Medical Tests for a Donor

[ksuresh]

Hi

I'm sorry for having posted this message on the wrong page. It was a mistake. I'm re-posting it here.

I'm preparing to be a donor and am trying to gather as much information as possible.

I'm a healthy 38 year old male and, according to the consensus of what I have found, I should not encounter any problems. That's gratifying.

I also want more information on the tests that a potentila donor has to undergo and the importance of these results. I understand that I will have to undergo routine blood tests, blood pressure check, EKG/ECG, chest X Ray (and perhaps an echocardiograph test), urine and liver function tests and, if required, a stress test.

The most important things are the:
Tissue typing
Lymphocyte crossmatch

Antigen matching is no longer a major issue, I could gather, what with much improvement in the quality and availability of drugs to suppress even a 0/6 match.

I need more information on the lymphocyte crossmatch. Is this the one (ofcourse, considering that all other tests are encouraging enough) that actually determines if the donor's kidney is OK? Or are there drugs to cover rejection in case of a "positive" match? I have indeed read that even a "negative" match does not guarantee rejection.

I would like folks to throw more light upon this for me.

Thanks.

Suresh

[Fr Pat]

Dear Suresh,
     Hi. At the homepage of this site you can click on "kidney donation" at the upper left and there you will find a detailed description of the testing process.
    I am not a medical professional, but have learned a lot since I donated 10 years ago, so I'll pass on to you what I have read.
    In the "cross match" portions of the blood of the potential donor and of the recipient are mixed, to see if there is a bad reaction (which might cause rejection of the donated organ). Sometimes even though the two match well by blood type the recipient may have developed anti-bodies (beacsue of past blood transfusions, etc.) that would react against that particular donor. As new antbodies can sometimes develop over time there is usually a first "cross-match" and then later a "final cross-match" shortly before the surgey date to make sure all is well. SOMETIMES when there is a bad reaction in the crossmatch it is possible to perform plasmapheresis on the recipient, by which the rejecting antibodoes are filtered out of his/her blood in several treatments.
     In the case of a donor who is healthy enough to donate but is not suitable to donate to this particular candidate sometimes a "swap" can be arranged in which two or more families in that same situation exchange donors so that everyone receives an acceptable kidney.
     I hope this explanation is helpful. Please feel free to post any other questions here as there are many knowledgable and experienced people who check in here.
   best wishes,
     Fr. Pat

[dodger]

You also need to know just what exactly your current GFR is.  You will have half of that after surgery.  You should get a little increase after surgery, but, some don't.  You might then be considered as stage 2 or 3 renal failure for some insurance coverages.  Please be sure to know this very important information.  If self insured, you could have trouble securing future insurance.  If you have a very physical job or work out a lot, it will make your tests look like your creatinene is too high.

Please ask all of the questions on the above information.

What you want to do is a wonderful thing, but know all the information.

I now have the same kidney function as my 93 year old father in law, 45 eGFR.  I have a physical job and workout an hour a day.  Even though WE know I'm in excellent health, insurance companies only look at numbers, not what a wonderful thing we did.

[ksuresh]

Thank you for your responses, FR Pat & dodger- I kinda expected the insurance folks wanting to cancel my insurance, but having it confirmed is scary.

I work at a desk as an analyst. So how soon actually before I hit duty? Is 7-10 days after the surgery a reasonable assumption?

I have never worked out in the gym or elsewhere. I do walk quite a bit daily- cover 10-12 kilometres daily in reasonable time. I do not suffer from hypertension and am not diabetic. So, I think I should be OK.

Will there be bloating of the stomach after surgery for me? If yes, how long does this last? I have also read that I might/will experience sleeplessness, nausea and lethargy. Is that so?

Other than a ECG/EKG, is a echocardiograph test too mandatory for me? Even if the ECG comes out as OK?

Will I be able to walk and climb stairs after say, 3 days after surgery? Am I going to be advised to do so?

