Living Donor vs Deceased Donor: Which Is Better?

Organ donation saves lives, but not everyone is eligible to donate, and not all organs can be donated in all circumstances. Cases of end-stage renal disease and end-stage liver disease are on the rise. There is always a shortage of organ transplants which remains one of the major challenges in transplantation. So, mainly kidneys and livers are donated by living donors and deceased donors. In this blog, we will see the best options for a kidney transplant and liver transplant in living donor and deceased donor.

A person who has passed away and has given written approval to donate his/her organs for transplant is a deceased donor. In a living donor who wants to donate an organ, transplanted into another person who needs a transplant. For a liver transplant, a donor undergoes surgery where a 30 to 65% amount of liver is cut and transplanted in recipients body.

Organ Transplant Donors and Their Types

For organ transplantation, there are broadly two types of donors: deceased donor and living donor. These are categories according to the organ which is donated during the person’s life or after their legal death.

The living donors are healthy people who donate an organ or a portion of an organ. This type of donor mostly donates the kidney because a person can live with one kidney and the liver because it can regenerate.

The deceased donors are those who have died. After that, their family or their legal registries authorize that the organ of that person will be taken out. After being taken out, the organ is transplanted into another person to save their life.

​Guidelines for Deceased Organ Donors

The deceased organ donor has guidelines which have strict protocols, medical, legal and ethical rules for the patient. They can only donate after the person is declared dead. There are some guidelines by which the doctor decides about the transplants. Doctors and the transplant team see the four main things to decide if a person’s organs can be donated to the patients.

Legal and Consent Guidelines

Before removing any organ the hospital ensures that the donation is fully legal or not. They check whether the person signed up for the official organ donor registry, like on a driver’s license. If the person had signed up that after his/her death their organ will be donated. Then the organ transplant will begin and if they didn’t sign up, then the closest family members should give written permission to take the organs. The organ can only be donated after the person is declared dead legally by the doctor, who is completely separate from the transplant team.

Medical Eligibility

The thing they see in this is how that person died and it is the legal rule. If the person or anyone who died in a hospital while a ventilator or breathing machine is attached to that person can be considered for donation. This helps to circulate oxygen throughout the body. So that the organs can stay alive. Lastly, the doctor declares the person dead in two ways: first is brain death and second, circulatory death.

Age and Health of the Person

The age of the death person doesn’t matter the most and there is no limit to age in donating the organ from a deceased donor. From newborn babies to adults in their 80s can successfully donate the organs. But the thing that doctors look for is the health of the organs. It is more important than the age of the donor. A person should not have any disease or infections which can be spread to the recipients through the donor’s organ. If the people have it, then the organ cannot be donated.

Testing and Safety Guidelines

Once the donor is legally cleared, the transplant team runs intensive and fast tests to protect the patient’s life. Tests like blood and tissue matching, in which the blood type and immune system should match the patient who is on the waiting list. They also perform other tests like X-rays, ultrasounds and other blood tests to identify how healthy the organs are. ​

Medical Note: Deceased donor guidelines vary by country, hospital, and legal jurisdiction. Always refer to your local transplant authority for applicable guidelines.

Types of Deceased Donors

When a person passes away then they save other people’s lives by donating their organs like kidneys, liver, heart and many other organs and tissues. In the deceased donor transplant, the kidney and liver are donated after the death of an individual and the family agrees to donate the deceased’s organs. There are many types of deceased donors. Doctors divide them into different groups on the basis of how they died, how healthy the organ is and how the organ is put into the patients.

​Some of the kidney donors and liver donor types are the same, but some are different. Let’s see which are the same and which are different:

Standard Criteria Donors (SCD)

People who are young or any of the age under 50 and die in an accident because of any trauma or anything but didn’t meet any of the critical situations. In this situation, the organs are perfectly in shape. Because of this, the chances of the risk are lower and the organ can stay fresh for many years.

