Everything you need to know about living kidney and living liver donation
Nationwide, the demand for organs from deceased donors far exceeds supply. In the United States, the two organs in the greatest need are kidneys and livers. Approximately 90,000 patients in the United States need a kidney transplant, and 11,000 need a liver. But in 2021, only 18,699 kidneys and 569 livers were transplanted from deceased donors.
With the vast shortage of organs, those in need of a kidney or liver transplant have another option — to receive a transplant from a living donor.
The first living kidney donation in the United States — in which a healthy person donates one of their kidneys to a recipient — happened in 1954. While initially experimental, living kidney donation now makes up a third of all kidney transplants in the nation. But it wasn’t until the breakthrough of laparoscopic donor surgery, performed at Ohio State since 1999, that living kidney donation really expanded. On the other hand, living liver donation is a relatively newer procedure, first occurring in the United States in 1989.
At Ohio State, we performed our first living liver donor transplant in 2018, and now with the help of imaging software and 3D modeling technologies, have a highly accurate understanding of donor and recipient anatomy to make these surgeries routinely successful.
Across the country, transplant centers are still grappling with a low supply of available deceased donor organs. To offset this need, The Ohio State University Wexner Medical Center developed a robust living donor program for our Comprehensive Transplant Center, simultaneously creating the infrastructure and adding the medical talent needed to safely perform these operations. We're encouraging those in our community to consider living donation to potentially save a life.
- Question What is living organ donation?
Living organ donation occurs when a healthy person donates either one of their kidneys or a portion of their liver to a recipient with end-stage kidney or liver disease.
For living kidney donation, a healthy individual can donate one of their kidneys and still live a normal life as their remaining kidney enlarges to accommodate the body’s needs very well. For living liver donation, a donor gives a portion of their liver, up to 70%, to their recipient, which then grows back to about 90% of its original size in two to nine months in both the donor and the recipient. In both instances of donation, the surgeries typically occur at the same time in adjacent operating rooms to ensure the health of the donor organ and a quick transfer to the recipient.
According to the Organ Procurement and Transplantation Network (OPTN), 16% of all transplanted organs in the U.S. in 2021 were from living donors. These donors are truly heroes, making a major sacrifice to save another person’s life. And while we’re on the right track, we still need more living donors to meet demand here and across the country.
- Question Are organs from living donors better than deceased donors?
In general, yes. If available, a living donation is often the best option for the recipient. Since the entire medical history of the donor is understood, we know to the best of our ability that the donated organ is of high quality.
Also, with surgeries happening simultaneously, organs spend very little time outside the body before being transplanted, so they begin working faster in their recipient for better outcomes.
For patients in need of a kidney, living donation is the fastest option to transplant, as candidates can wait years until a matching deceased donor kidney becomes available. Living kidney donation surgery can be scheduled when the recipient is at their healthiest, often within months, and can potentially avoid dialysis.
Finally, kidneys from living donors last nearly twice as long as kidneys transplanted from deceased donors. At Ohio State Wexner Medical Center, we have patients celebrating more than 40 years with their living donor kidney.
Living liver donation is also the better and recommended option for recipients, but not always the fastest. Unlike patients with end-stage kidney disease, who can go on dialysis until a kidney becomes available, liver patients don’t have this option. Depending on disease progression, liver patients could need a new liver within days to weeks. If liver disease is caught early enough for a living donor to be identified, the primary advantage is to enable scheduling of surgery before the recipient becomes too sick.
- Question Donating a kidney or liver sounds scary. Is it?
That depends on how the donor feels about undergoing a major surgery. It’s important to note that living donation is 100% voluntary, and the donor can stop the process at any time up until surgery. The preparation process deliberately includes several consultations, not only with our doctors and nurses, but also transplant psychologists, social workers and living donor advocates, to ensure all questions are answered and fears addressed.
Of the two donation surgeries, living kidney donation is considered a low-risk procedure, lasting two to three hours. It is also performed laparoscopically by making two small, half-inch incisions under the rib cage, along with a 4-inch incision below the belly button to remove the kidney.
