Donor Medical Evaluation
The purpose of the donor medical evaluation is to make sure that donation will not pose any unusual risk to you during the procedure, or risk to your future health.
Once we are informed of your interest in donation, we will ask that you complete a health questionnaire. It is very important that you are completely honest in answering these questions. The information you share will be kept confidential. The living donor nurse will review the information on your questionnaire and contact you to discuss donation in more detail.
You will be required to have medical insurance and establish with a primary care doctor before starting a donor evaluation to ensure continued medical follow-up after donation.
Once the nurse coordinator has cleared your questionnaire, blood typing and crossmatching will be done. The lab needs blood from both the donor and the recipient to do the test. The quickest way to get it done is for the donor and recipient to go to the lab together. If that is not possible, your visit to the lab must be coordinated with the recipient blood draw.
When compatibility is confirmed, blood and urine tests will be done to evaluate general health and kidney function. If these results are normal, the donor will be scheduled for a visit to the transplant center for a series of appointments and medical tests. The evaluation testing at the transplant center takes one to two days, depending on donor age. The evaluation for living donation includes:
History and Physical
The history and physical is like an annual visit to the doctor. The doctor will go over the information on the health questionnaire and do a physical exam. The purpose of the exam is to determine whether your general health is good and there are no unusual risks to donation.
During the psychosocial interview you will talk with the clinical social worker who serves as the independent donor advocate. This visit is a very important part of the living donor evaluation. The goals of the psychosocial interview are:
1. To review the nature of the relationship between donor and recipient.
2. To explore the reason for donation and to be sure that the donor is free of undue pressure to donate.
3. To be sure there are no social or mental health issues that might make the recovery from living donation difficult.
4. To decide if the donor needs additional education or other treatment before making the final decision to donate.
5. To determine that the donor understands the short and long term risks of living donation for both the donor and the recipient.
6. To make sure the donor is capable of making the decision to donate and cope with the stress of a major surgery.
7. To make sure the donor knows that their evaluation is confidential and they may decline at any time.
8. To check for high risk behavior that might risk giving an infectious disease to the recipient.
9. To check for history of smoking, alcohol and drug use/ dependence.
10. To be sure the donor understands it is against federal law to receive anything of value in return for donating a kidney (money, gifts, etc.).
11. To discuss how donation might impact the donor’s job or family relationships.
12. To explore current / past history of psychiatric disorders and treatments.
13. To review the donor’s job and insurance status and financial impact of donation.
14. To review the donor’s living arrangement, to determine that the support systems are in place and the donor has a realistic plan for recovery.
15. To explain the requirement for 6, 12 and 24 month follow up after donation, and to confirm the donor’s commitment to participate in the follow up
If you have a history of depression, anxiety or any past psychiatric diagnosis or have ever taken medication for any of these problems, you may be asked to see the transplant psychiatrist.
You will have a consultation with the dietician to evaluate for diabetes risk and discuss ways to maintain a healthy weight after donation.
Included in the schedule of appointments during the evaluation is a presentation by the living donor nurse coordinator. This one hour class provides education about all aspects of living donation. This class is open to all who wish to attend (family and friends) and is an opportunity to ask questions in an informative and relaxed setting.
Many blood tests will be done to give us general information about your overall health.
A urine test will be done to check your urine for obvious signs of kidney disease or infection. In addition, you will be collecting your urine at home for a 24 hour period. This collection will give us much more information on the function of your kidneys. When you turn in the urine collection, your blood will also be drawn.
The EKG is done to evaluate the whether the heart rhythm is normal and if there may be previous heart injury.
If a donor is over the age of 50, more extensive testing is done to rule out heart disease. Usually this is an exercise test during which you walk on a treadmill while the heart is monitored.
A chest x-ray will be done to rule out lung disease or lung tumors.
Donors over the age of 50 will need to have a colonoscopy or sigmoidoscopy to rule out colon cancer. This is a routine part of health maintenance and is recommended for all adults. This test should be done through your primary care doctor.
This test, also known as a CAT scan, is done to evaluate the anatomy of the blood vessels going to and from the kidneys and to screen for kidney stones. This test helps the surgeons decide which kidney to remove.
During this test an IV line will be placed and a contrast iodine solution will be injected into your IV to help show the vessels clearly. The contrast solution will give you a “warm all over” feeling when it is injected. This procedure takes about an hour.
Pap Smear and Mammogram
Female patients will need a pap smear and mammogram as recommended by the American Cancer Society. These tests are a routine part of healthcare maintenance and should be arranged through your primary care doctor.
When all of the evaluation studies are completed, the results will be reviewed by the transplant team. Once approval is given by the team, the surgery can be scheduled.