People sometimes remark humorously that “the easiest part of donating a kidney is the surgery”, and as with most jokes, there is an element of truth in this, as the process that every potential kidney donor undergoes proves. It is a lengthy, thorough and painstaking process, because its purpose is to ensure that, with God’s help, no harm will occur to the donor.
A donor must be at least 23 years old and a healthy individual, who doesn’t suffer from high blood pressure or diabetes, isn’t excessively overweight and has no record of kidney problems. Women should preferably have already given birth.
The process takes on average between 3-6 months and sometimes even more, depending on the hospital, the donor’s health and other factors.
In order to reduce the effort involved and avoid unnecessary tests, we have developed a procedure in which the transition from one step to the next usually occurs only when the previous step has been completed satisfactorily.
The process is made up of seven stages:
First Step – preliminary tests in the local health clinic
At this stage you will be asked to undergo several preliminary tests, in order to determine your fitness to be a donor. Your family doctor will refer you to do these tests at your local health clinic, according to a list you receive from Matnat Chaim. This list includes the following tests:
- Blood test: blood count, blood chemistry and blood type
- General urine test and culture
- Blood pressure (a nurse will measure this for you)
- Kidney ultrasound
Second Step – send the results to Matnat Chaim
When the results of the tests arrive, send them on to Matnat Chaim. You can send them by e-mail to firstname.lastname@example.org or by fax to 072-2555757. It’s advisable to keep copies of these test results.
Third Step – matching patient and donor
When we have all of the test results, provided they are all normal, we can match you with a potential recipient. We try to match you with a recipient at this early stage, because the considerable cost of all subsequent tests undergone by the donor from this point onwards is covered by the health care provider of the recipient.
Donor-recipient compatibility is based on blood type and any requests on the part of the donor.
Fourth Step – contacting the hospital
Matnat Chaim refers the patient and donor to a transplant center, which invites the donor for a meeting and makes an appointment for compatibility testing.
The transplant centers are hospitals that perform organ transplants. Each transplant center has a department for liaison of transplants, which handles the process leading up to the transplant: arranging all the necessary tests, making appointments for the various committees and offering any assistance needed.
Fifth Step – hospital tests
The following tests are carried out in the hospital:
- Tissue typing – At the transplant center the donor and patient undergo preliminary compatibility testing; blood samples taken from the donor and the recipient are compared and checked for compatibility. If the recipient is found to have no antibodies to the donor’s blood type, compatibility is approved.
On the same day, the donor meets with the transplant coordinator and a nephrologist.
- Intensive day of testing – an intensive day of testing in the hospital, during which you do a number of important tests, such as a C.T., chest x-ray, urine collection, psychological assessments, meeting with an anesthetist etc.
If you are donating to a relative, the hospital’s internal committee convenes and external committees are unnecessary.
Sixth Step – Health Ministry Committees
After completion of the tests at the transplant center and medical approval is given, the decision regarding the file is sent to the Ministry of Health for referral to the National Transplant Center, the institute authorized to give final approval for the transplant. The National Transplant Center arranges for the donor to appear before two different committees:
- Psychological committee: a session with a psychologist to assess the donor’s emotional fitness. The assessment includes the Rorschach test, a projective test designed to examine the donor’s personality characteristics and cognitive and emotional functioning.
- Ministry of Health Assessment Committee: This committee is comprised of a social worker, psychologist, lawyer, physician and representative of the public. The committee operates according to the criteria defined by the Organ Transplantation Law (Clause 15). Its purpose is to ascertain that the donor is prepared to make a living organ donation of his own free will and not under duress, with no promise or expectation of payment for the donation, other than the imbursement granted to donors by the government under the Transplantation Law and its regulations. The committee also has to make sure that the donor has fully understood the nature of the process and its ramifications and has received all the medical information needed to make an intelligent decision regarding the donation.
After receiving the approval of the Ministry of Health, a date can be set for the operation.
Final Step – surgery
On the day of the operation, or the evening before, you come to the hospital for a three to four-day hospitalization.
Surgery is performed under general anesthetic, using one of two techniques: laparoscopy or open nephrectomy. Medical considerations determine the choice of technique.
Surgery is performed via 3-4 small incisions in the stomach wall. The stomach is inflated with gas, creating an internal work space. A camera is inserted through one of the openings, so that the inside of the stomach can be observed on a screen. Special instruments for operating inside the stomach are inserted through the other incisions. The surgeon’s hands remain outside the stomach and he can see his movements on the computer screen. The kidney is removed from the body through a small incision of about 7 cm at the bottom of the stomach.
Recovery is easier and quicker when laparoscopy is used, since no incisions in the stomach muscles are involved. Two or three days after the operation the patient can walk around, and any pain responds well to pain-killers. Shortly afterwards he is discharged. Return to work and to normal functioning is fairly quick, but each case must be assessed individually, because of differences in recovery rates and work demands.
- Open nephrectomy
An incision is made in the muscles of the stomach wall and one of the kidneys is removed. Recovery after use of this technique is slightly longer and hospitalization is about a week on average.
Diary of (someone who wanted to be) a donor (in Hebrew): The detailed diary of Dan Seter who went through the whole process to donate a kidney but was rejected at the very end because of a medical issue.