DEAR MAYO CLINIC: I'd like to become a living kidney donor. What's involved and how do I prepare if I'd like to donate a kidney?

ANSWER: You've made a generous and meaningful decision to become a living kidney donor. More than 90,000 people in the U.S. are on a waiting list for a kidney transplant. 

Your donation offers life-changing benefits for someone with kidney failure. The kidney's role is to filter waste from the bloodstream. Receiving a kidney transplant frees the person from the rigorous schedule and restrictions of dialysis and allows them to participate more fully in life — working, raising a family, traveling and returning to the activities they value. 

Living donor kidney donation can be made in several ways:

• Directed. This means your kidney will go to someone you know — a family member, friend or co-worker. Blood relatives are usually the most compatible living kidney donors.
• Paired. If you aren't compatible with your intended recipient, you may participate in a kidney exchange so that both recipients receive compatible kidneys.
• Voucher (advanced donation). You can donate your kidney now through a national program and receive a voucher for a designated person. If that person needs a transplant in the future, the voucher helps prioritize them for a compatible living donor kidney through the exchange system
• Nondirected. Your kidney goes to someone you don't know, based on medical need and compatibility.

This is a big decision, and you want to go into it feeling well informed. Typically, when you decide to become a living donor, a living donor advocate will contact you, followed by the living donor team, who will explain the risks and benefits, the process, and provide care and support along your donation journey.

Throughout the entire process, you shouldn't feel pressured. If you change your mind, that's OK too. Also, your confidentiality as a donor is protected unless you choose otherwise.

The cost of the donor evaluation and testing is covered by the transplant center or the recipient's insurance. Living donors aren't financially responsible for medical testing related to donation.

Health history and criteria

You'll start your donation journey by filling out a health history form. Living donors are carefully selected based on health criteria. Factors such as chronic diseases, diabetes, previous cancer treatment, certain medications and anything that could affect the future health of your kidneys are considered. Weight, blood pressure and kidney function also are key factors.

If you meet these criteria, you'll undergo a comprehensive evaluation at a transplant center. This includes a physical examination, blood and urine testing, imaging of the kidneys, and consultations with a nephrologist and transplant surgeon. In many centers, this evaluation can be completed in a single day.

Once all this information is gathered, it will be presented at a multidisciplinary living donor meeting where the whole team — living donor advocate, nephrologist, surgeon, nutritionist, pharmacist and social worker — will evaluate the results to determine whether you're an eligible donor. If you're approved, then the donation process begins.

Surgery

The first step is to schedule surgery. The timing depends on whether you're making a directed, paired or voucher donation. The procedure is typically performed laparoscopically using minimally invasive surgical techniques. Most donors stay in the hospital for one night and return home the next day.

After surgery, temporary symptoms such as pain, nausea and constipation are common and managed by your care team. Heavy lifting and strenuous activity should be avoided for the first two weeks, and most donors return to their usual activities within four to six weeks.

Your remaining kidney needs time to adjust, too. To take on the extra work, it will undergo internal changes to improve its filtration capabilities. Typically, donors regain 75% of the function they had from two kidneys.

Follow-up care is an essential part of donation. Transplant centers monitor donors at six, 12, and 24 months after surgery to ensure your long-term health.

By choosing to become a living kidney donor, you offer someone not just a transplant but a renewed opportunity for life.

Pooja Budhiraja, M.B.B.S., Nephrology and Hypertension, Transplant Center, Mayo Clinic in Arizona 

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