Would You Accept this Kidney?

[Kidneygirl]

I recently got a call about a potential living donor who has the same blood type as me, is a negative crossmatch and has excellent kidney function. This donor is a 2 out of six antigen match.   The concern is that the potential donor is 17 years older than me. Everyone's kidney function declines with age. 

I have a second  potential donor but the second donor and I have different blood types, we are a 3 out of 6 antigen match and this donor also has excellent kidney function. Which donor would you want and why?

Thanks.

[stauffenberg]

You mention that the second potential donor has a different blood type from yours, but do you mean that it is an incompatible blood type or just a different type?  Only renal patients with type O blood need a type O donor, although experimentally type A2 donors have been used for type O patients, with additional immunosuppression and mixed results.  If you are not type O then the fact of the potential donor being A, B, or O will not be a significant problem.

With living donors the HLA matching is not as important as with cadaver donors, but a three match is still marginally better than a two match.  Also, the most important HLA group for matching is the DR group, so if that site is a match that is an additional factor to consider.

Depending on the details of the blood type issue, the better choice would be the younger donor, since nephrons are programmed to die off at a certain rate, and many old people have subnormal renal function just because of age, even in the absence of any specific renal disease.  Also important is that age range in which the 17 year difference falls.  If you are 18 and your donor is 35, then the age difference is less important than if you are 40 and your donor is 57.

[sisterdonor]

kidneygirl,

Have you considered the non-blood type match donor being able to be a part of a paired exchange?  Has your transplant center talked to you about that?

[petey]

My Marvin said he would take either donor -- because, all things considered, some kidney is better than none at all.

[KT0930]

As Stauffenberg said, the blood type issue would depend on whether it's an incompatible type, or simply different. If you are type A, then you can accept with no problems from either A or O; if you're type B, then you can accept from either B or O; if you're AB, then you can accept from anyone at all.  However, if you're O, then your donor must be O unless you go through certain processes (see Tamara's thread about her transplant. She got an ABO incompatible, but is doing great).

If you're skittish about the extra processes involved in accepting an ABO incomp, then I don't see any problem with accepting the other. I received my father's kidney when I was 27 and he was 65. The kidney did not last quite 5 years, but there were other things at work other than his age that affected the kidney's life (although that could have been an issue).

Keep in mind, that depending on your age and general health, you may need a second transplant later in life, and the more transplants you have, the harder it is to find one that matches, due to PRA issues. If you have not been waiting very long, or have not run out of potential living donors yet, I would continue testing and waiting. An even better match may come off the list, as well. This, of course, assumes that you're doing well on dialysis and can stand to stay on for awhile to allow things to happen at a slower pace (though I certainly understand looking into all the options!)

Best of luck!

Katie

[Ang]

i  agree  whole  heartedly  with  marvin,  really  a  kidney  bthat'll  get  you  a  normal  existence  is  better  than  none,  i  reckon,  even  for  a  short  period,  10  years  is  a  fair  start.

[okarol]

In our experience things came up in testing and matching that took the choice out of our hands. Things will become clearer as the donors are evaluated.
Jenna's donor was 44 and Jenna was 21 at the time of her transplant. Could a better opportunity have come along? We'll never know. The best kidney is an available kidney!

[paris]

I agree, Okarol, the best kidney is any the doctors will approve. 

[Kidneygirl]

Thanks to all for your responses. To clarify, the younger donor is my age and she has type A blood and I am O. The older donor is 64 and I am 47.   And you are right, a kidney is better than none at all. I just want the best kidney (who doesn't, duh)  because if I get one and it fails, I am not going back on dialysis or getting another transplant. I will take it as my time to go. Thanks so much for responding so quickly.

[petey]

Thanks to all for your responses. To clarify, the younger donor is my age and she has type A blood and I am O. The older donor is 64 and I am 47. And you are right, a kidney is better than none at all. I just want the best kidney (who doesn't, duh) because if I get one and it fails, I am not going back on dialysis or getting another transplant. I will take it as my time to go. Thanks so much for responding so quickly.

kidneygirl, the bottom line is there is no guarantee that any kidney (even one that's a perfect match and from a person your age or younger) will last as long as it should (I think the average lifespan of a cadaveric kidney transplant is 8-10 years and one from a live donor averages 12-15 years).  I gave Marvin one of my kidneys -- we're the same blood type (O pos.), we were a 1-out-6 antigen match, and I'm seven years younger.  We thought (if he didn't reject) that it would last 12-15 years.  It lasted 3 years and 3 months before it contracted the same disease that destroyed his original kidneys.  You just never know.

As for going back on dialysis after a transplant, that's a hard thing to do.  I know because Marvin was there, too.  Marvin was on dialysis the first time for 5 1/2 years.  Then, my kidney lasted for a little over 3 years.  When the time came that he knew he'd have to go back on dialysis, there was no choice for him even though he knew what dialysis was like and what he'd have to endure when he went back on it.  He wasn't ready to die and said he had too many things to live for.  A return to dialysis meant that his life continued, and that was enough for him.  He's been back on dialysis and back on the waiting list for 4 1/2 years this time.

[Kidneygirl]

Petey, Marvin must be a very strong man.  I don't think I could do it.  I know there are no guarantees. I have two sons, ages 10 and 12. I just pray that it lasts long enough for them to reach 18.  I hope that Marvin gets another kidney soon.

[petey]

Marvin is most definitely the strongest man I know.  It's funny, but I always thought I was the stronger of the two of us, but I was wrong.  I know if the "shoe had been on the other foot" and I had been the one with ESRD that I would have given up a long, long time ago.  The most impressive thing about Marvin, to me, is that he has never viewed any of the things that happened to him as "bad luck."  He still says he's the luckiest man alive!  Not only do I love him with all of my heart, but I admire him and his attitude, too!

I hope that your transplant lasts longer than any other in the history of transplants and that you see your boys grown, old, and with children of their own!

[Kidneygirl]

Petey, from your lips to God's ears!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!