People who are considering being a kidney donor might want to know more about the testing that you have to do – both to see if you can be a donor, and to see if you can donate to a particular person.
The testing may vary slightly from one transplant center to another, but I think most of it is pretty standard. I’ll list the testing that I went through (for my specific case), as I think specific details are useful. But keep in mind that your situation will likely have its own variations…
Blood Pressure & Blood Type
The first thing I had to do was provide the transplant center with the results of blood pressure readings from three consecutive days, with the blood pressure checks occurring around the same time each day. I did these at a couple local grocery stores that have those “check-your-own” blood pressure machines by their pharmacy. It was really easy and only took about five minutes each time. The blood pressure readings are to make sure you don’t already have any issues related to high blood pressure. Once you only have one kidney, your blood pressure is something you’ll want to keep an eye on. The kidneys secrete an enzyme called renin that affects blood pressure regulation. So, with only one kidney, you’ll need to make sure this process is working sufficiently. In addition, high blood pressure can cause kidney failure. So, you don’t want your blood pressure harming the only kidney you have left.
In addition to my blood pressure readings, I had to provide proof of my blood type. I did this by faxing a copy of my Red Cross blood donor card. (Of course, the transplant center also confirmed my blood type later, during other, more extensive tests.)
Crossmatch #1
After receiving my blood pressure readings and my blood type information, the transplant center had me and my stepfather (the intended recipient) undergo a crossmatch test. This test involved having our blood drawn on the same day and Fed Ex-ing it to a lab to be tested. The point of this test is to make sure that the recipient’s blood does not have any antibodies that will attack the donor’s cells. The blood from each person is actually mixed to see what occurs. If the recipient’s blood does attack the donor’s cells, the test is considered “positive”. So, the outcome you want in this test is a “negative” result, which means there are no antibodies that will attack your cells. This test is done early on and then again right before the surgery. Therefore, I call this “crossmatch #1”.
24-Hour Urine Test
Just as delightful as it sounds – this is a test that you’ll want to do over a weekend or sometime when you can stay at home all day. It basically involves peeing into a container all day long and emptying that pee into a gallon jug, which you must keep on ice. You collect the final specimen the following morning and then must take the jug-o-pee to a lab to be tested that same day. Since you need to be able to take it to a lab on the day you finish the test, I started my 24-hour collection on a Sunday morning and then delivered it to a lab on Monday morning. I stayed at home all day Sunday and just did things around the house. Whenever I had to pee, I took my receptacle into the bath tub, collected it, poured it into my jug, and then put the sealed jug back into a cooler that I kept out on my deck. It was a little weird worrying that I would forget and pee in the toilet. I didn’t want to mess up the test, since I really didn’t want to have to do it again! Then, when the test was over, it was so nice to pee in a toilet again 🙂 What a strange experience. The main purpose of this test is to check to see whether you have protein in your urine. If you do, it could be an indication that your kidneys are not functioning as well as they should. You’ll also want to keep an eye on this after the donation.
EKG, GLOFIL, CT Scan, etc.
After the initial tests all went well, I had to travel from my home in Maryland to the transplant center in Atlanta, GA. That’s where my mom and stepfather live. While there, I underwent two days of outpatient testing that included standard blood work, an EKG, a chest X-ray, a GLOFIL test, a CT scan, and consultations with a psychiatrist, social worker, donor coordinator, donor advocate, a nephrologist, and a surgeon. These tests and consultations are then reviewed by a board, which decides whether the donor-candidate is healthy enough and mentally/psychologically adjusted well enough to go through with the donation.
The transplant team was really nice, and they clearly wanted to make this as good an experience for me as possible. The initial tests were pretty basic. The various nurses & technicians got my height and weight, drew some blood and had me provide a urine sample. They also took my blood pressure and pulse and then did the EKG. The EKG was not really a big deal. A technician hooked up some electrodes to various places on my upper torso for about five minutes, and then it was over. I couldn’t even tell that anything was going on. I later learned that my EKG came back “abnormal”, because – being that I’m a triathlete, my heartbeat/pulse were very low and didn’t seem normal. But the doctors knew that I do a lot of running, etc. So, this outcome did not raise any red flags for them.
Next, I had the GLOFIL (Glomerular Filtration) test. This test lasts 150 minutes. They have you ingest a nuclear isotope in some juice and then you drink a lot of water over the 150 minutes. A technician periodically draws your blood and collects the urine you produce throughout this period. The test checks to see how your kidneys filter what they are supposed to filter. My GLOFIL result was 110. After the surgery, it is expected to go down to half of that initially. But the hope is that your remaining kidney will provide more and more function over time and return to a level above 60 or so.
