When You Are Thinking About

Donating Your Kidney…...

A book about living related

kidney donation

50 Charlton Ave East

Hamilton, ON
Canada
L8N 4A6
905-522-4941
www.stjoes.ca

PD 2393 (Rev 01/2008) File: cspears

© 1992-2007 This book was written and produced by
members of the Kidney Urinary Team and the
Department of Educational Services, St. Joseph’s
Healthcare, Hamilton.
All rights reserved

Cover “Heart Ribbon” image used with the kind

permission of Shannon Steffen from
http://www.angelcove.us

PD 2393 Revised May 2007

Page 31

Notes and Questions….. Table of Contents

What do I need to know if I am
thinking about donating a kidney?……………1
Some words you should know………………..2
About donating a kidney...……….…………....3
Types of kidney transplants….……………... ..4
How safe is kidney donation for me?……...…5
What are the advantages of having
a living related transplant?.……………………6
Is there anyone I could speak to
about donating a kidney?..…………………….7
Can I donate a kidney if I am pregnant?..…...7
If you want to be a Donor: getting tested..…..8
Talking to the Transplant Nephrologist..…... 14
How long does the whole process take?..….17
Before the donation…………………………. 17
The day of the transplant ..…………………..18
After your surgery..………………………….. 20
Why are people rejected as Donors?……... 22
What does the Recipient have to do
before the transplant?.................................. 23
Please ask us………………………………... 25
Telephone Numbers…………………………. 26
Nephrologists and Urologists………………. 27
Page 1 Page 30

What do I need to know if I am thinking of Notes and Questions…..

donating a kidney?
The decision to donate a kidney is a personal
one. It should not be made lightly or under
pressure from family members. The Transplant
Team can answer any of your questions and
talk to you about your concerns. Your Family
Doctor may also be a good resource person to
talk to. Your own needs and health are very
important. You should know that all discussions
between you and the Transplant Team and
your Family Doctor are kept confidential. We
want to help you make a decision that is right
for you, not someone else.
Page 29 Page 2

Notes and Questions….. Some words you should know...

A Nephrectomy is the surgical removal of a

kidney by a Transplant Urologist.

A Transplant Nephrologist is a Doctor who

specializes in kidney function, diseases and
kidney transplantation. The Nephrologist will do
a medical assessment before you can donate a
kidney.

A Transplant Urologist is a Surgeon who

specializes in kidney transplants and other
kidney related surgeries. The Transplant
Urologist decides if you are able to have this
type of surgery. The Urologist is the Surgeon
who removes your kidney and looks after you
after your operation.

A Radiologist is a Doctor who specializes in

analyzing x-rays and related tests.

A Recipient is the person who is receiving the

kidney.
Page 3 Page 28

About donating a kidney Notes and Questions…..

When a person’s kidneys do not function, the

person is in kidney failure. A person cannot live
without some kidney function. There are 2
choices for the kidney failure patient:

1. To begin some form of dialysis and/or

2. To have a kidney transplant

Dialysis does require a restricted lifestyle.

Many patients have or develop other health
problems that go along with dialysis, while
others do quite well.

