Kidney and pancreas transplant surgery

• A commitment to taking care of your health after donation. It's strongly recommended that you are seen every year by your doctor after donation.

• A willingness to voluntarily donate a kidney

• Free from diabetes and cancer

• Nonsmoker

• Normal blood pressure or no more than one or less medications to control blood pressure

• Not significantly overweight with a body mass index (BMI) of 35 or less (less than 25 is fit)

• Over the age of 18

Testing to see if you are a match will first need to be done. This will involve blood testing. Once that is completed, we will need to determine that you are physically healthy enough to donate. This will typically include:

• A chest X-ray

• An appointment with the donor advocate

• An appointment with the donor surgeon

• An appointment with the nephrologist (kidney specialist)

• An appointment with the social worker

• An EKG or electrocardiogram of your heart

• An MRI (magnetic resonance imaging) of your kidneys — similar to an X-ray

• Blood and urine testing

• If you are female and over 20 years of age, you will need a Pap smear; if you are over 40 years of age, you will need a mammogram (if you have had these done within the last year, please let us know as you will not have to repeat them)

Additional testing may be requested by the nephrologist or surgeon. If you have abnormal test results, you may be referred back to your own doctor for a thorough evaluation.

The donor should not incur any direct costs for donation. The testing, the preoperative appointments, the hospitalization, the surgery and one to two postoperative visits will be paid either by Medicare or the recipient's insurance. Insurance coverage varies greatly.

The costs a donor may incur are:

• Expenses related to another health concern that may be identified during the evaluation process will not be covered by the recipient's insurance or Medicare.

• There is some financial assistance offered for housing and travel expenses if the donor meets the qualifications; please discuss this with the transplant coordinator to see if you may qualify.

• Those associated with lost wages due to time off from work for testing and surgical recovery (approximately three to four weeks after donation).

• Travel and housing expenses if the donor does not live in the area.

We are responsible for ensuring that you are well-informed about your decision to donate. We need to be sure you are aware of all of the potential risks and benefits of donation. Education is also a very important part of this process. We want you to know your health and well-being is as much of a concern for us as the recipient's health and well-being.

The following is a list of some of the information that will be reviewed with you.

• The fact that we will be in contact with you over the two years after your donation to collect data that we are required to provide to the United Network for Organ Sharing (UNOS).

• The potential recipient's medical options other than transplant.

• There are some potential medical, financial and psychosocial risks associated with donation. These will be discussed with you on an individual basis in your appointments at the transplant center.

• The type of surgery that will be performed, how long you will be in the hospital and what the typical follow-up after surgery will be.

• This is a process. There will be many tests done to ensure that you are safe to donate. A surgery will not be planned until the majority of the testing is completed.

• You may at any time in the process decide not to donate.

• You understand that this is a completely confidential process. We cannot discuss your results with anyone else unless you give us permission to do so.

Live kidney donation is the donation of a kidney from a live person to a patient whose native kidneys are no longer working. Sharp has a living donor team dedicated to facilitating and walking patients and their donors through the process of transplantation.

Living kidney donation is rightly named the "gift of life". Without a healthy living donor, the potential kidney recipient waits years for a deceased kidney donation. Donors are able to make an immediate and dramatic impact on another person's life. There are tremendous physical and emotional benefits for kidney recipients once they are off dialysis.

Live kidney donation has increasingly become more common due to the very long waiting time for a deceased kidney. Currently, the wait time in San Diego is five to ten years, depending on your blood type. Other advantages include:

• Kidneys from a living donor usually function more quickly because there is less delay between removing the organ and transplanting it.

• Living kidney transplants typically last longer than transplants from a deceased donor.

• The ability to donate a kidney to a person in need can be a very positive experience.

• The transplant surgery can be scheduled for a time that is convenient for both the recipient and donor.

• Transplants can greatly improve a recipient's quality of life; if it is able to happen more quickly for them, they will realize more of a benefit.

• Living related kidney donors: A blood relative of the person who is waiting for a kidney transplant such as a sibling, parent or child.

