Anyone can submit a living donor application. It’s a common misconception that only family members can be a living donor, or that living donors have to be in perfect health. This is patently false. The quality of your health is a factor for sure, but it’s not as strict as you might think. There are also many different types of living donors. Often, it’s not a blood relative or even someone that’s known to the recipient who donates a lifesaving organ. This type of living donor is known as an altruistic living donor.

The most basic qualification all living donors must share in common with their organ recipients is the same blood type. Generally speaking, if you have the same blood type as your recipient, you’re over 18, in good general health, financially and mentally stable, and have normal kidney function and anatomy,you can submit your information online to be considered as a potential living donor candidate.

Check with the hospital or transplant center living donor advocate where the transplant surgery will occur for their living donor requirements as the guidelines and qualification standards for living organ donors can vary slightly between hospitals and transplant centers.

The testing and approval process for living donors is relatively fast and simple. Once your living donor application is received and accepted by the hospital or transplant center, you will be asked to submit urine and blood samples for testing. If you live in a different state or more than 10-15 miles away from the hospital or transplant center where the living donor transplant surgery will occur, the hospital or transplant center will typically issue a prescription where you live so you can have your labs done closer to your home.

Quest Diagnostics is a common satellite lab location used by many hospitals and transplant centers, but there are many other approved labs in every state. Check with your living donor advocate at your hospital or transplant center for the approved lab location nearest to your location.
 

The tests and labs check for certain living donor genetic markers and specific numbers in your urine and blood labs to ensure you are healthy, have adequate kidney function, and can survive fine with one kidney. Hospitals and transplant centers require living donorsto be living in a stable home environment with a solid family and social network support system.

Hospitals and transplant centers expect potential living donors to demonstrate a thorough understanding of the organ donation process, the risks involved in the surgery, potential long-term life and diet changes, and changes to meds you may take. They will also want to see you for follow-up visits after the donation surgery.
 

Potential living donor advocates will receive packets of information explaining everything from the hospital, transplant center, or living donor advocate.

There are variations in testing and approval processes state to state and different guidelines between the hospitals and transplant centers. Be sure to check with your living donor advocate, hospital, or transplant center to fully understand what will be expected of you as a living donor candidate. 

Again, if you have the same blood type as your recipient you are already high on the list as a prime candidate so don't be discouraged. After that, so long as you’re over 18, in good general health, financially and mentally stable, and have normal kidney function and anatomy, you can submit your information to be considered as a living donor candidate. 

Hospitals and transplant centers may have different guidelines regarding smoking, drinking, meds, and some may have diet, physical fitness, and other requirements or expectations other hospitals or transplant centers do not have.

Check with the living donor advocate assigned to your case at your hospital or transplant center for a comprehensive list of their specific living donor requirements or expectations.

The testing and approval process for living donors varies from state to state and depends on many factors. For instance, the hospital or transplant center performing the transplant surgery in your case or state may have lab scheduling issues that can add weeks to the testing and approval process. COVID-19 is also a factor in many cases these days.

Hospitals and transplant centers across the nation are dealing with a pandemic and each has its own COVID restrictions and scheduling guidelines to deal with it. Working around these scheduling issues and guidelines may add weeks to the testing and approval process. There are other factors too, such as your schedule and your recipient’s schedule, your location and proximity to the hospital, transplant center, or lab, your work schedule, or availability to get to a lab. 

Barring any unforeseen scheduling issues with you or your availability, COVID restrictions, etc., the living donor testing and approval process should be relatively simple and fast. Our Founder and Executive Director, Glenn Cogan went through the living donor approval process in his hometown of San Diego, CA June – August 2021. 

We’ve provided the timeline of his journey as a living donor from when he learned about the need, to the date of his living donor transplant surgery below: 

• DAY 1 – Monday, June 14, 2021 – Glenn learns a close family member has terminal end-stage renal kidney failure, he verifies he has the same blood type as his relative, and he completes the UT Southwestern Medical Center Dallas online living donor application.

• DAY 3 – Thursday, June 17, 2021 – UT Southwestern Dallas calls Glenn      to let him know he may be a good living donor candidate and sends a prescription to Quest Diagnostics (in CA) for his initial labs.

• DAY 25 – Monday, July 12, 2021 – Glenn goes to Quest Diagnostics CA for initial labs and takes overnight supplies for 24 Creatinine (Urine)  test. *Glenn delayed these labs 2-weeks to eat right, exercise, hydrate, and flush his system for best results.

