5% increase in incidence at 15 years). Kidney donation seems to elevate the risks of gestational hypertension and pre-eclampsia (Reese, Boudville, & Garg, 2015). Future studies must clarify the lifetime incidence of long-term outcomes, particularly in relation to a donor's age, race, and history of comorbidities(lam, Lentine, Levey, Kasiske, & Garg, 2015). It is important to know that living kidney donation s risk can be modified, for example, by a healthy lifestyle; by regular medical surveillance of renal function, proteinuria and blood pressure; and by timely and aggressive treatment of newly developed risk factors such as hypertension or albuminuria (Maggiore et al., 2017). ESRD Risk Tool for Kidney Donor Candidates is available in below link:

13 Transplant Process and the Concept of Tissue Typing/Matching Match criteria includes medical criteria like blood and tissue type, as well as length of time waiting, body weight, size of recipient diseased organ, and severity of illness. As a result transplant wait times can vary from a few months to several years because of matching difficulties. There are actually three tests that are done to evaluate donors. They are blood type, cross match, and HLA testing. This blood test is the first step in the process of living donation and determines if you are compatible or a match to your recipient.

14 How Kidney Transplantation Works During a kidney transplant, the surgeon places the new kidney inside lower abdomen and connects the artery and vein of the new kidney to your artery and vein. Recipient s blood flows through the donated kidney, which makes urine, just like own kidneys did when they were healthy. The new kidney may start working right away or may take up to a few weeks to make urine. Unless previous kidneys are causing infection or high blood pressure, they are left in place.

15 History of Living Organ Transplant in British Columbia The first living organ transplant in British Columbia was performed in 1976, when a mother donated a kidney to her daughter. Since then, hundreds of living donor transplants have occurred. In 1999 more kidney transplants were received from living kidney donation compared to deceased donor kidney transplants. Since then, the number of living donor transplants has steadily increased. In early 2001, BC Transplant established a living liver program, and the first of these transplants was performed in March In BC living donor kidney transplants have been performed since 1976, hundreds of live donor kidney transplants have taken place since then("becoming a Living Donor,"). How do you become a living donor in British Columbia? If you are considering being a living organ donor, it s important to educate yourself about the donation process, required testing, financial considerations,

16 risks and recovery. If you decide to be a living kidney donor, you will need to contact transplant centers in your area to learn more about the types of living donor transplants they perform and how to proceed. If you are thinking about being a living donor for someone you know, you should contact their transplant center for more information. All living donation is managed through the appropriate programs at Vancouver General Hospital s (VGH) and St. Paul s Pre-Assessment Transplant Clinics. The referral process includes prescreening, laboratory and diagnostic testing, and evaluation by the transplant teams. You can also contact the Vancouver General Hospital or St. Paul's Hospital Living Donor programs directly for more information ("Becoming a Living Donor,").

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21 Reference: Becoming a Living Donor. Retrieved February 28, 2017, from de Souza Rodrigues, T., Amorim de Albuquerque, A. L., de Oliveira Cosme, F. A., de Oliveira, J. A., Magalhaes, I., Teles, F., & Pedrosa, A. F. (2017). Evaluation of renal function in a specific population of living kidney donors. J Ren Care. doi: /jorc Lam, N. N., Lentine, K. L., Levey, A. S., Kasiske, B. L., & Garg, A. X. (2015). Long-term medical risks to the living kidney donor. Nature Reviews Nephrology, 11(7), Locke, J. E., Reed, R. D., Massie, A., MacLennan, P. A., Sawinski, D., Kumar, V.,... Segev, D. L. (2017). Obesity increases the risk of end-stage renal disease among living kidney donors. Kidney Int, 91(3), doi: /j.kint

22 Maggiore, U., Budde, K., Heemann, U., Hilbrands, L., Oberbauer, R., Oniscu, G. C.,... Abramowicz, D. (2017). Long-term risks of kidney living donation: review and position paper by the ERA-EDTA DESCARTES working group. Nephrol Dial Transplant, 32(2), doi: /ndt/gfw429 Muzaale, A. D., Massie, A. B., Wang, M. C., Montgomery, R. A., McBride, M. A., Wainright, J. L., & Segev, D. L. (2014). Risk of end-stage renal disease following live kidney donation. Jama, 311(6), doi: /jama Parajuli, S., Clark, D. F., & Djamali, A. (2016). Is Kidney Transplantation a Better State of CKD? Impact on Diagnosis and Management. Adv Chronic Kidney Dis, 23(5), doi: /j.ackd Reese, P. P., Boudville, N., & Garg, A. X. (2015). Living kidney donation: outcomes, ethics,

23 and uncertainty. The Lancet, 385(9981), Robinson, B. M., Akizawa, T., Jager, K. J., Kerr, P. G., Saran, R., & Pisoni, R. L. (2016). Factors affecting outcomes in patients reaching end-stage kidney disease worldwide: differences in access to renal replacement therapy, modality use, and haemodialysis practices. The Lancet, 388(10041), Soneji, N., Vyas, J., & Papalois, V. (2008). Longterm donor outcomes after living kidney donation. Experimental and clinical transplantation: official journal of the Middle East Society for Organ Transplantation, 6(3), Steiner, R. W. (2016). The risks of living kidney donation: Mass Medical Soc. Terner, M., Redding, N., & Wu, J. (2016). Increasing Rates of Kidney Failure Care in Canada Strains Demand for Kidney Donors. Healthc Q, 19(3),

24 Tsai, S. F., Shu, K. H., Ho, H. C., Wu, M. J., Cheng, C. H., Lian, J. D.,... Chen, C. H. (2012). Long-term outcomes of living kidney donors over the past 28 years in a single center in Taiwan. Transplant Proc, 44(1), doi: /j.transproceed Uptodate. (2017). D&selectedTitle=2%7E5.