Expanded Criteria Donors (ECD)

The other name of expanded criteria donor is marginal or high kidney donor profile index donors. In this, the organs come from two criteria donors who died. First, those who are aged 60 or between the ages of 50 and 59. Second, those who have a history of high blood pressure, a stroke, or a creatinine level higher than the normal laboratory result. The organs can not stay as long as standard organs. They are just a life saving options for someone and have an excellent choice for older recipients who are on the waiting list for so long and need the organ immediately.

Donation after Cardiac Death (DCD)

These donors do not fit the usual definition of brain death. Their hearts had stopped before the organs were extracted. In this, the donor has brain injury but there dead is not fully brain dead. And once their heart stops beating naturally before the surgery, doctors declare them dead. There are two types of transplantation that are done: one is kidney and the second is liver transplantation.

During kidney transplantation, the kidney can go without oxygen for a few minutes. These kidneys are still in good condition but they can take a few days or weeks to work properly. And during that time, the patients can get short term dialysis while waiting.

During liver transplantation, the liver has a high risk of long term complications like bile duct scarring. Doctors use machine perfusion systems to pump the blood through the liver before the transplantation so that the risk of complications will be reduced.

Donor after Brain Death (DBD)

When the individual is suffering from the loss of all brain function but their heart is still beating with machines and their lungs are breathing. At that time, when they transplant the organ, we call it donor after brain death. During the organ transplant surgery the heart continues to pump blood. It makes surgeon to safely remove their kidney and liver to save other people. During the surgery, the machines keep the blood and oxygen flow throughout the body. So that the organ remains healthy. After removing the kidney and liver, they are placed on ice so they can remain fresh.

In the kidney transplant, the kidneys receive oxygenated blood. During this donation, they have a lower risk of complications. The transplant surgeon has to complete this procedure under 24 to 36 hours. Because of this surgery, the kidney immediately starts working in the patient. There are fewer chances that the patient will need temporary blood cleaning just after the operation.

In the liver transplant, the liver needs a supply of oxygen to stay alive. Since the heart of the donor is still beating until the surgery, the liver will stay in good shape. This has a very lower chances to have a long term liver or bile duct problems in the patient. After this surgery, the liver starts working immediately in the recipient’s body.

Double and Dual Kidney Transplants

Sometimes an older or less healthy donor has kidneys that are too weak to work on their own. So in this case, the surgeons put both kidneys into one patient. According to research, utilizing both the weak kidneys in the same recipient is better than using only one kidney. Two weak kidneys will do the job of one healthy kidney.

Increased Infectious Risk Donors (IDRD)

Those donors who had a lifestyle which put them at high risk of behavior that is linked with such donors. For example, sexually transmitted diseases, drug use, incarceration, or infections like hepatitis or HIV. During the organ recovery process or before the surgery, all of these donors are checked to make sure that the kidney is safe. After that, you will be informed about the high-risk conduct. If the donor was infected with hepatitis C then with the help of modern medicines, the patient will be cured after the transplant.

Guidelines for Living Organ Donors

The living organ donors have strict guidelines. They ensure that the donation of kidneys, a portion of the liver or other organ which is donating is completely safe for the donor and will not harm the recipients. There are some criteria by which the living donor is able to give their organ.

Eligibility and Basic Rules

They should have the eligibility and meet the basic rules like the donor should be at least 18 years old, but some hospital centers require the age to be 20 or older. The choice to donate the organ is your own without any external pressure, guilt or any financial exchange because selling the organ is highly illegal. Your mental health should be stable and you should be able to understand the requirement to give the organ for legal purposes.

