Donor Medical Evaluation
The purpose of the donor medical evaluation is to make sure that donation will not pose any unusual risk to you during the procedure, or risk to your future health.
Once we are informed of your interest in donation, we will ask that you complete a health questionnaire. It is very important that you are completely honest in answering these questions. The information you share will be kept confidential. The living donor nurse will review the information on your questionnaire and contact you to discuss donation in more detail.
You will be required to have medical insurance and establish with a primary care doctor before starting a donor evaluation to ensure continued medical follow-up after donation.
Once the nurse has cleared your questionnaire, blood typing and crossmatching will be done. The lab needs blood from both the donor and the recipient to do the test. The quickest way to get it done is for the donor and recipient to go to the lab together. If that is not possible, your visit to the lab must be coordinated with the recipient blood draw.
When compatibility is confirmed, the remaining tests will be scheduled. A urine collection and blood test will be done before your visit to the transplant center. The evaluation testing takes two to three days and will include the following:
History and Physical
The history and physical is like an annual visit to the doctor. The doctor will go over the information on the health questionnaire and do a physical exam. The purpose of the exam is to determine whether your general health is good and there are no unusual risks to donation.
During the psychosocial interview you will talk with the clinical social worker who serves as the independent donor advocate. This visit is a very important part of the living donor evaluation. The goals of the psychosocial interview are:
1. To identify any potential emotional risks to you as a donor;
2. To ensure that you understand the risks, benefits and potential outcomes for you and your recipient;
3. To determine that you are capable of making the decision to donate and cope with the stress of a major surgery;
4. To explore your rationale for donation and to be sure you are free of pressure, guilt, etc;
5. To discuss how donation might impact your job or family relationships;
6. To ensure you are able to understand and comprehend the information provided to you;
7. To explore current / past history of psychiatric disorders and treatments;
8. To review the nature of the relationship between donor and recipient;
9. To determine that the support systems are in place and you have a realistic plan for recovery;
10. To be sure you have received and understand information about the risks of complications, recovery phase, and financial ramifications of donation;
11. To reinforce that if you wish to decline at any time, the transplant center will provide a general statement of unsuitability;
12. To reinforce that the transplant center will not discuss the donor evaluation with the potential recipient.
If you have a history of depression, anxiety or any past psychiatric diagnosis or have ever taken medication for any of these problems, you may be asked to see the transplant psychiatrist.
You will have a consultation with the dietician to discuss ways to maintain a healthy weight after donation.
Included in the schedule of appointments during the evaluation is a presentation by the living donor nurse coordinator. This one hour class provides education about all aspects of living donation. This class is open to all who wish to attend (family and friends) and is an opportunity to ask questions in an informative and relaxed setting.
Many blood tests will be done to give us information about the general condition of your organs. The blood tests will screen for diseases of the liver, kidneys, heart and blood.
A urine test will be done to check your urine for obvious signs of kidney disease or infection. In addition, you will be collecting your urine at home for a 24 hour period. This collection will give us much more information on the function of your kidneys. When you turn in the urine collection, your blood will also be drawn.
The EKG is done to evaluate the whether the heart rhythm is normal.
If a donor is over the age of 50, more extensive testing is done to rule out heart disease. Usually this is an exercise test during which you walk on a treadmill while the heart is monitored.
A chest x-ray will be done to rule out lung disease or lung tumors.
Donors over the age of 50 will need to have a colonoscopy to rule out colon cancer. This is a routine part of health maintenance and is recommended for all adults. This test should be done through your primary care doctor.
This test, also known as a CAT scan, is done to evaluate the anatomy of the blood vessels going to and from the kidneys and to screen for kidney stones. This test helps the surgeons decide which kidney to remove.
During this test an IV line will be placed and a contrast iodine solution will be injected into your IV to help show the vessels clearly. The contrast solution will give you a “warm all over” feeling when it is injected. This procedure takes about an hour.
Pap Smear and Mammogram
Female patients will need a pap smear and those over the age of 40 will also need a mammogram. These tests are a routine part of healthcare maintenance and should be arranged through your primary care doctor.
When all of the evaluation studies are completed, the results will be reviewed by the transplant team. Once approval is given by the team, the surgery can be scheduled.