• DAY 26 – Monday, July 12, 2021 – Quest lab results start posting to  Glenn's UT Southwestern MyChart.

• DAY 27 – Wednesday, July 14, 2021 – UT Southwestern Dallas calls Glenn to confirm all but one lab (creatinine) came back great.  Glenn was drinking 1-2 gallons daily and it caused an erroneous lab result.  *Being hydrated is good, but stick with water (only), and only drink what you need daily (6-8  glasses daily). Overhydrating or hydrating with anything other than water can adversely affect lab results.

• DAY 27 – Wednesday, July 14, 2021 – UT Southwestern recommends reducing his water intake and sends another prescription to Quest new labs.

• DAY 28 – Thursday, July 15, 2021 – Glenn leaves with his family on a 6-day summer vacation.

• DAY 34 – Thursday, July 22, 2021 – Glenn returns from vacation and heads to Quest for new round of labs.

• DAY 35 – Friday, July 23, 2021 – New round of Quest lab results start posting to Glenn's UT Southwestern MyChart.

• DAY 39 – Tuesday, July 27, 2021 – UT Southwestern calls to notify Glenn he may be a match, UT Southwestern starts sending informational videos, disclosures, consent forms, releases, and other legal docs for signatures.

• Day 40 – Friday, July 30, 2021 – UT Southwestern calls Glenn to schedule a new round of labs, physical exams, eys exams, psych, and social worker counseling, meetings with the transplant team, MRI's, CT Scans, echocardiograms, stress echo, ultrasounds at the UT Southwestern Dallas campus August 11, 2021.

• DAY 51 – Monday, August 9, 2021 – Glenn flies out of San Diego International Airport CA for UT Southwestern Dallas labs.

• DAY 52 – Tuesday, August 10, 2021 – Glenn checks into UT Southwestern Dallas for pre-op labs, tests, counseling, etc,

• DAY 53 – Wednesday, August 11,  2021 – UT Southwestern lab results start posting to Glenn's UT Southwestern MyChart, Glenn  flies out of Dallas Love Field, TX for San Diego home to await for results.

• Day 61 – Thursday, August 19, 2021 – UT Southwestern calls Glenn to let him know all of his labs have been reviewed. and he is  approved to donate a kidney, 

After Glenn was approved to donate a kidney, all that remained to do was to schedule a transplant surgery date that didn’t conflict with anyone’s schedules. Transplant surgery is set for October 25, 2021.

• DAY 128 – Monday, October 25, 2021 – Glenn and his recipient check into UT Southwestern Dallas for transplant surgery.

• 2:00 pm Monday, October 25, 2021 – Glenn is out of surgery alert, surgery is a success, and he is up roaming the hospital floor.

• 5:00 pm Monday, October 25, 2021 – Glenn's recipient is out of surgery, her surgery is a success, her transplant team tells her the new donor kidney she received is large, healthy, and is functioning great. We hear it went right to work producing urine!

Glenn and his recipient are both doing great today. Both are back to business as usual. If you have a few minutes be sure to watch some of the videos we posted of Glenn’s journey on our “VIDEO” page.

We see this question a lot. It’s a great question. It’s the same question our Executive Director, Glenn Cogan, asked UT Southwestern to answer during his living donor journey. For the record he never got an answer or even a broad approximation on his approval odds from UT Southwestern. 

Determined to find the answers he was seeking, Glenn didn’t just ask UT Southwestern nurses, doctors, and surgeons; he turned the internet inside out looking for stats and other related data.  During the process, he concluded there must be some unwritten understanding among medical professionals, transplant centers, and kidney nonprofits because none were willing to answer this question or post any firm numbers, for example – “Living donors with a blood type match have a 50%, 30%, 80% or 10% chance of approval.” We used arbitrary numbers here, but you get the idea. 

While searching for answers, Glenn was told by a reliable source at UT Southwestern that medical professionals, doctors, surgeons, hospitals, transplant centers, kidney disease, and kidney donor nonprofits generally are not willing to answer this question with a firm number, or even with an approximation because they don't want to say or post anything that might give false hope to a recipient, donor, or their families. Considering the odds being tossed around loosely are dealing with real-life-and-death outcomes an incorrect prediction would be devastating for a recipient or donor.

We will not be answering this question with the usual vague or neutral canned precautionary medical response you probably got from your living donor advocate, hospital, or transplant center. We will answer this question to the best of our ability based on our personal experience as living donors and living organ recipients, and we will support this answer with verified, peer-reviewed medical information and other accepted medical stats.

