With August being Organ Donor Awareness Month, Transplant Education for Living Legacies (TELL) is dedicated to raising awareness about the critical importance of organ donation.
According to Stella de Kock, TELL managing director, there are two types of donors – a living donor and a deceased donor.
Living organ donation
De Kock said one can donate a kidney or part of the liver to a patient on the waiting list. “This may be someone you know or a stranger.
To be listed for a transplant, the recipient goes through a variety of tests and ongoing assessment by their specialist.
When the recipient has been cleared to be listed for a transplant, the assessment of the living donor will start.
“The work-up process for the donor is done in phases and can be stopped at any time if the donor changes his or her mind or if it comes to light that the donor has a medical condition that will prevent a transplant,” De Kock said.
The World Health Organisation (WHO) defines donor selection: “Live donations are acceptable when the donor’s informed and voluntary consent is obtained; when professional care of the donor is ensured and follow-up is well organised; and when selection criteria for donors are scrupulously applied and monitored.”
.She said the Declaration of Istanbul, of which South Africa is a signatory, and by law in South Africa, financial incentives for living donations are prohibited.
The testing process for kidney and liver patients awaiting a transplant
In a kidney or liver transplant, the testing process involves several crucial steps:
• Evaluation: Comprehensive medical evaluation, including physical examinations, medical history review, and psychosocial assessment.
• Blood tests: Blood type and tissue typing to ensure compatibility with potential donors.
• Imaging tests: Chest X-rays and ultrasounds, to assess the current state of overall health.
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• Functional tests (liver recipient): Liver function tests, including bilirubin, albumin, and clotting factor levels, are crucial.
• Infection screening: Testing for infections such as HIV, hepatitis, and other transmissible diseases.
• Cardiovascular assessment: Ensuring the heart and blood vessels are in good condition to handle surgery.
• General: Pap smear, mammogram, BMI, dental health.
• Some of these tests will be repeated annually or as requested by the transplant coordinator
Tests for living donors for kidney or liver transplants
Living kidney or liver donors undergo a rigorous screening process to ensure they are healthy and suitable for donation:
• Initial evaluation: Detailed medical history, physical examination, and psychosocial assessment to determine overall health and motivation.
• Blood tests: Blood type and cross-matching to confirm compatibility with the recipient.
Kidney donor: tests for kidney function (creatinine, eGFR).
Liver donor: tests for liver function (ALT, AST, bilirubin).
• Imaging studies: CT scans to assess the anatomical structure and function of the donor’s kidneys/liver. A liver biopsy might be performed.
• Cardiac evaluation: Stress tests, echocardiograms, and other cardiovascular assessments to ensure the donor’s heart can withstand surgery.
• Infection screening: Testing for infectious diseases like HIV, Hepatitis B and C, and other transmissible infections.
• Psychological assessment: Evaluating the donor’s mental and emotional well-being to ensure they understand the risks and benefits of donation.
“Once all tests are completed, the case will be presented to the transplant panel and when they approve, the case will be referred to the Department of Health advisory committee for approval for a non-related living donation or altruistic donation. Only directly blood-related donors are not required to get approval from the Department of Health,” she explained.
Who can be a donor?
Living donors can be family members, friends, or even altruistic donors who volunteer to donate to someone they do not know. Key criteria include:
• Age: Typically 18 or older.
• Good health: Donors must have good overall health without significant medical conditions that could complicate surgery or recovery.
• Compatibility: Blood type and tissue matching with the recipient.
• Informed consent: Donors must fully understand the risks and benefits and voluntarily consent to the procedure.
TELL encourages individuals to learn more about living donation and consider becoming a donor. By stepping forward, individuals can give someone else a second chance at life.
For more information visit www.tell.org.za
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