These and plenty other questions I have got. I thank you for offering to answer as many questions as possible for me. (I did go through the Living Kidney Donation section, Fr Pat. But please forgive me if I still have questions)

Thanks

Suresh

[Fr Pat]

Dear Suresh,
     There is a good deal of variety in recovery times of kidney donors. I myself had a fast recovery, and was back to desk work in a week. Others have taken longer. Fatigue in the weeks and months after donation is very common, so plan on needing a nap during the day and an early bed-time.
     I had the open-cut (10-inch) surgery, while now many donors have the laporoscopic surgery method, so that can make a difference as well. Bloating is a frequently recorded problem, and it subsides only gradually for many. (So, bring extra-large clothing, underwear and shoes to wear going home from the hospital, as your regular clothes may be much too tight for a while.)
    Most donors are up and walking short distances on the same day of the surgery (and the nurses encourage this.) You should be walking and doing stairs slowly within a day or two. You should not try to drive for a couple of weeks even if you feel fine, because the left-over anesthesia and drugs may slow your reaction time without your noticing it.
     (I forget to mention: you said you worked as an analyst. You may experience mental sluggishness for a while due to all the drugs you have received, so be cautious about making decisions as you may not have your mental sharpness back 100% right away.)
     I believe that most hospitals require an echocardiograph only if there is some reason to suspect a possible problem. But keep in mind that each hospital has its own requirements.
     There is a list of helpful hints that the National Kidney Foundation collected from past donors at:
www.kidney.org/transplantation/livingdonors/infotips.cfm
     Fr. Pat

[elephant]

Dear Suresh,
Cancellation of medical insurance is not the usual course of events.  I think most problems are when  people seek new coverage.   
Some people have returned to work quite early, but I think 2-5 weeks is more likely.  Personally, I took 3 1/2 weeks and could have used one more week.
You will be very bloated immediately after surgery, due to the inflation of the abdomen during the surgery and the large amount of IV fluids you will receive.  This lasts a couple of days. 
I was extremely nauseated from the anesthesia, but it was controlled very well with medication in the hospital. 
I had no sleeplessness, in fact I slept about 16 hours a day for the first week!  The fatigue continued for about a month, gradually improving. 
I think people over age 50 are given more complete heart testing due to greater risks.  Some are given treadmill stress tests.  I didn't have any of these.  Each hospital will have different protocol.
The normal post surgical advice is to start walking as soon as possible. I was walking (well, shuffling with an IV pole) on the evening after surgery.  I went home on the second post surgical day and was climbing steps and walking.  By the third day I was taking walks, and got up to two miles after a week.  Your mileage may vary.
 love, elephant

[tanimbarcorella]

Hi Suresh,

I would be cautious to assume that 7-10 days will be enough recovery time to get back to work. I am a 26y female - I had a really easy recovery and was walking before my uncle was out of surgery, but I took three weeks off. I have a very physical job and had to come back on light duty. I would say I could have come back to work at 1 1/2 to 2 weeks but I would tire pretty quickly at that point. I was fortunate enough to have the financial help to stay off work for three solid weeks, and when I did get back I felt like nothing had ever happened. There were several people asking why I was filing and such when normally I am out wrestling animals (I am a licensed veterinary technician) because they recognized me as my normal energetic self and said I didn't appear to have had anything done. If you can take additional time, please do. I think you will benefit in the long run from getting a solid recovery and returning to work strong and healthy. If you really need to, I would maybe look into working shorter days at first, just to make sure your body can handle it.

As for the echocardiogram question, I did not need one. I had a normal ECG and chest x-ray, so they didn't require the ultrasound exam. There are additional tests depending on your family history and any abnormal findings - for example they had me do a fasting glucose tolerance test (FYI the orange stuff tastes disgusting) because there is a history of diabetes in my family. I was originally set to do two 24-hour urine collections for creatinine clearance testing, but due to my scheduling issues they had an alternative test for creatinine clearance (iothalamate, an injection that BURNS). So, I think if you have any issues with the testing it doesn't hurt to ask for alternatives, and they should only require additional tests if your results are wonky or your family history warrants it.

Best of luck to you!
Taryn