Living Donor vs Deceased Donor Kidney Transplant: Key Differences Explained.

Introduction

People who have advanced kidney disease often choose to undergo a kidney transplant rather than years of dialysis. This raises questions concerning how and from where a kidney will become available. A kidney transplant can be performed using either a living donor or a deceased donor. Both of these options involve many factors that pertain to the timing and donor evaluation, the functioning of the kidney, and the expected lifespan of the transplanted kidney.

Understanding the deceased donor vs. living donor comparison helps patients and families to have productive discussions with their transplant team.

What Is a Living Donor?

A living donor is the term used for someone who voluntarily undergoes surgery to have one of their kidneys removed. Most people are able to live a normal and healthy life with a single functioning kidney. Therefore, after thorough medical and psychological assessments, a potential donor may be deemed eligible.

A living donor can be a family member, friend, spouse, or anyone who is eligible. The donor is evaluated to ensure that his/her long-term health is not impaired as a result of donation.

In the case of this kidney transplant, it is possible to choose the time when a transplant will take place. This is not possible with a deceased donor because the transplant is only scheduled after an organ is available.

What Is a Deceased Donor Kidney Transplant?

A deceased donor meaning refers to a kidney that is transplanted from someone who has died. In most cases, the donation is procured after brain death has been determined, and it is done with the donor’s consent and after all the required legal documents have been processed.

Patients without an appropriate living donor may be evaluated and waitlisted for transplantation. Various factors, such as blood type, compatibility, and the type of allocation, may affect kidney availability.

At KIMS Hospitals, we provide facilities for both living and deceased donors.

Deceased Donor vs Living Donor: What Is the Difference?

The answer is primarily the timing and the process of the donation.

For living donation, the donor and recipient can both undergo evaluation to determine if they are a good match, and if so, the donation and transplantation can occur immediately. This process decreases the wait time for the recipient and may allow for a pre-emptive transplant in certain cases.

For deceased donation, the recipient must wait for a donated kidney that matches them. There can be a drastic variation in the waiting time due to different factors and the availability of compatible organs.

There can also be differences in the amount of time the transplanted kidney takes to begin functioning. Kidneys from living donors become functional more quickly and tend to remain functioning longer than kidneys from deceased donors.

Does Kidney Transplantation With Deceased or Living Donor Affect Graft Survival?

In most scenarios, a kidney from a living donor has a longer average graft survival than a deceased donor.

One reason is that living donors allow for planned transplants with less time spent with the kidney outside the body. Living donors also go through comprehensive evaluations, and in some cases, living donors are a good match for their intended recipient.

The survival of the graft is a result of many factors, including the recipient's health status, donor's health status, immunological matching, rejection episodes, and adherence to immunosuppressive therapies and other medical factors.

For this reason, the survival analysis should be used as an average expectation for individual patients and not focused on as a predicted outcome.

Kidney Transplant Survival Statistics

When looking at kidney transplant survival statistics, there are two components: patient survival and graft survival. The patient survival component refers to whether the recipient survives. The second component, graft survival, refers to whether the transplanted kidney continues functioning.

In general, published reports show better outcomes for living donor kidneys. NHS Blood and Transplant states that 99% of transplant recipients of living donor kidneys survive for one year. For deceased donor transplants, the outcome is 96% to 97% survivorship. After ten years, the outcome for living donor kidney transplants is 86% to 90% and for deceased donor transplants, it is 72% to 76%. 

These statistics should be viewed as general trends and may vary from country to country, transplant center to transplant center, and patient groups. It’s important to note that long-term positive results can be achieved by living donor transplantation as well as by deceased donor transplantation. The most appropriate option depends on the recipient and donor situations.

How Long Can a Transplanted Kidney Last?

People often search for the maximum life after a kidney transplant. However, the answer to this varies from person to person and should not be generalized by taking the average.

There are numerous examples of transplanted kidneys lasting for many years beyond the average lifespan. The health of the recipient, the donor, adherence to medication and health care routines, and many other health and social factors can affect the outcome of a transplanted kidney.

What Are the Types of Kidney Transplant Donors?

There are two main categories that make up the types of kidney transplant donors: living donors and deceased donors. Living donors can be parents, children, siblings, spouses, or any other person, as long as there is medical compatibility and the donor is not breaking the law. A deceased donor is someone who has died and whose kidneys can be transplanted. Some transplant groups also perform paired kidney swaps when a potential living donor isn't directly compatible with the desired recipient.

So, who can donate a kidney? Potential living donors go through a detailed medical and psychiatric evaluation along with an assessment of kidney function and blood type to ensure donation is safe and voluntary. Donors can even donate a kidney to their parent.

However, donating a kidney to a parent is possible under the right medical, psychological, and legal evaluation. Being a relative does not automatically guarantee compatibility, and the transplant team has to evaluate the donor and the recipient.

Conclusion

The choice between a deceased donor vs living donor depends on donor availability and recipient health issues and the timing of kidney availability.

Living donor kidney transplants generally have shorter waiting times and better average graft survival, while deceased donor transplants provide an alternative to patients who are unable to arrange for living donors.

The most crucial step for any prospective transplant recipient is a full evaluation by a competent transplant team. Once the options are understood, the transplant recipient and family can balance the interests of the recipient and the donor.

Frequently Asked Questions

Is a living donor kidney better than a deceased donor kidney?

While comparing a deceased donor vs. a living donor, living donor kidneys have a better chance of average graft survival and can start working quickly. However, this is just an average observation and may not be applicable in all cases.

Can a family member donate a kidney?

Yes, a family member can donate a kidney provided that all medical, psychological, and legal assessments are followed. However, it should be noted that being a relative does not automatically guarantee compatibility.

Do all living donors have to be blood relatives?

No, living donors may or may not be blood relatives. They can even be unknown individuals depending on the kidney compatibility.