Live donation allows patients to receive a transplant without waiting for an organ from a deceased donor. The Massachusetts General Hospital Transplant Center has one of the most active and experienced living kidney and liver donor programs in the region, as well as the largest, and performed the most deceased and living donor kidney transplants in 2019.
Living Kidney Donor Program
Donating a kidney to another individual is an act of great kindness. Nearly half of the kidneys transplanted at Mass General are given by living donors—family members, friends, co-workers and donors who are unknown to the recipient.
Living donor kidney transplants have several benefits, including:
- Improved short and long-term survival rates
- Eliminated need for placement on a waiting list
- Fewer recipients requiring temporary dialysis
- Knowledge of the donor, his/her lifestyle and medical history
- Shorter wait time for others on the waiting list
- Convenient scheduling of transplant surgery, as decided by donor and recipient
Patients who choose to undergo a kidney transplant may have identified a living donor who is willing to donate a kidney. Even in cases where the donor is incompatible with the recipient, our active living donor transplant program can match patients with compatible living donors through the UNOS Paired Kidney Exchange Program or the National Kidney Registry. We also have a successful desensitization program for patients with positive cross match to their living donors.
The Process to Become a Donor
Individuals who wish to become living kidney donors undergo a three-part evaluation process. Our dedicated donor coordinators guide potential donors through each step, keeping them informed of testing and evaluation results. Typically, the recipient's insurance will cover the cost of the evaluation and surgery.
Phase One: Living Donor Health Questionnaire
- Donor evaluation begins with the prospective donor submitting a completed living donor health questionnaire to determine their overall health status and candidacy to donate
- Once a completed living donor health questionnaire is received, the donor will receive a confirmation email with further instructions
Phase Two: Multidisciplinary Team Evaluation (Part 1)
- The donor candidate will complete lab work (blood and urine, including a 24-hour urine collection) at a local lab. Once the donor team receives the results, and if they do not find any serious abnormalities, the donor candidate can be scheduled for an appointment(s)
- Candidates come to Mass General for a half-day donor evaluation visit. This visit includes an educational session, a meeting with the donor coordinator, social worker and a nephrologist (a doctor who specializes in kidney care), who reviews the candidate’s medical history and conducts a physical examination
- The physical examination includes an electrocardiogram (EKG) and chest x-ray
- Based on the medical history and physical exam, other tests may be necessary and can often be scheduled close to the candidate’s home
Phase Three: Multidisciplinary Team Evaluation (Part 2)
- The donor candidate returns to Mass General for a computed tomography (CT) scan of the kidneys and blood vessels, as well as any other necessary appointments or tests (depending on scheduling availability)
- This visit includes meeting with the surgeon to discuss the candidate’s ability to donate, as well as the surgical procedure and hospital experience
- The donor candidate also meets with the independent donor advocate, who works with the donor candidate to ensure that his or her best interests are represented and that decisions made are to the benefit of the donor
Once all tests are complete, the donor’s candidacy is reviewed at the Mass General Transplant Center’s multidisciplinary kidney transplant selection meeting. If the donor is approved, donation surgery can be scheduled on a date that is convenient for both the donor and recipient, or the donor can begin the process of being entered into the paired exchange.
National Kidney Registry
Mass General participates in the National Kidney Registry (NKR), an independent organization that facilitates transplants for patients with incompatible living donors, and for antibody, blood type, size and age issues. A computer program finds suitable donors from other mismatched pairs in the NKR, and identifies the necessary exchanges needed to allow all corresponding recipients to be transplanted from a suitable donor. Patients may be part of a multi-pair chain that results in several recipients being transplanted across many states.
UNOS Paired Kidney Exchange Program
Mass General can register patients with incompatible living donors in the UNOS Paired Kidney Exchange Program, which works to expedite transplants in patients with blood group antibodies or other incompatibilities to their potential living donors.
Some patients awaiting kidney transplant may be unable to receive a kidney from a living donor because of a positive cross match. A positive cross match can result from antibodies produced by the recipient following pregnancies, blood transfusions or prior transplants. The Mass General Kidney Transplant Program has an effective protocol in place to clear these antibodies from appropriate candidates. After additional blood testing, medications and treatment, a final evaluation determines if the transplant can take place safely. Close follow-up after transplantation is required.
Living Liver Donor Program
Mass General has one of the most active and experienced living donor liver transplant programs in New England. Through living donor liver transplantation, a family member or friend donates a portion of his/her liver, allowing patients to receive a transplant without a prolonged waiting period. The donor’s healthy liver grows back to full size within a few weeks.
Donating a portion of your liver to another individual is a great act of kindness and can be life-saving for the recipient. A liver transplant is a complex surgery for both the donor and the recipient. In order to effectively plan for the surgery and ensure the best possible outcomes, the Mass General liver transplant team evaluates living donors in a three-part process. Potential donors may choose to discontinue their evaluation at any point in the process, for any reason, with complete confidentiality. Typically, the Transplant Center and the recipient's insurance will cover the cost of the evaluation and surgery.
The Process to Become a Donor
Phase One: Questionnaire and Blood Tests
- Donors must be between the ages of 18 and 55, and have no serious medical problems
- The donor evaluation begins with the potential donor contacting our transplant center and answering a few questions that allow us to determine the donor’s overall health status
- Standard blood tests will be done to determine blood type, liver function and overall health status. Blood testing can be performed at Mass General or at another local hospital
Phase Two: Team Evaluation and Surgeon Visit
- The donor will meet with our hepatologist (a doctor who specializes in the treatment of the liver, gallbladder, biliary tree and pancreas), living donor nurse coordinator, financial coordinator, social worker, living donor advocate and nutritionist to learn about the donation process and to ask any questions
- The evaluation includes a complete medial history and physical examination, and additional testing such as an electrocardiogram (EKG), chest X-ray, a CT scan of the abdomen to evaluate liver anatomy and other blood work or tests as needed
- Next, the donor will meet with a surgeon from the Mass General Liver Transplant Program to discuss the surgical procedure and hospital stay. The operation is performed using a laparoscopic-assisted technique, and the majority of donors go home five to seven days after surgery
Phase Three: Anesthesia Evaluation and Scheduling Surgery
- Once all tests are complete, the transplant team will discuss the donor's eligibility at our weekly multidisciplinary liver transplant meeting to determine if the donor is approved for surgery. Once approved, we will schedule the surgery on a date that is convenient for both the donor and recipient
- The donor will meet with his/her surgeon to sign the surgical consent form and to answer any last-minute questions. The donor will also meet with an anesthesiologist to discuss the anesthesia process and answer any additional questions