The first thing we can tell you definitively is that sharing a similar blood type (RH factor) with a recipient puts you high on the list of potential living donor candidates. Since we repeatedly hit roadblocks getting the answers we sought, and since our thorough internet search for reliable information didn’t yield any firm answers to help us narrow down the odds to estimate reliable approval percentages, we will use notes, timelines, and the personal experience of our Directors who’ve been through this process,

1) BLOOD TYPING

Blood Typing is an exact black and white science. You are either a good match if these markers match, or you are not a good match if they do not match. Living donor transplants are still performed between mismatched donors/recipients but this is a topic for another post. Here is everything you need to know about Blood and HLA Typing:

   1 a) DONOR: BLOOD TYPING

• Blood type A living donors      can donate to recipients with blood types A and AB.
• Blood type B living donors      can donate to recipients with blood types B and AB.
• Blood type AB living donors      can donate to recipients with blood type AB only.
• Blood type O living donors      (universal donors) can donate to recipients with blood types A, B, AB and O.

   1 b) RECIPIENT: BLOOD TYPING

• Blood type O recipients can receive an organ from blood type O donors only.
• Blood type A recipients can receive an organ from blood types A and O.
• Blood type B recipients can receive an organ from blood types B and O.
• Blood type AB recipients (universal recipient) can receive an organ from blood types A, B, AB and O.

2) HLA TYPING: HUMAN LEUKOCYTE ANTIGEN

After blood typing, the next most critical match/mismatch typing in the approval process is HLA Tissue Typing. HLA Antigens are genetic markers on the membrane of human cells that allow our body to differentiate between self and non-self-cells. Our body protects itself against disease and foreign cells by recognizing and attacking anything that it does not recognize, or that it believes does not belong, i.e. bacteria, viruses, a newly conceived fetus...

100’s of different HLA Antigens have been identified on human cells but just six of those have been isolated and determined to play a vital genetic role in the success rate of organ transplant surgeries. These antigens are: A, B, and DR antigens. Each parent contributes a full set, and each of those is identified by numbers. Here’s an example of what a donor or recipient’s HLA Typing might look like:

1. A2
2. A30
3. B8
4. B70
5. DR3
6. DR8

3) CROSSMATCHING

Crossmatching is the final deciding factor in the living donor approval process. This test is done just before the parties' transplant surgery and it can derail a person’s plan to donate an organ to a specified recipient. Crossmatching determines whether the donor or recipient has antibodies that might attack the donor's antigens. UT Southwestern explained this process to us, and we were surprised to hear how it’s done. In crossmatching, the lab takes a vile of the donor’s blood and a vile of the recipient’s blood then combines them both into a single lab dish.

If either the donor or recipient has developed antibodies that would attack the other’s antigens, as it was explained to us by UT Southwestern, the (2) blood samples in the lab dish will go to war. Apparently, lab technicians watch this happen with their naked eyes. When this happens, even if your Blood and HLA Typing were a great match, the presence of these antibodies in the blood samples in the lab dish indicates the donated organ would be attacked and rejected by the recipient if it was transplanted into this person’s body. It is vital to know if you have antibodies against a potential donor because if you are incompatible with that donor you would not be able to safely receive a transplant from him/her.

How does one body develop antibodies against another body?

A living donor or recipient can make antibodies against another person’s HLA. For example, when a male and female couple conceived a child together, the female body develops antibodies to fight off the foreign cells in the body (a baby) that’s living inside her. The female body attacks a developing fetus just as it would a virus, bacteria, or infection which is why women experience morning sickness. These antibodies that are programmed to fight against the HLA of the father are the same antibodies that would attack and kill a kidney donated by the father.

The more children a couple has together, the more antibodies the female develops against the father’s HLA. This is why husbands and wives are often excluded from donating an organ to save their mates life. Over time, the mother has built up a defense against the father’s cells. If the father were approved to donate his organ to the mother, her body would already be ready and have more than enough antibodies on standby to fight anything with his HLA markers. In this case, it would be his donated kidney, and her body would attack it and try to kill it (reject it) because that is what it has been trained to do over the years of having children. Fortunately, medical technology has come a long way, and the lab results will show your doctors whether you have antibodies that would reject a transplant.
 

• Other ways living donors and recipients develop antibodies against each other are through blood transfusions, pregnancy, infections, and viral illness. None of these guarantees that you might have antibodies against the HLA of your living donor but having strong antibodies against a donor’s HLA exponentially increases the risk of rejection, so a healthy, willing donor would be excluded as a living donor for that reason.

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