Preparation of the donor

  • Who are the people who will prepare you to the donor kidney removal?

    Transplantation team, consisting of professionals and working together in P. Stradins Clinical University Hospital Latvian Transplant Center, will support you and your family will provide the necessary information and answer any questions considering the kidney transplant from a living donor. This support and care will not end after the kidney will be removed. The same team will continue to monitor your health after kidney removal surgery as well.

    Transplant Center nephrologist will assess your physical and medical condition and suitability for operation, will take care of you before kidney removal, will participate in your treatment during post-operative period in hospital and will monitor your health after your check-out the hospital.

    Transplant coordinator will organize graft retrieval and transplantation process, and will make sure that you are aware of all that goes on in the process, will provide you with complete information on all aspects related to the kidney donation, so that you can give consent to surgery.

    Transplant surgeon will be responsible for the kidney removal operation, together with other professionals will treat you during post-operative period.
    Psychiatrist is the specialist that each potential kidney donor has to visit. Psychiatrist will ascertain psychological balance of the potential donor, the ability to handle the stress associated with this complex procedure, if necessary, and the ability to deal with these issues. The doctor will verify that the kidney donation is your voluntary decision.

    Physiotherapist will teach you the correct breathing exercises on the first postoperative days, will show right leg and arm muscle training exercises, as well as the easiest and most suitable ways of physical activation after the surgery.

    Care personnel (nurses, nursing assistants) will help you and will take care of you prior the surgery and in the postoperative period.
    During the kidney transplantation preparation period and transplantation itself, in case of need, doctors and other personnel of different specialities can be involved in the care process of donor or recipient (e.g., social service, hospital chaplain service, etc.).

  • What tests have to be performed for the potential donor?

    A person wiling to donate a kidney has to undergo a comprehensive health investigation.  On the completion of all tests just about 40 – 60% of potential donors may donate a kidney for further transplantation.

    Primary examination

    • Family doctor (general practitioner) refers a potential kidney donor to Latvian Transplant Center where a nephrologist (kidney doctor) will proceed with all the necessary tests and examinations prior the expected surgery, as well general practitioner indicates all the known serious diseases. Afterwards the nephrologist provides the family doctor with a complete review of findings and evaluation of possibility that the person becomes a kidney donor;
    • Consultation with transplant coordinator;
    • Nephrologists’ examination in Latvian Transplant Center. There the nephrologist assesses the overall status of health, medical history, options of anaesthesia and kidney removal operation.

    Potential donor education
    a person who wants to donate a kidney for transplantation in order to be fully informed of all issues considering operation should:

    This information on all the benefits and adverse effects of kidney donation will allow the anticipated kidney donor to make an informed choice.

    Kidney donor and recipient immunological compatibility test
    In order to determine immunological compatibility of the living donor and recipient and predict the risk of renal graft rejection immunological tests have to be done.

    • ABO blood group compatibility - kidney donor and recipient's blood group must be the same or compatible;
    • Determination of the HLA antigen system (it is the human leukocyte antigen system that allows the immune system to distinguish between "self" and "foreign", the National Blood Service of Latvia. The more kidney donor and recipient antigens of this antigen system match the lower is the risk of kidney graft rejection;
    • HLA cross-compatibility ("cross-match") - an individual compatibility testing in HLA system. In order to make kidney transplant the "cross-match" test must always be negative. It is usually repeated a short time before the expected kidney transplantation.

    Donor kidney function tests - Glomerular filtration rate (GFR)
    So that one kidney of the potential donor could be removed and transplanted to another person the renal function of both kidneys should be estimated. This is checked by:

    • Blood biochemical tests (determination of creatinine and urea),
    • renal scintigraphy,
    • kidney ultrasound examination.

    The kidney can be removed for further transplantation only if the function is normal, i.e. if the GFR of both kidneys is more then 80 ml / minute in total, and there are no significant anatomical defects.

    Investigation of renal blood vessels - angiography
    In order to perform a successful kidney transplantation operation it is very important to know the placement of renal blood vessels. Therefore the donor kidney examination with X-ray contrast media - renal angiography, has to be done.

    Estimation of overall health status
    All the disease that may affect the function of the other kidney after one kidney will be removed (e.g., diabetes, certain inherited kidney disease - polycystic kidney, etc.) must be excluded, as well as some viral disease and risk of oncologic disease transmission from a donor to recipient. Therefore, all potential kidney donors undergo the following examinations:

    • Chest organs X-ray, electrocardiogram (ECG), echocardiography (heart ultrasound examination). May be some additional check-up is required - bicycle ergometry (heart examination under load), the glucose tolerance test, etc.,
    • Clinical and biochemical blood tests,
    • virological analysis,
    • if the kidney donor is a woman more than 50 years of age, gynecological examination is required in order to exclude oncological diseases.


    Evaluation of tests and examinations
    To ascertain the suitability of potential donor for the surgery, all the tests and examination results are assessed by the number of specialists - Latvian Transplant Center nephrologists and transplantologists. All results are clearly explained to the prospective donor, as well the family doctor is provided with a written opinion on the examinations performed. If there are any doubts about the medical condition of donor or a disorder found, this could mean an additional examinations for the potential donor that are not listed in this booklet.

    If the donor's health status is found to be suitable for the surgery the  date of operation is scheduled.