Liver donor surgery is a more complex procedure, lasting 4-6 hours. It requires an 8- to 10-inch vertical opening in the lower abdomen to reach the portion of the liver being donated.
Following either procedure, donors are encouraged to get up and walk the day after surgery. But while kidney donors usually go home on their second hospital day, liver donors typically stay five to seven days for recovery.
- Question What are the risks of donating a kidney or liver?
There are of course inherent risks with any surgery. However, complications for the donor are rare, in part because donors are so thoroughly screened for the health markers that make them ideally suited for this procedure.
In fact, from 1999 through 2021, Ohio State’s Comprehensive Transplant Center performed more than 2,000 living kidney donor surgeries, with no deaths. The greatest instance of complication was the occurrence of a hernia, seen in less than 2% of cases.
Living liver donation is still a relatively new procedure. The risk of death is estimated to be 0.1%, or one death per 1,000 surgeries.
- Question What is recovery like after donation?
Recovery from kidney donation is relatively quick. Because these are typically minimally invasive surgeries to retrieve the kidney:
- Most donors can return home within two days after surgery
- One to two weeks later, donors can drive
- Donors return to work between two and four weeks
- All normal activities can resume after six weeks
Because liver donation is a more serious surgery, recovery does take a bit longer, in part because the incision is made through the abdominal muscles. And while everyone reacts differently:
- Most donors can return home five to seven days after surgery
- If living more than two hours away, donors may need to stay in the Columbus area for up to two weeks after surgery
- May be up and about the week after surgery
- All normal activities can resume within eight weeks
- Question How are living donors evaluated?
There are many steps to the donor evaluation process to protect both the physical and mental health of the potential donor as well as the recipient. Eligible kidney donors can be between 18 and 75 years of age. For liver donors, the age restriction is between 18 and 55.
In both instances, donors must be within a healthy weight range (not obese), in good overall physical and mental health, no history of cancer and free from chronic or serious medical conditions. Donors will be required to have the help of a support person while recovering at home and will need the ability to take time off work during recovery.
The process to become a living donor starts with a detailed health history questionnaire. Potential kidney donors can start by filling out the health history questionnaire online. Potential liver donors will need to download and fill out an assessment form.
Once initial qualifications are met, a full evaluation appointment is scheduled in our transplant clinic at the Ohio State Wexner Medical Center. This involves several evaluations and education sessions with doctors, clinicians and mental health professionals.
Once all pre-screening qualifications are met, the donor’s case is presented at our Patient Selection Committee (PSC) for approval by our transplant team. The PSC is made up of transplant surgeons, medical transplant physicians, cardiologists, psychologists, pharmacists, dietitians, social workers, nurses and administrators. The PSC reviews a patient’s medical history, tests, medical compliance, potential surgical complications and more. When approved, surgery can be scheduled.
- Question If I donate, who gets my kidney or liver?
Many living donors are family member or friends with a recipient in mind when they donate, choosing the person they donate to in a directed donation. Non-directed (also known as altruistic) donation is when the donor doesn’t have a specific person targeted for their donation. In this instance, the donor can remain anonymous to their recipient, if they so choose.
In order to meet the demand for organ transplants in the United States, we need more people to consider living organ donation. It’s an extraordinary opportunity to give a new chance at a healthy life for someone and their family and give yourself the reward of happiness for giving to a patient in dire medical need.
- Question Is there a cost to the donor for undergoing this procedure?
Insurance held by the organ recipient covers the medical expenses of donation surgery, including testing and evaluation. Costs not covered include travel and lodging expenses, if the donor lives far from our transplant center, and lost wages, if they don’t have paid leave or vacation time saved up.
Most living donors are back to work in one to two months, depending on the physical demands of their job. If the donor qualifies based on income, the National Living Donor Assistance Center may be able to provide financial help for travel and lodging and potentially lost wages.