After the GLOFIL test, I had a chest Xray and then a consultation with a psychiatrist. I found this consultation one of the most challenging things I had to go through. I have a feeling that every psychiatrist does this portion of the evaluation differently. So, my experience may not be anything like what you experience. But the psychiatrist I spoke to really made me question what I was doing and why I was doing it. I think he wanted to raise doubts in my mind so that I could be sure I knew what I was doing and that I was still okay with doing it. Like many of the people on the transplant team that I consulted with, he told me several times that I can back out if I want to – all the way up until the time that they put me under. This consultation did really make me think, and I think that was the whole point. But, like I said, my experience may be different from yours.
The next consultation I had was with the nephrologist. I really liked the nephrologist – Dr. Zayas. He is a really warm person, with a great bedside manner. He’s also very upfront and easy to understand. I got a lot of comfort out of talking with him. I also talked to a donor advocate. Her job was to let me know that I can go to her if I have any issues/problems with the transplant team, as she is not a part of the team. She also explained a lot about dialysis. I think this was for two reasons. On one hand, she wanted me to understand the dialysis that my stepfather has been undergoing and to know that there is more than one type of dialysis. I think she may have also told me all about this because, the fact is that I could one day need dialysis if my one remaining kidney ever loses function and can’t do all I need it to do later in life. (I could be wrong about whether that’s why she told me about it. But I did find it useful to know more about dialysis in general.)
That concluded my first day of testing at the transplant center.
My second day started with another consultation with Dr. Zayas (the nephrologist). He showed me the results of the first day’s tests and went over them with me. Then, I went to have the CT scan.
CT Scan
During the CT scan, a technician injects you with some sort of dye. When it gets injected, you feel warm all over. It’s a little freaky, but not too bad. Then, you are lying on a machine that slides you into and out of a sort of scanner. The machine talks to you and tells you to breathe in and hold your breath, then let it out. I imagined that I was in a yoga class, doing the deep breathing. The machine scans you several times, and then it’s over.
The cool thing about the CT scan was that literally 15 minutes later, my donor coordinator and I were able to look at the pictures from it on a computer screen. I could see that yes, I do have two kidneys. That was a relief! And, yes, everything else looked good. It shows whether you have only one artery going to each kidney, or multiple arteries and veins. Some people have more than usual. If you have a complicated set of arteries and veins on one side, it can dictate which kidney the surgeon will decide to remove. But most often, they decide to take the left kidney. This is because the left kidney has a longer artery, making it easier to attach when they put it in the recipient.
At this point, I spoke with a social worker, who evaluated whether I have a good enough support system in my family and my work place. That was a really short consultation, and everything seemed to be pretty straight forward.
After that, I got to meet the surgeon who is likely to do my surgery. Dr. Pollinger seemed like a really great surgeon, and he explained how the procedure would go. He suggested the possibility of doing a robotic procedure instead of the hand-assisted laparoscopic procedure. I chose not to go with the robotic procedure, and this is why… On one hand, the robotic procedure sounds really cool and is probably going to be the standard of care one day. If I were doing this surgery a year from now, I bet I would have no problem doing the robotic procedure. But since it is still so new, and my surgeon has only done a handful of surgeries with this procedure, I decided to go with the more tried-and-true procedure at this point. He has done a couple hundred of those. But, I do believe that in the future, most people will want to have the robotic procedure – due to its many benefits. For example, the incisions are smaller; the robot has a steadier “hand” than a human has; the robot can move more like a human hand than the instruments they use for the typical laparoscopic surgery; and all of these features contribute to a shorter recovery time. So, I was really close to going with the robotic surgery. But in the end, I decided that the learning curve that may be involved is something I’d rather not be a part of.
That concluded my second day. I had a lot to think about after everything. But, in general, I felt pretty good about the experience. One thing that kept running through my mind was how thankful I am to be so healthy and have such a great support network. Since all the testing took place in a hospital, I would see various people who are dealing with tough illnesses or disabilities. It really made me appreciate what I have and the fact that I can help someone else. How often do you get to help prolong someone else’s life?
I had to wait a few days for the board to meet and make a decision. Then, the following week, I received a call letting me know that I had been approved to be a donor. We set up a surgery date of Dec. 9. And, then, there was only one more test to do…
Crossmatch #2
My stepfather and I had to do the crossmatch one more time – just to be sure that he still has not developed any antibodies against my cells. It’s very important, because, at the end of the day, we all want this to work, and we don’t want his system to reject my kidney. No one would want to go through all this and have it not work. Of course, there is still no absolute guarantee that it will work. But we need to check everything beforehand to make sure we have the best circumstances possible. We each had our blood drawn on Nov. 28, and now we’ll wait to get the results. But aside from that, we only have a little over a week left until the surgery!
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