MEDICINE FOR ALL

DONOR AND RECIPIENT MATCHING

Blood group

If your transplanted kidney comes from a deceased donor, the ordinary blood groups (A,B, AB O) and red blood cells of the donor must be compatible with yours. This is similar to matching blood groups for a blood transfusion. We all have antibodies to blood groups different to ours.

If your transplanted kidney comes from a living donor it may be possible to have the transplant even if you and your donor are not from a compatible blood group. This is called an ABO incompatible transplant. Extra treatments will be needed to remove the antibodies before the transplant can go ahead.

How are kidneys matched and allocated?

Kidney donor and recipient matching can be divided into several areas. These areas  include blood group matching, tissue type matching, cross matching and survival matching. This involves the assessment of how long a certain kidney is likely to last. It also involves allocating kidneys partly based on how long different recipients are likely to survive.

For these reason, allocation and acceptance of a kidney offer needs to consider compatibility, your waiting time and the quality of the kidney being offered and its likely benefit to you.

A computer can manage  of these factors. Your doctors will also need to consider other issues and possibly discuss these with you if needed.

Each area of compatibility is impotant for donor and recipient matching for both living and deceased donors.

If you are receiving a kidney from a living donor  it may be possible to get around some of these matching issues. For example, it may be possible to prepare your immune system so that you are able to receive a kidney that would have been incompatible.

Deciding whether to accept the kidney

Once you have received the phone call that there may be a kidney available for you, there may be further issues to think about. Your doctors will need to assess the compatibility, the safety, as well as the quality (likely survival) of the kidney that is being offered for donation.

Some of these issues may involve possible risks to your health. For example, it is discovered that the donor had suffered from cancer or other infection.

In recent years there are more kidneys coming from elderly donors who may had illnessess such as high blood pressure, diabetes or a history of smoking. In some cases, donors may have had a history of taking illegal drugs.

All these factors need to be taken into account by your doctors or by yourself. The quality of the kidney being offered may also influence the decision to go ahead with the transplant.

You may have to decide whether it’s best to accept an immediately available, but less-than-ideal deceased donor kidney or take the chance and wait for a healthier one in the future.

What happens when a deceased donor kidney becomes available?

When a kidney from a deceased donor becomes available for transplantation a number of laboratory tests are done. These tests include tissue typing and cross matching. The tests are done to work out who would be the best match for the kidneys.

Once the laboratory tests have been completed the organ donor coordinator will receive a list of potential recipients. They will then contact the transplant unit responsible for the first potential recipient on the list.

If you are selected to receive a kidney from a deceased donor the hospital will contact you.

Stay healthy while waiting for your kidney transplant by:

• Keeping to your regular dialysis schedule
• Following your recommended diet and fluid restrictions
• Taking your medications as prescribed
• Controlling your weight with  diet and physical activity
• Visiting your dentist regularly to watch for any infections
• Protecting your skin, which will help to prevent skin cancer after your transplant
• Being a non-smoker
• Keeping your vaccinations up to date
• Avoiding blood transfusions if possible

Staying healthy while waiting for a kidney transplant

To give  your transplant the best chance of success, it is important that you look after your self while you are on the transplant waiting list.

You will also need to provide routine tissue typing and antibody blood tests every one to two months. This allows current samples to be used in the cross match tests. Small amounts of these samples are sent in case a donor matches with you. If you do not do these blood tests, the laboratory will not be able to assess your compatibility with a donor and you may miss an opportunity. You will also have regular reviews where you can discuss any concerns about your transplant preparation.

Transplant waiting list

When you have been evaluated as being suitable for a kidney transplant your name will be placed on the transplant waiting list to receive a kidney from a deceased donor. You will be referred to as being active on the transplant waiting list.

You will only be activated on the transplant waiting list for a deceased donor once you have started dialysis. This doesn’t mean you still can’t look into having a transplant from a living donor. If you have started dialysis you can go on the transplant waiting list while you are waiting to see if you have a compatible living kidney donor.

If your health gets worse while you are waiting for a kidney, you may be temporarily taken off the active list. This is because your transplant would have less chance of success if you are not well. Once you are well you will be active on the waiting list again.

The kidney transplant waiting list is not just a queue where you slowly work your way to the front. Each time a deceased donor kidney becomes available a recipient is chosing taken  into account a number of factors. A computer generates a score for these various factors, and the recipient with the highest score will be offered the kidney.

Your waiting time is based on the day you started dialysis, regardless of when you were officially placed on the waiting list. If you come off the waiting list for any reason the same “dialysis start” date is used when you become active on the list again. This means that you do not lose your accumulated waiting time

If you are receiving a second, third or even fourth transplant, your waiting time is based on the date that dialysis was re-started after your transplanted kidney failed.