Medical Health is Required

Before the surgery for donating the organ, the doctor performs some tests to ensure that after the donation you will live a completely healthy and normal life. For a kidney donor, they check if the other kidney can have an exceptional filtration rate which is a GFR of 80 ml/min or higher. For a liver donor, they check if the liver is fully healthy and capable of growing back to normal size. The donor should not have diabetes as it can damage the other kidney over time. Should not have a problem with high blood pressure as sometimes it can’t be controlled with one or two mild medications. The donor should not have active cancer or any chronic transmissible infections that can be transferred to the recipients like HIV.

Test and Safety Guidelines

If you have passed these two parts, then you will undergo the other things like a medical checkup at a transplant center. They ensure that your blood group or type is capable of matching the recipient’s blood. Your blood and urine samples will also be checked to identify your blood sugar, immune compatibility and organ function. After that, your surgeon does X-rays, a CT scan and an MRI of your organs and blood vessels so that they can check the best anatomic path medicines for the surgery.

The transplant hospitals will provide you with a personal advocate who is completely separate from the medical professionals. Their only job is to protect you, your safety, health and to see that you are not forced to donate your organ. They will talk to you alone and ask for your consent.

Medical Note: If you are considering living organ donation, a full independent medical and psychological evaluation at an accredited transplant centre is mandatory.

Types of Living Donors

A living donor is a healthy living person who decides to give one of their kidneys or a piece of the liver. So that they can save someone’s life. The liver can grow back to its full size in some weeks for both the donor and the recipient. Doctors divide the group of living donors into 4 simple types.

Direct Donor

The donor selects a specific someone to receive the organ. A donor may be biologically related, someone whom you know or care for. For example, a family member like a parent, child, sibling, cousin or nephew. But the donor may also be someone who is not biologically related but has a personal relationship with the recipient like they must be close friends, neighbours, husbands, wives or coworkers.

An Unknown Donor

A person who wants to donate a kidney or a piece of their liver to a complete stranger and wants to keeps his identity undisclosed. Also known as good Samaritans. In this, the receiving person and the donating person are unknown to each other. Depending on the blood group and medical needs the donor and recipient are matched. In this, the donor does not have a specific patient in mind; they just want to do a good deed and help someone.

The following attributes are necessary when a person receives a kidney from an unknown donor: Be healthy and emotionally capable of donating. Complete medical and other tests at a transplant clinic. Get connected to a donor team. Be well-informed and willing to proceed. The hospital sees the national waiting list and gives that organ to the sickest patient who matches the donor blood type.

Paired Exchange Donors

In this, a family member wants to give their kidney to their loved one but due to their blood type or tissues not matching they are not able to donate. Because the patient’s body will reject the organ. So to solve this problem, doctors use a swap system in which one person can donate their kidney to a stranger and a stranger gives their kidney to that person’s patient.

Better Long-Term Results for Organ Transplant Recipients

Getting a new kidney or liver gives people a second chance to start their life over. These new organs last for 10, 30, or more than 30 years. To help kidney and liver transplant patients live long and healthy lives, doctors do a lot of things and focus on medicine management, picking the right surgery timing and healthy daily habits. For achieving the better long term results for kidney and liver transplant recipients requires a lot of things. Such as proactive complication management, tailored surgical approaches, highly individualized immunosuppression and lifelong patient compliance. Here is how the doctors and patients get the best long term results:

Take Anti-Rejection Pills Every Day

Your body wants to naturally fight with new things, in which your kidneys or liver are also involved. To stop this, you should take special medicines called anti rejection pills. So, before taking medicines you should keep some points in your mind like:

• Never Miss a Dose: You should take these pills at the same time and exact time every day. If you miss a dose then it can cause the biggest reason for your kidney or liver to stop working properly. It can also cause your body to attack and damage the new liver and kidney.
• Keep the Balance: You have to take the exact amount of medicine in your body. Even a doctor will also do regular blood tests to make sure about the amount of the dose in your body. You should take the exact amount of dose, not too much and not too little.
• Change Doses Safely: Over time, your body gets used to your body. After that, the doctor will lower your medicines to the safest amount to protect your health.

