Former Washington, D.C., mayor and current city council member Marion Barry, who is now recovering from a kidney transplant, was lucky: A 47-year-old woman described as a friend donated the kidney. That meant Barry didn't have to wait on a long list to receive a cadaveric kidney—one from a deceased donor. The 78,000-plus people on the waiting list for kidney transplants at the moment make up the bulk of the nearly 101,000 people waiting for all types of organs (a list that also includes liver, pancreas, heart, lung, and intestines), according to the Organ Procurement and Transplantation Network. Everyone waiting for an organ from a deceased donor must register with the OPTN. "The worst thing that can happen obviously is to have patients die while waiting for organs," says Bradley Warady, director of dialysis and transplantation at Children's Mercy Hospital in Kansas City, Mo., and a medical adviser for the National Kidney Foundation. "But it happens every day."
Donations from living donors aren't as rare as they once were: A study just published in Kidney International found that rates of living-donor kidney transplants have increased in most parts of the world; the rates of organ donation from living donors in this country have tripled since 1990, according to the National Kidney Foundation. In the vast majority of cases, live kidney donors are family members or friends. There is not an official waiting list for kidney donations from live donors, but paired exchange programs seek to link two or more pairs of willing donors and recipients for a swap when the individual donor-recipient pairs are not compatible. It can take from one month to two years to find a suitable pair to exchange kidneys with, according to the Johns Hopkins University, which started a paired kidney exchange program in 2001. The National Kidney Registry is a nonprofit that helps facilitate kidney donations from living donors. Canada also recently launched a Living Donor Paired Exchange Registry that officials hope will increase live kidney donations by 15 to 20 percent in Canada.
Besides being able to skip the waiting lists, advantages of getting an organ from a living donor include a greater likelihood of a good match (if the donor is a family member) and the fact that the kidney may be in better condition, since it won't be transported from one hospital to another. But donating a kidney is no simple process. Potential donors must be thoroughly evaluated. Besides having a blood type compatible with the recipient, for instance, they have to pass a thorough health assessment and a psychological evaluation. Certain contraindications for kidney donation include high blood pressure, diabetes, or other chronic illness where giving up a kidney would mean an unacceptable risk to the donor's own health.
Research is ongoing to monitor the health of living kidney donors throughout their lifetimes, but data so far show that a healthy person's life expectancy isn't compromised by donating a kidney, Warady says. The transplant itself can be done laparoscopically, using a minimally invasive technique that can cut down recovery time by several weeks in comparison to an open procedure. And the reward can be great. "Being able to donate to someone you know can change their lives," says Jan Finn, chief operations officer at the Midwest Transplant Network in Kansas City, Mo.