Live vs Cadaver donation

[George Jung]

I was told today that the only advantage a living donation that is not from a direct relative would have over a cadaver kidney donation is the time in which you would receive it.  In other words, there is no advantage of longevity between the two (friend/match or cadaver).  This is from my social worker in center.

How true is this?

[okarol]

I was told today that the only advantage a living donation that is not from a direct relative would have over a cadaver kidney donation is the time in which you would receive it.  In other words, there is no advantage of longevity between the two (friend/match or cadaver).  This is from my social worker in center.

How true is this?

There are more things to consider George.
This info is from the National Kidney Foundation and UNOS:

* Studies show that persons who have a live donor kidney transplant experience a higher success rate as well as a longer life span of the transplanted organ. Living donor transplantation is the most successful kidney transplant procedure. Typically, living donor transplants last longer than cadaveric transplants. Based on national data provided by United Network for Organ Sharing (UNOS), more than 90% of living donor kidneys are functioning after one year as compared to approximately 85% of cadaveric kidneys. 
* Also, with a live donor, the long waiting period on a transplant list can be avoided. In some cases, attempts can be made to arrange the transplant before the need for dialysis.
* In the case of a non-living donor, you may not have a full health history if the deceased had not had recent check ups, so you don't know the whole health picture, such as drug use, alcoholism or other factors that may affect the quality of the kidney. Living donors are thoroughly evaluated and are any underlying health problems are ruled out.
* The organ from a living donor is transferred under the most desirable conditions—it is put directly into the recipient in an operating room next door to that of the donor, so the organ is only without a blood supply for a short period of time (An organ taken from a deceased donor has to be cooled and kept in preservation solution until it is transported to the transplanting hospital).
* A kidney from a living donor usually functions immediately, making it easier to monitor. Some non-living donor kidneys do not function immediately, and as a result, the patient may require dialysis until the kidney starts to function.
* Potential donors can be tested ahead of time to find the donor who is most compatible with the recipient. The live-donor kidney transplant can be scheduled at a mutually convenient time when both the donor and the recipient are in the best condition. When on a waiting list for a cadaveric kidney, a patient never knows exactly when the surgery will happen. Since a living donor kidney transplant is a scheduled surgery, patients know ahead of time when the surgery will occur. This gives patients a better opportunity to prepare both mentally and physically.

You can find some statistics on the United Network for Organ Sharing (UNOS) web site. UNOS compiles statistics on every transplant center in the United States. To view all UNOS data, go to http://www.unos.org/data/about/viewDataReports.asp. You can find statistics on the number of non-living and living donor transplants performed at that particular center, respectively, and the graft survival rates for the transplant recipient.

The best source of information on expected donor outcomes is from your transplant team. See the list of "Elements of Disclosure" at http://www.kidney.org/transplantation/livingDonors/pdf/jama_article.pdf (page 3) for a list of issues to discuss with your transplant team. You can also check http://www.transplantliving.org/livingdonation for additional information about donation and transplantation.

[stauffenberg]

The rule of thumb is that while the average cadaver kidney will last for about 12 years, the average kidney from a living donor will last for 24 years.  The main reason for the difference is that the tissue characteristics of cadaver-source kidneys have been changed by the brain-death of their owners, and when your body receives a cadaver kidney, the immune system goes into overdrive attacking it because it recognizes it as 'dead' tissue, which in most cases presents a serious danger to the body from infection. In contrast, the only problem with a kidney from a live donor is the rejection due to the immunological difference.  As a result, a kidney from a living donor who is a zero antigen match with you will still function better than a kidney from a cadaver who is a three-point antigen match for you.

[George Jung]

The social worker's argument was that a cadaver kidney comes only from a brain dead donor therefore the donor is still "alive", resulting in a transplantation that has no drawbacks from from a functional standpoint.  In my research, this goes against just about everything I have read.  My dilemma is, do I accept a friends offering IF they are found to be a match or do I wait it out for the alternative.  My number one thought is to receive the kidney with the greatest potential since the second go 'round comes with far less probabilities, but if there are minimal differences than I would consider not accepting a friend to put themself through the ordeal and I would wait.  It sure sounds like a friend or relative is the best way to go?

[jbeany]

Your social worker sounds pretty uninformed to me.  Everything I've read stresses how much better a live donor is, and not just in terms of convenience and timing.

[okarol]

The social worker's argument was that a cadaver kidney comes only from a brain dead donor therefore the donor is still "alive", resulting in a transplantation that has no drawbacks from from a functional standpoint.  In my research, this goes against just about everything I have read.  My dilemma is, do I accept a friends offering IF they are found to be a match or do I wait it out for the alternative.  My number one thought is to receive the kidney with the greatest potential since the second go 'round comes with far less probabilities, but if there are minimal differences than I would consider not accepting a friend to put themself through the ordeal and I would wait.  It sure sounds like a friend or relative is the best way to go?

George, the social worker is really simplifying the discussion and may be just trying to reassure you. However, if a non-living donor kidney comes along, I don't think I would turn it down!

The donor is not "alive" - the life support is turned off. And if the donor died in your hospital, the cold ischemic time might be less, but typically the kidney has traveled a short or long distance before it comes to you. Cold ischemic time of the kidney is the time the donated organ is in iced storage between the donor and recipient (usually minutes for a living donor, hours for a deceased donor transplant). Then there are also hours spent doing crossmatch tests with your blood at your center. The coordinator pulls together the surgical team, and this takes some time.

You might have 9 people who offer to donate and none will be suitable - that's what happened in Jenna's case. The wait here in Los Angeles is 5 to 7 years, so we tried to find a living donor while still hoping that a non-living donor would become available.

[George Jung]

[
George, the social worker is really simplifying the discussion and may be just trying to reassure you. However, if a non-living donor kidney comes along, I don't think I would turn it down!

Exactly right.  Unfortunately, I do not operate like that.  I am trying to make the decision weather or not to accept a relative or friend's offering should they be a match.  I am not living a pipe dream I am simply trying to make thought out decisions, considering as much knowledge as possible.  About the social worker, I hope she realizes the differences  concerning donation and was trying to be reassuring about the situation.  I also hope she realizes I want the cold hard truth.

Thank you Karol for your helpful, constructive replies.  You RocK 

[angela515]

Some peoples live donation transplant lasted fewer years than their cadaver transplant. My mom's kidney lasted 5 years... I only received this cadaver 5 months ago, so.. can't say in my case yet. My mom was a 5/6 match, my cadaver kidney was a perfect match. However, in my case, I believe my moms kidney would of lasted longer but I had 2 children and te pregnancy's most likely stressed the kidney out even though my last child was born in 2002 and my transplant did not fail till 2004... hmm.

Either way, I agree with what Karol has said in the majority of all transplants.