A kidney transplant provides the patient with

the best chance to return to a normal life but
some restrictions still remain. For example, the
person will have to take medication for the rest
of his or her life.
Page 27
Nephrologists
Dr. Arlen..………………………….905-521-6049
Dr. Ludwin..……………………….905-521-6049
Dr. Russell..……………………….905-521-6049
Dr. D. Treleaven…………………..905-521-6049
Urologists
Dr. Kapoor..…………...905-522-1155 ext 33218
Dr. Piercey.……………905-522-1155 ext 34987
Dr. Whelan..…………………..…..905-521-6014
Page 4
Types of kidney transplants
There are 2 types of kidney transplants:
• a deceased donor transplant
• A living or emotionally related transplant
A deceased donor kidney comes from a healthy
person who has suddenly died. The person’s
family have kindly agreed to organ donation.
There are many patients waiting for a
deceased donor kidney. Patients can only go
on the waiting list after they start dialysis.
Patients are put on the transplant list according
to their start date on dialysis.
A living related transplant kidney comes from a
relative in your immediate family. This could be
someone such as a sister, brother, parent,
daughter or son. The best chance of having a
good genetic match are from these relatives.
Page 5
An emotionally related person such as a
spouse, cousin, in-law or friend can also
donate a kidney.
Living Donors must have extensive medical
testing to ensure that they are in good
health and will not be endangered by being
a Donor.
How safe is kidney donation for me?
Living Donors must have extensive medical
testing to make sure they are in good health
and will not be harmed by being a Donor.
Follow-up over many years has shown that the
long-term risks of donating a kidney are very
low. The Transplant Doctor will discuss this with
you at your visit and answer any questions you
have.
Page 26
Telephone Numbers
St. Joseph’s Healthcare……..…..905-522-4941
Direct Line……………………..….905-522-1155
Transplant Unit...………………….…..ext. 34048
Pre-Admission Assessment Clinic….ext. 33830
Departments
Chest and Allergy Clinic……………..ext. 36000
Electro-Diagnostic Services…………ext. 36082
Nuclear Cardiology…………………..ext. 36073
Social Work…………………………...ext. 33101
Diagnostic Imaging…….………….....ext. 36074
Kidney Foundation:
Hamilton Chapter….…………….905-318-8627
Transplant Coordinators
Maria Bennett…………………………ext. 33236
Ron DeNardis………………………....ext. 34289
Tracey Hamilton…………………...….ext. 33193
Melodie Jansen……………………….ext. 33136
Page 25
Please Ask Us
We have a book called “Your Kidney
Transplant” that explains all about the
transplant for the Recipient. Ask your
Transplant Coordinator for this book if you
would like more details at this time.
The Transplant Team is here to answer any
questions you or your family may have. Please
feel free to call and we will try to help you out.
Page 6
Blood Types
Your blood type must match the blood type of
the person you are thinking of donating your
kidney to. The Transplant Coordinator will
explain this to you.
Recipient Blood Type Your Blood Type
O O
A A OR O
B B OR O
AB A, B, AB, OR O
What are the advantages of having a living
related transplant?
The success for a living related transplant is
improved because:
• There is usually a better genetic match.
• The procedure is planned.
• The waiting time for a kidney transplant is
shorter.
• The Recipient can be prepared well before
the transplant with anti-rejection medication.
• The time between the removal of the Donor
kidney and the transplant is very short.
Page 7 Page 24

