A life-saving step: What’s required to be a living donor

Candidates must be in optimal health to enter the Providence Sacred Heart Medical Center’s living donor program. For Spokane, eligible recipients wait on an organ transplant typically three to five years.

“For 2021, our program had 268 applications for potential living donors – and this really speaks to donors’ optimal health – we had four accepted,” said Michelle Thurston, a nurse and living donor coordinator.

“With our program on the recipient side, we currently have 208 recipients on our wait list, so the need is great.”

To accept a donor, the process requires four to six months that includes the person’s health checkups. It starts with an online application, at sacredheartlivingdonor.org, with about 10-15 confidential health questions online. The program has accepted donors ages 18-65.

Other steps include a review by professionals, signed consents and a candidate speaking to an advocate on their behalf. Donors’ health checkups and any cancer screenings are their financial responsibility. If any medical issues arise, a donor might be rejected. A psycho-social evaluation occurs, as well. Then, there is donor-match testing.

“The factors that determine matching are what we would call human leukocyte antigen, or HLA,” Thurston said. “They’re a group of six proteins that make up tissue type, and they’re targets of organ rejection.

“When we are matching a donor or testing compatibility between the donor and recipient, we want those proteins or numbers to match, so the more proteins that are the same or matching, the better that compatibility is.”

A donor’s procedure and hospital stay are typically covered. Evaluation and hospitalization costs are paid for by the transplant program, and the insurer of the person receiving the organ typically covers these medical expenses after the transplant, the program’s website says.

However, donors need to consider costs that might include lost wages, transportation, lodging and child care. Financial help is available, and donors can receive information from the National Living Donor Assistance Center, which helps make a donation more affordable.

Donors return for a two-week checkup, again at no charge. “That’s covered by our Providence transplant program and the recipient’s insurance,” Thurston said. “Then regulatory-wise, we’re required to follow up with our donors at six months, one year and two years to see how their kidney is doing.”

If donors aren’t from this region, the center can work with a primary care provider remotely to monitor.

Recipients must return to the center for more intensive follow-ups, so if they have to drive greater than one hour, they’re initially asked to get temporary housing for three to five weeks. Any organ transplant patient must take immunosuppressants lifelong to avoid rejection.

Stacy Adams, a living donor social worker, is part of services that include evaluating a person’s motivation to donate and explaining risks and benefits along with a donor’s financial impacts. Adams said some people don’t realize that as donors, they could be off work for four to six weeks.

“Finances are probably the biggest barrier when people come forward,” Adams said. “If you have a desk job, you can go back much quicker than if you’re a construction worker because you’re only able to lift 10 pounds for six weeks.

“Not a lot of people have paid leave accrued for that amount of time, so we talk to them and make sure they’re aware.”

Evaluating motivation is another key, she said, and to monitor that a donor wouldn’t have any regrets or potential mental health issues.

“We want the kidney to last the rest of their lifetime, and we want to make sure they’re stable from a mental health perspective. Most people, you can tell, truly have an altruistic reason and want to help their loved one, but if they’re hoping to gain something in return beyond that, then obviously we get concerned.

“It’s against the federal law to receive any kind of payment or gift or anything of value for your kidney.”

Living donors can come from all over the U.S., she said, as long as they can be here for the weeks spanning surgery.

Thurston said living donors after surgeries generally recover rapidly, but having the one kidney will reduce kidney function by about 25% to 35%. “With that said, most donors go on to live a very normal life and can’t even tell after they’ve recovered from initial surgery.”

Initially, donor fatigue is the most common complaint until recovery. Adams also connects living donors to any resources they might need.

Overall, such donations are gifts beyond helping one person, Thurston added, because people on the waitlist essentially are waiting for a deceased donor organ, but when a living donor comes forward and surgery occurs, that recipient is removed from the waitlist.

“It allows the next person to be moved up and receive either a deceased donor offer transplant or have their own living donor workup.”

For more information, check the program’s website, or for general questions on the living kidney donor program, call (509) 474-4500. Pancreas transplants are done in the program when a deceased donor organ is matched.