A living kidney donor is the best option

A person diagnosed with kidney failure or end-stage renal disease has two options: dialysis or transplant.

In a perfect world, says Dr. Robert R. Redfield III, chief of the UCI Health Kidney Transplant Program, transplants would happen as soon as they are needed.

“We would like patients to never go on dialysis and just get transplanted,” he says. “Dialysis is hard. It’s a hard way of life and it’s hard on the body.”

Avoiding dialysis is easier said than done. To do so, one must have a living kidney donor available so they can receive an organ transplant right away.

“Otherwise, you would have to wait for a kidney from a deceased donor to become available,” Redfield says. “That can take upwards of 10 years.”

Finding a living donor

Living kidney donations happen in several ways:

• A donation from a relative or loved one whose blood and tissue type is compatible with yours
• A relative or loved one donates to someone who is a match, and you receive a kidney from another matching donor, in what is called a paired exchange
• Someone donates a kidney anonymously to anyone who may need it, called a non-directed donation

The first step usually is to ask relatives and loved ones if they’d consider donating one of their kidneys.

Redfield acknowledges how difficult it is to bring up the question.

“We work with our patients to give them the language to bring it up, using icebreakers and role-playing,” he says. “We try to give them the resources to find a living donor.”

Avoiding the waiting list

Initially, Redfield says, patients would rather be on a years-long waiting list than make such a consequential request of anyone they know.

“The first thing patients need to understand is that a kidney from a living donor is simply the superior option.”

Waiting for a kidney from a deceased donor means going on dialysis, which Redfield says is physically taxing and time-consuming because it involves being hooked up to a machine three days a week to filter toxins, waste and excess water from your system.

“It’s hard to work — how are you going to have energy for your kids, your spouse?” he asks his patients.

“And that could go on for eight years, 10 years.”

In fact, about 90,000 people in the United States are waiting for a kidney transplant. Because there is a shortage of viable deceased donor kidneys, 11 people on the wait list will die each day, U.S. statistics show.

Moreover, by the time a donor kidney is found, one’s body is not as strong as it was before, making it harder to recover from the surgery, Redfield says.

Once patients see the value of finding a living donor over waiting for a deceased donor kidney, they are frequently convinced to start approaching loved ones.

The benefits of shifting their focus to finding a living donor are enormous, Redfield says.

“You can avoid the difficulty of dialysis. You can get back to life, back to work, back to having energy.”

Donor evaluation process

Any kidney donor must be both healthy and willing.

Redfield says that in Orange County alone, there are enough people who are sufficiently healthy to donate a kidney that they could wipe out the nearly 700-person long waiting list at UCI Health.

It is not a simple process. Each donor goes through an intensive evaluation, including genetic testing, risk assessment for end-stage renal disease, themselves, as well as tests for HIV, hepatitis, cancer and more.

“The question we want to answer is, ‘Do we think this person can live a normal life with one kidney?’” Redfield says.

“If the answer is ‘Yes,’ then you are able to donate.”

Non-directed donors can also name up to five family members or friends who can be prioritized to receive a kidney should they ever need one.

Benefits of live donor kidneys

A kidney from a living donor is ideal because, as Redfield puts it, “It’s a healthy kidney.”

Living donor kidneys last twice as long as ones from deceased donors. They also have a lower risk of rejection and function better.

The work to find a living donor is worth it, says Redfield.

“The best therapy I can offer is a living donor. I just can’t write a prescription for it.”

The kidney transplant team at UCI Health has long filled a critical need in the region. It is the county’s oldest and largest kidney, pancreas and kidney-pancreas transplant program. It is also the only one that’s part of an academic health system in Orange County.