Is there anyone I could speak to about 10 days before the transplant is scheduled,
donating a kidney? the Recipient may be started on medications.
There are many living related Donors who are The Recipient will also need to have a blood
willing to share their personal experiences with test after starting the medications to check the
potential Donors. level of medication in their blood. The test
must be done at St. Joseph's Healthcare.
If you would like to speak to someone, please
call the Transplant Coordinators and we will
arrange it for you. You may also want to speak The Recipient needs to have a final cross-
to one of the Transplant Coordinators or match blood test at 7:15 am at the St. Joseph’s
Transplant Nephrologists. Healthcare Pre-Admission Assessment Clinic.
It is done 48 hours to 1 week before the
transplant.
Can I donate a kidney if I am pregnant?
The day before the transplant the Recipient is
If you are pregnant or think you could be
admitted to the Transplant Unit around
pregnant, let a Transplant Coordinator know.
1:00 p.m. under the Nephrologist and
Pregnancy affects many parts of the body
Transplant Surgeon’s care. The surgery takes
including the kidneys. Pregnancy can cause
place when the Donor’s surgery is finished.
false results on some of the kidney function
tests so you must wait at least 6 months after
delivery to begin testing. Being pregnant does
not mean you cannot be considered as a
donor. It just means that we need to delay
some of the testing.
Page 23
• A cross-match will be done 3 times during
your transplant work up. If any one of these
cross-match results are positive, you will not
be able to donate your kidney.
• The Donor’s blood supply to the kidneys
could be complex, which would make a
nephrectomy a very difficult surgery. The CT
angiogram films are carefully reviewed by
the Transplant Urologist, the Transplant
Nephrologist and the Radiologist.
What does the Recipient have to do before
the Transplant?
About 1 month before the scheduled
transplant, the Recipient will meet with the
Transplant Coordinator. This meeting reviews
what happens to the Recipient before, during,
and after the surgery. The Recipient is
encouraged to bring a significant other, family,
or friend to this meeting. Members of the team
also meet with the Donor at this time.
Page 8
If you want to be a Donor: getting tested
If you have decided that you would like to
consider being a Donor, there are some steps
that you will follow. All information is
confidential between you and the Donor
Transplant Team.
You have the right to change your mind
about being a Donor at any time along the
way.
Testing your blood
This is a blood test that finds out what blood
group you are. If you already know your blood
group, just tell us and we will let you know if
you can move to the next step or not. If you do
not know your blood group, the test can be
done through St. Joseph’s Healthcare or your
Family Doctor’s office. If your blood group is
compatible with the Recipient’s blood group,
then you have more blood tests.
Page 9
The next tests are called HLA + DR + DNA
typing and cross-match. Seven tubes of blood
are taken using 1 needle puncture. The blood
needs to be drawn in the morning at St.
Joseph’s Healthcare. It can be done at another
Transplant Centre if you live a distance away.
The HLA + DR + DNA typing is done to test
your genetic match with the Recipient.
During the cross-match, your blood is mixed
with the Recipient’s blood. If a reaction occurs
between the blood, this is called a positive
cross-match. When this happens the chances
of your kidney being rejected by the Recipient’s
body is very high. This means you would not
be able to be a Donor.
If there is no reaction, this is called a negative
cross-match. When you have a negative
cross-match, you can move on to the next
set of tests. The Transplant Coordinator will
call the Donor with the cross-match results.
Page 22
There will not be any changes to your lifestyle
after you have donated a kidney. Many people
have commented on how normal they feel after
the donation.
There may be some contact sports you should
not take part in any longer. The Transplant
Surgeon can advise you.
You should have a yearly check-up through
your Family Doctor including a blood pressure
check, urinalysis, urea, and creatinine blood
tests.
Why are people rejected as Donors?
Many people are turned down as Donors
because of abnormal test results. This is to
decrease the risks to your health. It is very
upsetting to go through the testing and to be
turned down. Please remember the Transplant
Team is here to answer any questions or
discuss any of your concerns. Some of the
reasons Donors have been turned down are:
• If your blood group does not match with the
Recipient’s blood group, you cannot donate
your kidney.
Page 21
You will be in the hospital for 3 to 4 days. The
Transplant Surgeon will see you after your
surgery in his/her office. If your sutures or
staples have not been removed in the hospital,
they will be taken out at this time, or you can
arrange for your Family Doctor to do this.
You will need some help around the house
when you return home. Try to make
arrangements for this before you come to the
hospital. You will need to take about 4 to 6
weeks off from work including the time in the
hospital.
If you need any help with insurance forms
please let the Transplant Coordinator know and
he/she will have them completed by the Doctor
and returned to you as soon as possible.
Page 10
The next set of tests
These tests will be arranged through the
Transplant Coordinator’s office. Please let our
office know any dates that would be better for
you for any of the tests and Doctors’ visits.
If you would like to meet with the Nephrologist
before starting the testing the Transplant
Coordinator can arrange this.
A series of laboratory and x-ray tests will be
done to screen for kidney function, liver
function, hepatitis, and other viruses or
infections. A 24 hour urine collection shows if
your kidneys are functioning normally.
A chest x-ray and an electrocardiogram (ECG)
make sure that your lungs and heart are
normal.
Other tests may be needed depending on the
results of these tests.
Page 11
Do I need to fast for the blood tests?
Fast means that you cannot have anything to
eat or drink for a number of hours before a
blood test.
The Transplant Coordinator will send you a
letter that tells you what blood tests you need
to fast for. Some of the blood tests are done 2
times so there are 2 results at least 1 week
apart.
The first set of blood tests
The night before the first set of tests:
• Do not eat or drink anything after 8:00
pm
• Do not eat or drink anything in the
morning.
Come to the Outpatient Department at St.
Joseph’s Healthcare. You will have your blood
tests taken here.
The Transplant Coordinator also meets with
you during the morning to explain the tests and
answer any questions that you may have. Your
blood pressure will also be checked at this
time.
Page 20
Do not be afraid to ask for medication when
you need it. Pain medication will be given by
IV through a self administration system which
will be explained to you by the Anesthetist and
the Nurses. When you feel well enough to eat
and drink, your pain control will be changed to
a pill.
After your surgery….
The day after your surgery you will be
encouraged to get out of bed and sit in a chair.
Your Nurse or Physiotherapist will help you at
first. Take your time, as it is normal to feel
dizzy. The catheter is usually removed 24 hours
after your surgery so moving will become
easier after that.
You will be able to visit the Recipient within a
couple of days after the transplant. It is good to
go with someone and in a wheelchair, at least
the first time. Please check with the Nurses
before you leave the unit.
The telephone by your bed is available for you
to use after you pay a fee to St. Joseph’s
Healthcare. You can arrange this on your
admission day or a friend or family member can
do this for you later.
Page 19
You may be given a medication to help you re-
lax about an hour before your operation. The
transplant nephrectomy is usually scheduled at
8:00 a.m. or 9:00 a.m. The operation takes
about 3 to 4 hours.
Then you will go to the recovery area for 1 to 2
hours. You are then taken to your room on the
Urology Unit. You will be cared for by the
Transplant Urologist or Urology Resident and
the Urology Nursing Team.
When you wake up you will have the IV in your
arm. The IV stays in until you are able to drink
a lot of fluids. You will have a catheter in your
bladder. This is a long tube that drains your
urine from your bladder to a collection bag. It is
put in at the beginning of your surgery when
you are asleep. You will be uncomfortable from
the surgery. There is medication to help ease
the pain.
Page 12
24 Hour Urine Collection
Two 24 hour urine collections are needed for
your transplant work-up. Collections cannot be
completed on consecutive days. They must be
done at least 1 week apart.
Women cannot do 24 hour urine collections
when on their menstrual cycle.
1. Collect urine for exactly 24 hours.
2. Start the collection on the first day at
_____am. Remember: discard the first
urine of the day.
3. At exactly the same time the following
morning put your first morning urine sample
in the collection container. Your 24 hour
urine collection is now complete.
4. Keep the jug in a cool place during the
whole collection.
5. Label the jug with your name, the date and
time you started the collection and the date
and time you finished the collection.
6. Bring the jug into the laboratory along with
the requisition the same day you finish
collecting the urine.
Page 13
You will need to have a blood test done when
each of the 24 hour urine collections are
returned to the laboratory.
7. If you have any questions about any testing,
please call the Transplant Coordinators’ office
at 905-522-1155 ext 3161.
Social Work
As part of the work-up a Donor meets with a
Social Worker. During the meeting the Social
Worker talks about the transplant, motivation to
donate, wage replacement and any other
concerns you may have.
Seeing the Transplant Nephrologist
You are now ready to see the Transplant
Nephrologist.
This Nephrologist will be a different one than
the Recipient has seen. The Transplant
Coordinator will arrange this appointment for
you. During this visit you will:
• Give a detailed medical history
• Have a physical exam
• Talk about the risks and benefits of donating
a kidney.
Page 18
We will tell you what happens when you come
to the hospital for the surgery and when you
can expect to go home. This meeting usually
includes the Recipient and interested family
members. It takes about 1 hour. Your blood will
also be drawn on this day for a pre-final cross-
match.
Up to a week before the transplant…..
Up to a week before the transplant you will
come to the Pre-Admission Assessment Unit at
the hospital. Your blood will be taken for a final
crossmatch and your surgery will be confirmed.
The Team will ask you questions and answer
any questions you may have.
You will not be allowed to eat or drink
anything after midnight before your surgery
The day of the transplant…..
The morning of the transplant you will be
admitted to the Day Surgery Unit under the
Transplant Urologist’s care. You will have an
intravenous or IV started in your arm. This is a
thin tube used to give you fluids and
medication.
Page 17 Page 14