• Kidney donor chain: A nondirected, or altruistic, kidney donor volunteers to donate a kidney to an unknown recipient who has an incompatible donor. That recipient's donor then donates to a different recipient who also has an incompatible donor. This starts a chain that can continue indefinitely. This helps to increase the number of transplants that occur throughout the nation and also to reduce the waiting time for the recipient.

• Living unrelated kidney donors: A person who is emotionally connected to the person who is waiting for a kidney transplant such as a friend or a spouse.

• Paired kidney donation: A donor/recipient pair who are not compatible are matched to another donor/recipient pair who are also not compatible.

A live donor can be a family member or a friend. The donor must be in good health and not have high blood pressure or diseases like diabetes, cancer and kidney, heart or blood disease. Also, the donor's blood type much match the recipient's.

A crossmatch between the recipient and the donor will be completed to determine if the donor is compatible. This is a test that determines blood compatibility by mixing blood samples from the donor and the recipient. A positive blood crossmatch means the donor and recipient are not compatible for transplantation. A negative blood crossmatch means they are compatible and the transplant workup may proceed.

Though the donor will only have one kidney operating after the procedure, the risks are minimal — with the remaining kidney taking on the responsibilities of both. The donor will experience some pain and discomfort after the procedure, but will otherwise be able to resume normal activity with no lifestyle changes. As with any major surgery, there is always a risk of complications.

Have your donors come to the evaluation process, if possible. If they meet the minimum requirements for donation, they may be able to have some initial lab work done on the same day as the recipient's evaluation. This also is a good opportunity to thoroughly discuss the kidney donation process with the potential donor.

Potential donors living at a distance can usually be tested near their home and then come to San Diego for the surgery. Talk to your coordinator about arrangements. After lab test results are received, Sharp Transplant Center will determine who is best suited based on genetic match and the individual's health and willingness.

The selected donor will need to be evaluated medically and psychosocially. If that donor is approved, surgery will be scheduled. Several potential donors may need to be evaluated before a suitable donor is identified.

• A kidney exchange consists of two or more donor/recipient pairs whose blood types or blood cross matches are not compatible. In the first pair, Recipient 1 is not compatible with Donor 1. In the second pair, Recipient 2 is not compatible with Donor 2. However, Donor 1 is compatible with Recipient 2 and Donor 2 is compatible with Recipient 1.

• Matching occurs within our transplant center and with many other transplant centers in the United States. The donor kidney may be shipped to corresponding hospitals or the donors may be asked to travel. This is discussed at the initial education session and when a match is found.

• Sharp Kidney and Pancreas Transplant participates in a Living Donor Kidney Exchange Program. Many patients come to Sharp with kidney donors only to discover that they are incompatible. The Living Donor Kidney Exchange Program involves the matching and exchange of kidneys between parties who are compatible with each other.

• Upon comprehensive evaluation by the kidney transplant team, compatible willing donor/recipient pairs are matched for a kidney exchange.

Following an initial review, kidney transplant donors interested in live kidney donation will partake in the following evaluation process:

1. The donor's blood is tested against the recipient's blood to determine compatibility.

2. If compatible, a complete set of blood tests are done to rule out the possibility of disease.

3. If the above-mentioned tests are normal, the donor will be evaluated by an independent living donor advocate who is also a nephrologist, and will also be seen by the transplant social worker.

4. Once cleared by the living donor advocate, the donor will be scheduled for additional testing.

5. If the testing is normal, the donor will meet with the surgeon.

6. The donor will have several presurgical appointments approximately one week before the surgery; the day before the surgery, donors will follow a special diet.

7. The donor and the recipient will be admitted to the hospital on the morning of the surgery.

The recipient's insurance policy typically covers donor costs. There may be circumstances, however, in which this is not the case. If this should occur, Sharp Transplant Center may be able to assist. These situations will be discussed on a case by case basis with the transplant staff prior to surgery or testing.

No, compensation for organ donation is illegal.