About Kidney Transplants

Deceased donors are individuals who, while they were living, had requested that their organs be donated for transplantation. Most transplanted organs come from deceased donors. The transplant waiting list is for people waiting for an organ from a deceased donor. These organs are recovered and distributed under supervision of the United Network of Organ Sharing (UNOS). The average wait time on the list is 3-5 years, depending on blood type.

There are several types of deceased donors from whom you may get a kidney. They include:

• Standard Criteria Donor (SCD) is a donor that died from brain death that does not meet the definition of Extend Criteria Donor (ECD) or Donation after Cardiac Death (DCD).
• Extended Criteria Donor (ECD) is a brain death donor who is older than 60 years old, or a donor who is between 50 and 59 years old and had two of the following conditions at the time of death:

a. had a terminal creatinine higher than normal
b. the cause of death was from a Cerebral Vascular Accident (CVA)
c. had a history of hypertension (high blood pressure)

• Donation after Cardiac Death Donor (DCD) is somebody who did not die from brain death. This is someone who suffered a non-survivable illness or injury and was placed on a ventilator to survive. The donor’s family makes a decision to take the person off the ventilator with the expectation that the person’s heart will stop beating within a very short period of time.
• En Bloc Kidney Donor is a pediatric organ donor generally under 5 years old. Both kidneys from this donor come together and are transplanted into one person.

All kidneys are screened by the transplant center before they are accepted. Your transplant team will go over all these options with you and will determine what type of deceased donor organ will work for you. You must agree to accept offers from donors other than Standard Criteria Donors. The Avera McKennan Transplant Institute uses all types of donors. Our outcomes using all types of donors are better than the National Average*. (*See www.ustransplant.org for more of our program’s outcomes.)

Living donors make the decision to give up one of their kidneys. The number of living donors has been steadily increasing. 2001 was the first year that more living donors donated than deceased donors. The recent resurgence of living kidney donation has resulted not only because of the increasing shortage of deceased donor kidneys, but also because of the development of donor procedures that are less stressful for the donor. There are two types of living donors:

• Living Related Donors (LRD) are people who are genetically related like a parent, sibling or other blood relative.
• Living Unrelated Donors (LURD) are people who have an emotional connection to you like a spouse, a friend or a co-worker.

Keep in mind when looking for a living donor, the Avera Transplant Institute follows the guidelines for donation that have been approved by U.N.O.S., The American Society of Transplant Surgeons and The American Society for Transplantation. These guidelines do not permit “solicitation” of donors, either deceased or living. If a person whom you do not know calls to be a donor for you, we will follow our anonymous donor policy.

Anonymous Donors are living donors who do not know the patient, but want to help someone in need of a kidney transplant. Anonymous donors agree to donate a kidney to someone on the center’s waiting list that has been selected by the transplant program. These patients are selected by using similar guidelines that U.N.O.S uses when it selects patients to receive a deceased donor organ.

As you educate your family and friends about the need for a living donor, have anyone who is interested contact the Avera Transplant Institute. Even if your potential living donor does not have the same blood type (ABO incompatible), we do have options for these living donor pairs.

The first option is a desensitization treatment. This is a treatment that decreases the number of antibodies in your blood to keep your body from rejecting or attacking the transplanted kidney. This is not always an option for every living donor pair. The transplant doctors can further discuss this option with you.

The other option for ABO incompatible donors is Paired Donation. Paired donation is like a second list for transplant candidates who have a living donor, but are unable to receive their living donor’s kidney because of ABO incompatibility or positive crossmatch results. The living donor pair is placed on the paired donation list with other incompatible living donor pairs. A computer matching system, similar to those used for the deceased donor list, matches you and your living donor with another living donor pair. You would then trade donors with the other matched pair. The transplant doctors may further discuss this with you.

• www.kidney.org (NKF)
• www.transweb.org
• www.livingdonors.org
• Medscape's transplant section
• www.unos.org
• www.ustransplant.org

1. Word of Mouth
2. Personal Letter
3. Send Educational Materials
4. Leave Educational Materials Lying Around Your House
5. Church Bulletins “Prayers for _____________ who is in need of a kidney transplant.”
6. Newspaper Article
   Remember, your goal is to educate the general public about organ donation, including living donation. Using the media to solicit donors is discouraged by U.N.O.S.
7. Christmas letter
8. Newsletters at work/community organizations to which you belong.
9. Any other creative way to get the word out!

1. Decide who you will ask.
   Living donors no longer have to be limited to blood relatives. Think about all the people you know that may want the opportunity to help you. This should include spouse, friends, co-workers and any other persons you have regular contact with.
2. Tell your audience a little bit about yourself. Here is the opportunity to share with potential donors what you enjoy doing. Discuss what you may now be limited to do because of your health and why you think a transplant will improve your quality of life.
3. Inform them of your current health status.
   Tell your potential donors about your health status. Let them know you are nearing dialysis and you would like to avoid it. If you are on dialysis, share with them what it is like to receive this type of treatment.
4. Provide Reassurance.
   While this letter is meant to get people to think about the possibility of living donation, it is not meant to be a way to “guilt” someone into donating. Tell them that you understand that living donation may not be an option for everyone. Acknowledge that this is their decision and that your relationship will not be jeopardized if they choose not to donate.
5. Include information on how to contact the Avera McKennan Transplant Institute.
   Be sure to include the name of the donor coordinator and the transplant program’s toll free number.

Dear Family Member,

The last twelve years have been quite a gift. I feel that I have accomplished a lot during this time of freedom. Since my second transplant, I worked part-time, moved to Mayville and got my degree in Business Administration, and, after several part-time and temporary positions, I found a job that I enjoy. Furthermore, it is a job that allows me to be independent!

But as you may already know, the time has come for me to seriously start looking at the reality of a third kidney transplant. Dr. Nephrologist and my doctors at the Avera Transplant Institute are in agreement that a transplant will be a necessity in the near future. With this in mind, they have asked that I look for possible living donors. The hope is that I can find a match and get a transplant before dialysis becomes a necessity.

If you are interested in becoming a donor, please contact the Transplant Program at 888-909-1112. They will ask you some questions and instruct you on how to get tested if you are found to be a good candidate.

I know this is a big decision. Please think about it carefully and do it only if you want to do it. I don’t want anyone to feel pressured or to feel guilty about donating. Please think about your family and how this would impact them. Consider the risk you would be taking before you make your decision to donate. I have been on dialysis before and I know I can do it again. I also know that the people who choose not to donate have their reasons and that they love and care for me just as much as those who make the decision to donate. I love you and I hope that you will follow your instincts, what ever they may be, when you make your decision.

I spoke with my coordinator yesterday and was told anyone could call in to be considered not just immediate family. I am sending this letter to my immediate family only, so please share the enclosed information with your family members.

Love always, Jane and John

Date

Name Address City, State, Zip

Dear ___________,

As you may know, ______________is being treated for End Stage Renal Disease.

Treatment options include:

1. Dialysis
2. Deceased Donor Transplant (with a potential wait of 3-5 years)
3. Living donor Transplant

Of these treatment options, living donation has become the preferred treatment. Organs last longer, work quicker and this type of transplant prevents lengthy dialysis treatment. Today, more than half of all donors are living donors.

_______________has identified you as a friend or family member and has asked us to send you educational information on living donation. If you have questions or if you have an interest in pursuing this treatment option for _______________, please contact the Avera Transplant Institute. Our toll free number is 888-909-1112.

Sincerely,

The Avera Transplant Institute Team