Live Kidney Donation

LD and deceased renal transplant activity

0

50

100

150

200

250

72 75 78 81 84 87 90 93 96 9920

0220

0520

0820

11

Year

Kid

ney

Tra

nspl

ants

LD

Deceased

StatisticsStatistics

Deceased Donors/Transplants in Ireland

(Organ Procurement Centre)

0

100

200

300

400

500

600

700

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

TransplantsDonorsWaiting List

Live Donation

� Directed Donors – Genetically related -Family member

– Emotionally relate -Spouse, Partner, Friend

� Non Directed Donors– Paired Donation

– Altruistic Donation to the pool

Indications for Live Donation

� Meet organ donor shortage

� Length of time on pool

� Pre-emptive / Elective

� Paediatric Recipients

� Recipients with high PRA

� Better Graft & Patient Survival Rate

Live Donor Transplantation

� No risk to the potential donor

� The decision to donate must be voluntary

� The transplant must have a good chance of

providing a successful outcome for the recipient.

Ethical Considerations

� Exposes an otherwise healthy person to the risks of

major surgery and life with a single kidney entirely for

the physical benefit of another individual.

– Follow International Standards

– Consensus committee - all cases discussed

– Independent Ethics Forum

Evaluation of potential living donor - “First do no harm”

Stage1

– Identify Potential Donor

Stage 2

– Independent Medical & Psychological assessment

Stage 3

- Surgical Clearance

Donor Selection

� Self referral to Transplant Co-ordinator� Potential Recipient deemed fit for Transplant � Ascertain blood group compatibility� Complete Health & Lifestyle Questionnaire� Information booklet & Video� OPD to meet Transplant Coordinator +/- Tissue Typing

� Donor selection –� Results given individually to all potential donors� Optional Family meeting� Only one goes forward for further testing

Potential Donor Assessment

� Full medical - Independent Nephrologist

� Blood & Urine tests

� Further H&I screening

� XRays/Ultrasound/CT Angio

� Psychological Assessment

� Competent and willing to donate

� No coercion

� No underlying issues

� Surgical Assessment

� Surgical Review

� 3rd & Final Xmatch

� Explanation of Procedure

� Plan time for Surgery

Donor Work –up Period

� 12 weeks work up period approximately

� No pressure at any stage of process – donor dictates

� Confidentiality assured throughout the process

� Recipient remains on transplant pool until donor work up

complete.

Live Donor Recipient

� Recipient meets with recipient surgeon during the advance stage of donor work up

� Patient remains under the care of own nephrology team

� Feeling of isolation for some recipients

� Reviewed by multidisciplinary team prior to surgery– 3rd & Final Xmatch– Consent for surgery– Prescription to start Immunosuppressive meds 48hrs prior to Op

Donor & Recipient Operations

� Admission for Surgery

� Donor Nephrectomy &

Renal Transplant –

adjoining theatres

� Update surgical Teams

during surgery

� Liaising with the family

� Supporting relatives

Unsuitable Cases for Live Donation

� Fall off rate– 100 potential cases result in only 20 donation

� Medically unsuitable� Immunologically incompatible� Donor Opt Out� Recipient become unfit for surgery

� Counselling and support for unsuitable donors

Paired Exchange

� ABO/ Immunologically Incompatible Donors

� Agreement between Ireland and UK

� E112 funding

Paired Exchange

� Donor work up

� Recipient & Donor referred to UK

� 2 donors per recipient are accepted

� Suitable Pairs are entered into a paired exchange run in The UK (UKTS) 3monthly

� All donor operations must start at same time

� Anonymity is maintained

Donor 1

Coventry

Irish Pair

Recipient 2

Hammersmith

Recipient 1

Coventry

Irish Pair

Donor 2

Hammersmith

Donor 3

Glascow

Recipient 3

Glascow

Three WayExchange

The Future For Live Donation

� Increase Number of Live Donor Transplants�

� More Resources

� Financial Support for Potential Donors

� Altruistic Donation (non directed )

� Repatriate Paired Exchange Programme

Successful TransplantationSuccessful Transplantation

Thank You to My Donor

The Irish Team won

50 medals

Gold 14

Silver 15

Bronze 21

You have all

contributed so much

to this

THANK YOU