KIDNEY KNOWLEDGE SERIES - (13)

DECEASED DONORS (CONTD)

Q:     How can one get permission from the donor family?

A:      Abroad, permission is sought via:

1.     The donor putting his/her name on the national organ donor register; then their wishes have priority after death.

2.     If someone is not on the organ donor register, then the wishes of the family determine whether organs are donated.

This means that deceased donor kidney donation is a gift, even though it may come from tragic circumstances

Q:     Is there a difference between living donors and deceased donors?

A:     

·        Unlike living donation where the kidney comes directly from the donor to the recipient, kidneys from deceased donors are often injured by the death and preservation processes, so a delay in kidney function may occur.

·        Occasionally, dialysis is continued until the deceased donor kidney begins to function. When dialysis is needed, deceased donor kidneys may take up to two weeks to begin functioning.

·         With living donation, delay in kidney function is uncommon and function may be restored almost immediately.

Q:     How good is deceased donation?

A:     All kidneys from deceased donors are not the same. In fact, how well a kidney transplant works depends on both the donor and the recipient. Most deceased donors—of any kind—have less than perfect kidneys. This is what can affect the quality of kidneys from deceased donors:

1.     The donor's age

2.     Cause of death

3.     Any event that happened when the kidney was removed, such as low blood pressure or clotting in the blood

4.     Not knowing the exact condition of each deceased donor kidney; this is mainly because short-term problems can make the kidney work poorly for a while. However, after a few months, some kidneys from deceased donors are found to work better after the transplant.

5.     How long the kidney has been kept out of a body in cold solution, after it has been removed from the deceased donor. This time is more of a risk when it is in the range of 18 or more hours. It happens more often when a kidney is sent from one region of the country to another because it is a good match.

Q:     What are the risks involved in deceased donor kidneys?

A:     

·        There are a number of risks in choosing a deceased donor kidney for transplant in today's world.

·        Some kidneys that seem to work well may not, some that are not used for a transplant may have worked well. It may be hard to be sure of the quality of many deceased donor kidneys.

·        Yet these kidneys cannot simply be thrown away just because questions arise. Many working kidneys would be lost.

Q:    Can one be harmed by a kidney transplant from a deceased donor?

A:      Deceased donors and their kidneys are tested carefully.

·        First, doctors look at the condition that has caused brain death. Some deceased donors have other medical conditions or diseases. Family members are asked about the life style of the donor. Deceased donors are tested for syphilis, hepatitis B and C, HIV, AIDS, and other viral infections.

·        Some good donors may have infections caused by bacteria. This does not rule out taking the kidneys. But the transplant patients must be treated for these infections at the time of transplant.

·        Even with all the testing, there is always a risk that a disease from the kidney may be given to the transplant patient. This risk is much less than 1 in 100.

Q:     What are the barriers to deceased donations?

A:      Despite its vast potential, deceased donation in Nigeria may not be successful unless the following major barriers are removed:

1.     Inadequate public awareness

2.     Attitude of the medical community

3.     Frequently held misconceptions about religious guidelines

4.     Different conceptions of brain death

5.     Absence of legislation on deceased donation

Q:     What are the opportunities for deceased donation in Nigeria?

A:      We need legislative, religious backing and nationwide education on deceased donation of organs. It will serve as another alternate source of organs for donation. This promotes the growth of transplantation activities in the country, reduces, and eventually eliminates commercialization of organ donation which is ethically and morally wrong.

KIDNEY KNOWLEDGE SERIES - (12)

 DECEASED DONORS

Q:     Who is a deceased donor?

A:      This is an individual whose tissues or organs are donated after his or her death.

Q:     What types of diseased donors are there?

A:      Donations come from two sources:

1.     Patients who have suffered brain death. They are also known as heart beating donors or donor after brain death.

2.     Patients whose hearts have irreversibly stopped beating i.e. cardiac death. They are also known as non heart beating donors or donor after cardiac death.

Q:     Who are heart beating donors?

A:     

·        These are donations from people who have suffered an injury such as a fall, motor vehicle accident or a stroke.

·        The determination of irreversibility, as well as the determination that all brain function is not present, is only made after repeated, confirmatory testing over a prolonged period of time. 

·        Only then are the organs from a deceased donor retrieved by a surgical team.  

Q:     Who are non-heart beating donors?

