Donor Disqualificatrions

[George Jung]

Is someone disqualified from donating if the are clinically depressed?  What about if they have an eating disorder or a thyroid disease?  I realize the transplant team will rule a person out if they are not qualified, I just can't help but to be curious as to the things they generally consider to make someone ineligible to donate.

[okarol]

Anyone with a kidney disease, human immunodeficiency virus (HIV) or cancer cannot be a kidney donor. A donor cannot have high blood pressure, diabetes, mental illness or heart disease. A donor must not have any serious infectious disease that may harm the recipient. A donor must be mentally able to make this decision and there must be no financial reward of any kind for the donor.

An acceptable donor will be in good physical and mental health, over 18 years of age, and free from the following:

    * high blood pressure/hypertension
    * HIV infections
    * known viral infections (Hepatitis B or C, Lyme's disease, etc.)
    * active alcoholism with frequent and heavy alcohol intake
    * current psychiatric illness or treatment by a mental health professional
    * history of malignancy/cancer (exception: skin cancer)
    * heart and lung disease requiring medications
    * diabetes mellitus
    * obesity

Included in the evaluation for donation:
1. ABO blood group
2. Psychology evaluation
3. Social work evaluation
4. Routine examination by a doctor
5. Blood and urine tests
6. Women will need a gynecology exam and, a mammogram for some women (breast cancer screen)
7. Human leukocyte antigen (HLA) testing or “tissue typing” and crossmatch
8. Electrocardiogram (EKG)
9. Chest x-ray
10. History and physical examination by an adult kidney specialist
11. Radiology (X-ray) testing (Renal ultrasound and renal arteriogram)
12. Surgical evaluation and meeting with the surgeon who will remove the kidney

[okarol]

Guidelines for the Psychosocial Evaluation of Living Unrelated Kidney Donors in the United States

Excerpted from an email from Sue V. McDiarmid, M.D. UNOS President:

This article is made freely available by the American Society of Transplantation (AST), American Society of Transplant Surgeons (ASTS), and Wiley-Blackwell. It is available for viewing or download as an Adobe PDF document by accessing the link below.

http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1600-6143.2007.01751.x

The citation is Dew MA, Jacobs CL, Jowsey SG et al. Guidelines for the Psychosocial Evaluation of Living Unrelated Kidney Donors in the United States. Am J Transplant 2007; 7:1047-1054.

We encourage you to read this report and consider these guidelines in relation to your program’s protocols for living donor evaluation and consent. The transplant community can best serve needs and interests of the potential living donor through consistent application of well-designed protocols.

[stauffenberg]

A lot of the supposedly 'medical' reasons for disqualifying people from being kidney donors are purely arbitrary, and derive more from transplant team members wanting to play God with other people's lives than from any real problems.  I also question the general assumption made by the medical profession that they should bend over backward to screen people out of being donors, rather than to be aggressive in recruiting people to be donors.  If the government can seize healthy people bodily by the military draft to make them fight some useless war which will risk their health and even their life, why shouldn't dialysis teams try to minimize the criteria for excluding someone from being a kidney donor to save the lives of people who have no kidneys?  It would create a more equal, and thus a more fair, distribution of misfortune in society if kidney donors were allowed to bear a little risk of ill health by donating a kidney to someone who would suffer an enormous degree of illness from not having any kidney at all.

[goofynina]

Those are great posts Okarol, very helpful information 

[keefer51]

When i had my transplant in 92 my brother gave on of his to me. He was a "perfect" match. We were so close they said it was only found in twins. Perhaps due to the insurance problems that kidney lasted for a little over ten years. At the time i was offered two more kidneys from friends. I am glad i took my brothers. The other were a four match. Now i am on the list again and was told they can now transplant a three match cause they over load you with anti rejection meds. I wonder how bad that can be.

[kitkatz]

A lot of the supposedly 'medical' reasons for disqualifying people from being kidney donors are purely arbitrary, and derive more from transplant team members wanting to play God with other people's lives than from any real problems.  I also question the general assumption made by the medical profession that they should bend over backward to screen people out of being donors, rather than to be aggressive in recruiting people to be donors.  If the government can seize healthy people bodily by the military draft to make them fight some useless war which will risk their health and even their life, why shouldn't dialysis teams try to minimize the criteria for excluding someone from being a kidney donor to save the lives of people who have no kidneys?  It would create a more equal, and thus a more fair, distribution of misfortune in society if kidney donors were allowed to bear a little risk of ill health by donating a kidney to someone who would suffer an enormous degree of illness from not having any kidney at all.

'

Our little ray of sunshine.