We will also let your Family Doctor know the
transplant date. If you want your test results
sent to your Family Doctor please let the
Transplant Coordinator know and he/she will
arrange this.
This meeting takes about 1 hour. You are
welcome to bring a friend or family member
with you to this meeting. The Recipient does
not come to this meeting. The Nephrologist
may order some further testing at this
appointment as well.

A Psychiatrist is a member of the Transplant

Team that you may meet during the transplant
work-up process.
.
How long does the whole process take?
It usually takes 6 months to 1 year to complete
the Donor’s and Recipient’s work-up before we
can schedule the transplant. We understand
that this length of time is frustrating, but careful
monitoring of all results is an absolute
necessity. Remember, we have the Donor’s
and Recipient’s safety in mind at all times.

Before the Donation

About one month before the transplant.…

You will meet with the Transplant Coordinator.
You are encouraged to bring a significant other
person to this meeting.
Page 15
Once the Nephrologist clears me medically,
what is the next step?
The Transplant Coordinator contacts you to
arrange a CT angiogram. This procedure is like
an x-ray. A special dye is injected into a vein in
your arm and then you are scanned in a special
machine.
This angiogram allows the Surgeon to look at
your kidneys. It shows how many kidneys you
have, (most people have 2), how the blood
supply is and how many arteries and veins go
to each kidney. It will also shows how the
ureters drain urine from the kidneys into the
bladder.
This test provides information so that we may
determine if a transplant is possible and if so,
which kidney to use.
Page 16
Talking to the Transplant Urologist
You will then see the Transplant Urologist. The
Urologist is the Transplant Surgeon. He/she will
review the CT angiogram and discuss any
surgical risks with you. He/she will inform you
of the type or surgery you will have done
Reviewing your file
Your file will be reviewed often as you go
through these tests. Is may be necessary to
repeat some tests or do some others. This
depends on your special circumstances. If
everything has been satisfactory, you will be
accepted as a Living Related Donor by your
Transplant Nephrologist
Planning the transplant
Once the Transplant Urologist and the
Transplant Nephrologist have accepted you as
a Living Related Donor, the Transplant
Coordinator will schedule the Transplant. We
take into account your work and personal
obligations and schedule the transplant at a
time most convenient to you. Most often, the
transplant will be scheduled 1 to 2 months
ahead. We will contact the Donor then the
Recipient about the transplant date.