A:     

·        These are transplant kidneys from people whose hearts have stopped beating. These donors – called non-heart-beating donors – are people who have died very suddenly, usually from a heart attack.

·        Their hearts have stopped beating and they are brain dead. They have not been put on a life-support machine.

·        Kidneys from non-heart-beating donors often do not work immediately after transplantation and are not quite as good as those from heart-beating donors. However, advanced technology of organ perfusion and preservation has resulted in improved outcome.

Q:    Can the kidneys or any other organs just be removed from the deceased?

A:      No. Any organ for transplant has to be removed with the permission of the donor’s family.

Q:     What are the events that lead to being a deceased donor?

A:     

1.     The kidneys can only be removed after the patients have been diagnosed ‘brain dead’. This means that the part of the brain called the brainstem, which controls breathing, has stopped working permanently and patient is only being supported on a life support machine.

2.     When the brainstem is dead, there is a permanent loss of consciousness and all feelings.

3.     If the donor is on a ventilator (life support) machine, they are taken to theatre for donation while the ventilator is working and their heart is beating. For this reason, these donors are sometimes called heart-beating donors. Even though the heart is still beating, they would not breathe if they were not on a life support machine. Their brain is dead, and they have no chance of recovery, and indeed they have already been certified as legally dead by doctors from the intensive care unit.

4.     Although brain-dead (or "heart-beating") donors are considered dead, the donor's heart continues to pump and maintain the circulation. This makes it possible for surgeons to start operating while the organs are still being perfused.

5.     Treatment is discontinued (mechanical ventilation is shut off) then a time of death is pronounced. The patient is then rushed to the operating room where the organs are recovered. Storage solution is flushed through the organs. Since the blood is no longer being circulated, coagulation must be prevented with large amounts of anti-coagulation agents such as heparin.

6.     Several ethical and procedural guidelines must be followed; most importantly, the organ recovery team should not participate in the patient's care in any manner until after death has been declared.

Q:     Is diseased donation available in Nigeria?

A:      No. In Nigeria, the main sources of donors are living and are genetically or emotionally related and altruistic in nature. Deceased donors are the main source of kidney donors in UK and America

KIDNEY KNOWLEDGE SERIES - (11)

LIVE KIDNEY DONATION (Contd)

Q:     Will I have a normal life after surgery?

A:      We expect most patients to return to a normal life within two to three months after surgery, provided there are no serious complications.

Q:     How long will it take to recover?

A:     Recovery time will depend in part on whether your kidney is removed by an open incision, which involves a larger incision and longer recovery time of about eight weeks, or by laparoscope, which involves several small incisions and a shorter recovery of about four weeks.

Q:     What should I expect during recovery at home?

A:     When you return home, your activities will be limited. However, donors are encouraged to be active in between their periods of rest. Walking is considered excellent exercise during this time. You may also have some swelling around the incision area and should plan to wear loose, comfortable clothes.

Q:     What are the health risks associated with being a donor?

A:     

·        The risks of donation are similar to those involved with any major surgery, such as bleeding and infection.

·        Death resulting from kidney donation is extremely rare.

·        Current research indicates that kidney donation does not change life expectancy or increase a person’s risks of developing kidney disease or other health problems.

Q:     Will giving a kidney affect my lifestyle?

A:    

·        A person can lead an active, normal life with only one kidney.

·        Studies have shown that one kidney is sufficient to keep the body healthy.

·        After recovering from surgery, a donor can work, drive, exercise and participate in sports, though contact sports are not recommended.

·        A donor can continue in all types of occupations, including military duty.

·        Also, being a donor does not impact a person’s ability to have a child.

Q:     What kind of follow-up is needed?

A:

·        You will have a post-operative appointment with your surgeon 1-2 weeks after the surgery.

·        After donation, it is recommended that routine annual check-ups are completed with either your primary care physician or the transplant center.

Q:     What emotions do donors feel after the surgery?

A:    

·        Most living donors say they feel great satisfaction with the donation experience because they have helped to improve another person’s quality of life.

·        Even in rare instances where the transplant is not successful, many donors say they feel positive about their decision because they did their very best to help a relative or friend.

·        However, there is a small chance for donors to experience some negative or mixed feelings after the donation. These feelings have been more likely to occur in cases where the outcome of the surgery did not meet the expectations of the donor and/or recipient as well as in cases where the donor was unsure of his or her decision.

