In Sri Lanka, as in many parts of the world, kidney disease is a significant health concern affecting numerous individuals and families. With the prevalence of renal ailments on the rise, the need for organ donations, particularly kidneys, has become more pressing. Amidst this backdrop, living kidney donation emerges as a beacon of hope, offering a chance for individuals to extend the gift of life to those in need. 

Living kidney donation involves the voluntary act of giving one of your kidneys to someone in need of a transplant. Unlike deceased organ donation, where organs are procured from individuals who have passed away, living kidney donation occurs while the donor is alive and well. The altruistic act not only saves lives but also enhances the quality of life for recipients, enabling them to regain their health and independence.

If you are over the age of 18 and in good health, you can be considered as a living kidney donor. There are several tests that you will need to go through to make sure that you are healthy enough to donate and that your kidney is a suitable match for the intended recipient. You will not be able to donate if you have had cancer, or if you have diabetes, heart disease, or a condition affecting your kidneys.

Choosing to donate your kidney is a very big decision and you should talk it through with your family and friends, as well as your doctor. You have the right to change your mind about donating at any time, right up until the operation itself.

One of the most remarkable aspects of living kidney donation is its potential to create a chain of generosity and compassion. For example, a parent may wish to give a kidney to their child. This is called a directed donation. It is also possible to give a kidney to a complete stranger and this is called altruistic (non-directed) donation.

The process

In general, your kidney has to be the right blood and tissue type to ‘match’ the intended recipient. There are lots of tests during the assessment process to make sure that you are well enough to undergo major surgery and that you have enough kidney function to spend the rest of your life with one rather than two kidneys.

As part of the process, you also need to get ethical clearance. This process will be arranged by a dedicated officer in the respective hospital which does renal transplant.

In this process, it is a requirement for you to make sure that: You are who you say you are – you will need official identification as proof; you are acting of your own free will in offering to donate a kidney; and that you understand the process and what the operation will involve.

Following this, you will be given a letter which grants authority for the renal transplant as per Section 7 of the Transplantation of Human Tissues Act, No. 48 of 1987, which will include the name, age, National Identity Card number of both the donor and the recipient.

The donor will have to go through a number of tests known as the workup and the order of the tests may vary between hospitals and different nephrological units. 

In general, the tests can be divided into two phases: the First phase is to see your general fitness for donation, which will include – A questionnaire to check the general health and medical history; Height and weight related measurements; Blood pressure checks; Blood tests to make sure that you are in good health and to test for illnesses or infections; Blood group tests to ensure compatibility between yourself and the recipient; Urine tests to check for infections or problems with your own kidneys; An ultrasound scan of the kidneys to look for gross abnormalities; and an Electrocardiogram test to make sure that your heart is healthy.

If all phase one tests are normal, you proceed to phase two. These tests are more specialised and may include: Chest X-ray to make sure that there are no problems with your lungs; Computed tomography and magnetic resonance imaging scan of the kidneys to check their structure and position; A test to measure your kidney function (diethylene-triamine-pentaacetate); and Infective screen to see if you are infective and to assess any risk of transmission to the recipient.

Once the doctor thinks that you are fit for kidney donation, you will then discuss the operation with the transplant surgeon.

People living with one kidney rather than two have a slightly higher risk of developing high blood pressure or future kidney problems than the general population. However, it is also your responsibility to bring it to the attention of your doctor at an early stage if any problems arise.

Donating a kidney will not affect your ability to have children although you will need to tell your doctor that you are a kidney donor if you do become pregnant as you may need more frequent health checks during pregnancy. It is important that you maintain a healthy lifestyle after kidney donation and that you do not smoke as this can speed up the decline in kidney function that occurs with normal ageing.

Usually, the nephrologist will make sure that donating a kidney will not harm you or increase your own risk of having kidney problems in the future. If they decide that your risks are too high, they will advise you not to be a kidney donor and will explain the reasons to you.

In general, it takes between three and six months to complete all of the tests, but it may take longer if some tests need to be repeated or if you need extra tests.

Once a date is fixed, your operation will be done under general anaesthesia. After the operation, you will stay in hospital for a few days after your operation. You will be given pain killing medication and you will be encouraged to get out of bed and start moving around as soon as you feel able. You will need to rest at home for several weeks after you leave the hospital. It is generally recommended that you take between four to six weeks off work, or longer depending on the nature of your job.

Although all operations carry some degree of risk, kidney donation is a common procedure at the National Institute for Nephrology, Dialysis and Transplantation (NINDT), which will be carried out by an expert team who will quickly identify and treat any problems that occur. During your assessment, the risks of kidney donor surgery will be explained to you and you will be able to ask questions, but please speak to your transplant team at any stage if you have any concerns.

Overall, living kidney donation not only benefits the recipient but also the donor. Studies have shown that donors experience a sense of fulfilment and satisfaction from knowing that they have made a tangible difference in someone else’s life. Additionally, advancements in medical technology and surgical techniques have made the donation process safer and less invasive than ever before, further reassuring prospective donors.

As we strive to address the challenges posed by kidney disease in Sri Lanka, it is imperative that we recognise the critical role of living kidney donation in saving lives and improving health related outcomes. By fostering a culture of altruism and solidarity, we can ensure that more individuals have access to the life saving treatment that they desperately need. Together, let us embrace the power of living kidney donation to create a healthier and more compassionate society for all. 

(The writer is a Medical Officer at the Professional Unit of the National Institute for Nephrology, Dialysis, and Transplantation)

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The views and opinions expressed in this article are those of the author, and do not necessarily reflect those of this publication.