understanding-living-kidney-transplant | Singapore General Hospital

Imagine a symphony where each instrument plays a crucial part in creating harmony. Our body functions similarly, with each organ contributing to the grand performance of life. When kidneys fail, this harmony is disrupted.

When kidneys fail, the delicate balance of our body's internal environment is disrupted, leading to a cascade of health complications. Kidneys, those unassuming bean-shaped organs, play a vital role in filtering waste products, maintaining electrolyte balance, and regulating blood pressure. When they falter, it is critical the treat the kidneys as soon as possible.

Amongst the various available kidney failure treatments, living kidney transplantation may allow for faster and better restoration of health.

If a loved one or someone you know is suffering from kidney failure, read on to enhance your understanding of living kidney donation and learn how you can support those in need.

What is Living Kidney Transplantation?

In a nutshell, living kidney transplantation is a procedure that involves surgically transplanting a healthy kidney from a living donor into the recipient, effectively replacing the non-functioning kidneys.

We are born with two kidneys and can live a normal life with only one kidney. When one kidney fails or is removed, the remaining healthy kidney can continue to function sufficiently to maintain one’s health.

Living vs Deceased Kidney Transplant

The source of a healthy kidney could either come from a living or deceased owner.

There appears to be a declining worldwide trend of deceased donors which results in longer waiting times for patients. Instead, living kidney transplants emerge as the more favourable option of the two. Here's why:

Additionally, a planned timing for surgery allows the medical team to optimise the recipient’s health and ability to receive a kidney from their donor. Most importantly, it allows freedom from dialysis and better quality of life.

Becoming a Kidney Donor

The impact of living kidney transplantation extends far beyond the individual who receives the gift of life. First and foremost, the recipient experiences renewed vitality. Energy returns, daily activities regain their joy, and the burdens of dialysis become a thing of the past. But the ripples of this generosity touch everyone involved.

Loved ones who step forward as donors often find profound fulfillment in their act of selflessness of restoring the health of a loved one. Plus, early detection of medication conditions can allow for one to take preventive action against health risks that arise during assessment.

However, the decision to embark on a living kidney transplant journey requires careful consideration. It's not a choice made lightly. Medical evaluations ensure that both the donor and recipient are suitable candidates for the procedure. Informed consent and open communication between all parties involved are paramount. Donors must be prepared for the physical and emotional aspects of the procedure, while recipients need to commit to post-transplant care and follow-up.

Before volunteering your kidneys to help a loved one in need, do take heed of the following FAQs to better prepare yourself.

Can I Donate My Kidney?

The general criterion are:

Anyone who is 21 years or older. There is no upper age limit.
Tissue and blood type need not match with the recipient.
Normal kidney structure and function.
No significant risk of inheritable kidney diseases.
Blood pressure <140/90 mmHg, with or without low doses of blood pressure-lowering medications.
Not morbidly obese (BMI <35 mg/m2).
No history of cancer, diabetes, heart disease or stroke.
No infections e.g. HIV, Hepatitis B and C.
No active substance abuse.
No intellectual impairment or other mental disorder that will impair the ability to give informed consent.
Not pregnant in the past 6 months nor intending to get pregnant in the next 1 year

What happens if the tissue or blood type is not a match?

Donors who are of different tissue or blood type from their recipients can still donate as the following options are available with modern medicine.

Blood type incompatible donation

Through the process of immune conditioning, a recipient is able to receive a kidney from a donor of a different blood type.

In order to perform such a transplant, the recipient will need to receive additional anti-rejection drugs as well as undergo an additional procedure called plasmapheresis. This removes proteins called antibodies that can cause immediate rejection of the incompatible donor’s kidney. Due to the extra treatments required, ABO incompatible living kidney donor transplantation is more expensive and requires the recipient to stay in hospital for a

longer period of time.

Although the early risks of rejection and infection are higher, ABO incompatible transplants are as successful as ABO compatible transplants in the long term. These overall risks may be relatively small compared to the risks of complications during the long wait for a deceased kidney donor transplant or a lifetime on dialysis.

Paired Kidney Exchange Program

A paired kidney exchange can be done when a living kidney donor has incompatible blood type or tissue matching with the recipient. Another pair facing a similar barrier may be able to exchange donors so that both recipients can receive a compatible kidney.

What are the risks of living kidney donation?

This time, let's talk numbers.

Living kidney donation requires a healthy living person to undergo surgery. The risk of serious surgical-related complications such as those related to anesthesia, re-operation or bleeding is 2%. The risk of death is 0.03%.

Some studies have shown that the long-term risk of kidney failure increases from 0.03 to 0.3% among healthy individuals who are able to donate a kidney. However, this absolute risk is low (e.g. <1%) and it may depend on the genetic relationship to the recipient, lifestyle or the presence of other medical conditions. The risk remains lower than that of the general population.

Living kidney donation does not affect life expectancy, susceptibility to illness, energy levels, ability to work, sexual function or fertility.

How are kidney donors evaluated?

Aside from the medical suitability of the donor's kidney, the following principles are strictly adhered to:

Risks to the donor must be low
The donor must be fully informed of all procedures and implications related to kidney donation
The decision to donate must be voluntary. There must not be any coercion or offer of inducement to
the potential donor
Donation can only be supported if there is a good chance of a successful outcome for the recipient

If you have been deemed a suitable donor for a patient in need, head to Part 2 of our Gift of Life series for a detailed pre-transplant guide.