[George Jung]

A lot of the supposedly 'medical' reasons for disqualifying people from being kidney donors are purely arbitrary, and derive more from transplant team members wanting to play God with other people's lives than from any real problems. I also question the general assumption made by the medical profession that they should bend over backward to screen people out of being donors, rather than to be aggressive in recruiting people to be donors. If the government can seize healthy people bodily by the military draft to make them fight some useless war which will risk their health and even their life, why shouldn't dialysis teams try to minimize the criteria for excluding someone from being a kidney donor to save the lives of people who have no kidneys? It would create a more equal, and thus a more fair, distribution of misfortune in society if kidney donors were allowed to bear a little risk of ill health by donating a kidney to someone who would suffer an enormous degree of illness from not having any kidney at all.

I love this guy's posts!  Always a good read stauffenberg. 

[RichardMEL]

This is a difficult one. As someone who has just had his donor (sister) disqualified perhaps I am a little biased on the matter but I'll comment anyway:

My sister was denied because of feers about her blood pressure impacting her down the track - the actual word I had from the Neph was "in 20-30 years"

My sister is 38.

Now I can apprieciate that since the major concern I had with the whole process of her donating to me was that I could never forgive myself if something happened to her down the track as a result of having the kidney removed. Now of course the counter to that is that you can't predict the future, and what's to say that something might not happen anyway? However I know in myself I would feel horrible should something happen.

I do see and apprieciate the argument though that if someone is healthy enough and is *willing to take the risk* to donate.. having been informed of the medical opinion, that perhaps they should be given that option.

My sister was devistated when she was denied and I have a feeling if they had said to ehr "we are concerned with X, Y and Z but the choice is yours" then perhaps she would have gone ahead with it. (that would have put me into a position where I may have told her no since I would ALSO be worried about it. I'm not sure what I would have done given that choice).

The overriding motive by the decision of the medicos is basically that they don't want to create 2 patients when there's already one and the health of the potential donor is the overriding concern. I can understand that but I also feel if someone REALLY wanted to donate and suffer whatever might OR MIGHT NOT happen down the track that is their call because it's their life and their body.

I guess, unfortunately, in the system we live with now we don't get to make that kind of a call.

[jbeany]

Some of the docs are concerned with the "do no harm" part.  Some of them are also worried about getting sued.

[MiSSis]

I've been fortunate to receive two transplants.  The first, back in 1980, was from my twin brother.  He was the best choice out of my family (all 4 of my brothers and both my parents were tested) but we actually matched on only 2 of the 4 antigens used at that time.  I experienced many of the same concerns that RichardMel mentioned and was particularly upset the night before surgery.  Because I had been doing so poorly on hemodialysis at that time, my brother Mike was my biggest supporter for transplant.  As soon as he found out he was my donor, he wanted the surgery to be scheduled as soon as possible.  That kidney lasted 3 1/2 years which was considered fairly successful at that time but wasn't nearly long enough in my opinion considering all we had gone through as a family.  After waiting for 4 years on a list (no one else in my family was an acceptable donor), I was given a cadaver kidney in December of 1987.  Although from a "stranger", I matched on 3 antigens with this kidney and it functioned extremely well for the next almost 16 years.  I knew little about my donor other than the fact that he was a 13 year old boy.  My husband and I are now considering investigating another transplant with him as the donor.  I have no doubts that he will be an excellent candidate (in spite of his false hepatitis scare) however I'm more concerned that I won't be considered a good risk as a recipient.  I'm now 52 yrs old, have had 2 previous transplants, and have developed coronary artery disease which my cardiologist believes is a result of years of anti-rejection medication usage.  I think we're still going to give it a shot at least until we're given a definite "NO" from transplant doctors.  Until that time I like to think there's still some hope for the future and I'm unwilling to let that go for now.

[skyedogrocks]

When i had my transplant in 92 my brother gave on of his to me. He was a "perfect" match. We were so close they said it was only found in twins. Perhaps due to the insurance problems that kidney lasted for a little over ten years. At the time i was offered two more kidneys from friends. I am glad i took my brothers. The other were a four match. Now i am on the list again and was told they can now transplant a three match cause they over load you with anti rejection meds. I wonder how bad that can be.

Rob's transplant team at his hospital told us you don't even need to be a tissue match now, just a blood match.

[stauffenberg]

For both cadaver and living-donor kidneys, the more antigens that match the better, especially the antigen at the DR site, which seems to have a lot to do with eliciting the immune response.  However, with living donors, even a 0-antigen match is acceptable provided the Landsteiner blood type (A,B,O), the Rhesus factor (positive or negative), and the antigen cross-matching results are acceptable.

[skyedogrocks]

For both cadaver and living-donor kidneys, the more antigens that match the better, especially the antigen at the DR site, which seems to have a lot to do with eliciting the immune response.  However, with living donors, even a 0-antigen match is acceptable provided the Landsteiner blood type (A,B,O), the Rhesus factor (positive or negative), and the antigen cross-matching results are acceptable.

Well of couse the blood type needs to match, that is a given.  It doesn't matter if they are a positive or a negative though, as long as they blood type is there.  If there is a 0 antigen match, hospitals can work around this.