DEAR MAYO CLINIC: I was surprised to learn that even though I have type 2 diabetes, I possibly could be a candidate to donate a kidney to my husband who has end-stage kidney disease. Would donating a kidney be safe for me and my husband? I thought diabetes could cause kidney failure. 

ANSWER: Thank you for considering the gift of life through organ donation. I am wishing all the best to you and your husband. 

You are correct; diabetes is the top cause of kidney failure. This is why patients with type 2 diabetes previously were ruled out as potential living kidney donors. However, the Organ Procurement and Transplantation Network updated its living donor criteria to allow people with type 2 diabetes to donate a kidney if there is no evidence of organ damage or an unacceptable lifetime risk of complications. 

The major benefit of this policy change is to open up the door for those who would like to be living kidney donors who could not be donors in the past. This can increase the pool of potential living kidney donors and be a lifeline to many people who suffer from end-stage kidney disease. 

Mayo Clinic Transplant Center also adopted its own more stringent policies to minimize potential risks. In addition to national criteria, Mayo Clinic patients with type 2 diabetes also must meet the following criteria to be a donor:

• Be age 60 or older.
• Have well-controlled diabetes and not use insulin.
• If over age 65, can be using up to two oral medications for diabetes.
• Not be overweight.
• Have no family history of kidney disease.
• Undergo a thorough health assessment and individualized risk evaluation.

People with type 1 diabetes, however, remain ineligible to be a living kidney donor.

About 89,000 people are on the U.S. waiting list for a kidney transplant, according to the United Network for Organ Sharing. 

Unfortunately, kidney disease usually is irreversible and continues to worsen over time. While some types of acute kidney injury may recover, in general, chronic kidney disease is a progressive disease that leads to dialysis or the need for a kidney transplant.

If someone is facing end-stage disease, one option is to go through dialysis, which temporarily replaces kidney function. That can be done through the blood, called hemodialysis, or through the abdomen, called peritoneal dialysis. However, a kidney transplant is the gold standard treatment because studies show transplant patients live longer and have a better quality of life than those on dialysis. 

Receiving a living kidney donation also typically is faster than a deceased donor kidney, with arrangements taking weeks to months for a living kidney donation compared with an average wait of several years for a deceased donor kidney. Research has shown that people who receive a kidney from a living donor kidney have better outcomes than those who have a deceased-donor kidney transplant.

Kidney transplant surgery is done through a minimally invasive, laparoscopic approach through small incisions in your abdomen using surgical instruments and a thin tube with a camera on the end called a laparoscope. Patients typically have a short hospital stay and less pain than after an open surgery. Many donors return to work and their activities a few weeks after donating a kidney. — Naim Issa, M.D., Nephrology, Mayo Clinic, Rochester, Minnesota

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