Q:     When can I resume normal activities?

A:

·        The goal is to be back to normal health within two to three months.

·        Walking is very important to your recovery. Each day, you should push yourself a little bit more. By walking as soon after your surgery as possible, you will help prevent such complications as blood clots, pneumonia and muscle wasting.

·        If you are feeling well and not having complications, you may begin to return to your normal exercise activities. Begin slowly and build up your strength and stamina. You will need to avoid any heavy lifting for the first four weeks until your abdomen has completely healed.

Q:     Who pays for the medical costs of the donor?

A:     In Nigeria, this is usually borne by the family members of the recipient and usually includes testing required for the living donor evaluation as well as the hospitalization costs and physician services provided during the donation process.

Q:     Is kidney transplant covered by the NHIS?

A:      For now, the NHIS does not cover transplant or dialysis.

KIDNEY KNOWLEDGE SERIES - (10)

LIVE KIDNEY DONATION (Contd)

Q:     Do some donors have trouble making the decision to donate?

A:    

·        The decision to donate can vary from person to person. Some people make the decision instantly with few worries or concerns.

·        Other people go through some soul-searching and will talk with close friends or family before deciding whether or not to donate.

·        It is normal for some people to be afraid of donating a kidney as well as to experience guilt about not wanting to be a donor.

·        Individuals should not, under any circumstances, feel pressured to donate.

·        The only “right” decision is the one that makes the donor feel comfortable.

·        Potential donors are encouraged to speak with the transplant team if they have any questions or concerns about their decision.

·        It is a safe procedure with minimal acceptable risk.

Q:     What does the donor evaluation involve?

A:    

·        The purpose of the evaluation is to make sure your kidneys are normal and that you don't have any medical or psychiatric illness that would make this procedure risky or difficult.

·        It makes sure you don't have any medical conditions that could be transmitted to the recipient and to confirm that you're donating voluntarily, without pressure.

·        Tests are comprehensive including blood, urine etc. chest x-ray and an angiogram to outline kidney blood supply.

·        Once all results from the entire evaluation process are available, they will be reviewed by a multidisciplinary committee who decides whether you are able to safely proceed with the donation.

Q:     When will I be told if I can be a donor?

A:     Generally, you should know within two weeks of completing the evaluation. The decision to donate your kidney is not one to make lightly. Consider it carefully and discuss it with your family and significant others.

Q:     If I am approved to be a donor, when will the transplant take place?

A:

·        This decision is made jointly by the transplant team, you and the recipient.

·        The transplant team — particularly the doctors involved in the recipient's care — will determine the best time for the transplant, based on the recipient's medical condition.

·        Unfortunately, a number of factors could affect the plans. For example, the recipient's condition might deteriorate so that he or she is too sick for a transplant. Or, the recipient or donor might develop an infection or other condition that must be treated before a transplant.

Q:     How should I prepare for the surgery?

A:     The medical evaluation of potential living donors is extremely thorough. Once your evaluation is complete and the transplant team decides to proceed, there is not much additional testing to be done.

Q:     How is my kidney removed?

A:    

The kidney is removed one of two ways

1.     An open incision on the side of the abdomen or

2.     Several small incisions with the aid of a scope and camera, called a laparoscope.

The laparoscopic approach has advantages of; less pain, lower complication rate, shorter hospital stay, shorter recovery and return to normal activities. The small incision scars are also cosmetically more acceptable. However it requires additional surgical skills and expertise with appropriate high-tecnology tools.

Q:     Will I require a blood transfusion?

A:     Blood transfusion during this surgery is uncommon. As a precaution, you may be asked to "donate" one or two units of your own blood before the surgery, we use your own blood so you're not exposed to possible risks of a transfusion from someone else. Blood may also be obtained from the general blood bank if required.

Q:     How long will I be in the hospital?

A:     The average hospital stay for donors is five to seven days after surgery.

Q:     Will I have a scar?

A:     In most cases, the incision heals quickly; leaving a scar that fades over time but will always be visible.

Q:     Will I have pain after the surgery?

A:      Unfortunately, you may have significant pain after this surgery. Pain medication will be given but you will still be very uncomfortable for at least the first week. You will begin to have less pain as each day goes by, but most donors say they have significant discomfort for one to two weeks after surgery.