Protect the Kidney from Medicine Side Effects

When anti rejection pills are saving your kidney and taking them for so many years can cause a reaction and can create the health problems. The medicines you are consuming to save your liver can cause your other body parts to get sick for so many years. After the liver transplant, the function of the kidney can affect if you get a condition like hepatorenal syndrome or calcineurin inhibitor nephrotoxicity. Some patients may require temporary dialysis after the operation for some days. Doctors work to prevent from many things like:

• ​Watch your Kidneys: These medicines are hard and high in doses, so they can badly impact your kidneys. The doctor will advise you to do regular blood and urine tests so that you can make sure that your kidneys are safe or not.
• Weight, Blood Pressure and Blood Sugar: Anti-rejection pills can cause high blood pressure, weight gain or diabetes. You should eat healthy food and take the proper diet. Also, a daily walk will help you to keep the blood pressure and blood sugar under control. And if they are in control then they will not hurt your new kidney.
• Switching Medicines: If, out of a sudden, a pill starts to hurt your body after years then your doctor might change your medicines to a gentler medicine.

Avoid Infections and Illnesses

As your medicines are already lowering your body’s natural defenses, you can easily get more sick. The most common infections are chest or urine infections. So, you should follow some tips to maintain everything like:

• Wash Hands Often: You should keep a habit inside you of washing your hands. You should also stay away from sick people and protect yourself from getting dangerous viruses.
• Skin Care: These medicines can make your skin more sensitive to the sun. So applying sunscreen and wearing hat will help you to prevent skin problems.

Choose a Living Donor If Possible

If you are waiting for a transplant, then getting a kidney from a living person like a family member or friend. It will give you the better long term result like:

• Lasts Longer: Having a kidney from a living person can usually last 5 to 10 years longer than a kidney from a deceased donor.
• Starts Working Faster: A living donor kidney immediately starts working inside your body. As it spend less time on ice as compared to deceased donor organs.

Never Drink Alcohol

After the organ transplant, especially the liver, the new organ needs proper care and protection from everything that scares it and makes it sick again. So, to protect it, you should follow some things like:

• Zero Alcohol: If you drink any of the alcohol then it can cause damage to your liver or kidney. And because of that it can stop working.
• Check all Medicines: Always do a checkup and ask your transplant team before taking any new medicines, pills, vitamins or herbal teas. As any of these can do bad or negative reaction and hurt your liver.

The Risks that Living Organ Donors are Likely to Encounter

Living organ donors face the short term health risks from the surgery and long term changes in their bodies, emotionally and stree of money. Recovery from the surgery can take time. Because of this, the donor can have a medical problem; that’s why they have to take time off from work and stop doing some activities for some time. Most of the donors recover and live a happy life after the surgery. Here are the risks that living organ donors face:

Risks Right After the Surgery

All donors require a major operation under general anesthesia and just after the surgery, the donor faces some problems like:

• Pain: They face normal but sharp pain around the cut area.
• Infection: Bacteria can get into the wound, bladder and lungs.
• Bleeding: Donors have heavy bleeding during or after the surgery. So the donor needs extra blood at that time.
• Blood Clots: Because of lying straight, the donor’s legs or clots of thick blood form.
• Death: Mortality from living kidney donation is approximately 3 in 10,000 (0.03%). For living liver donation, the risk is higher at approximately 2–5 in 1,000 (0.2–0.5%) due to the complexity of the surgery.

Risks Based on the Organ You Give

The long-term risks that affect your body which depend on the kidney or a piece of the liver which is donated. So, for living donors there are some long term health risks such as:

If you donated a kidney:

• High Blood Pressure: Donors can develop higher blood pressure than normal after so many years. Similar to non-donors, the living donor manages the high blood pressure. It is managed with the help of medication in the right doses.
• Kidney Failure: The risk of developing kidney failure after the donation is increased in living donors. After the donation, if you end up needing a kidney transplant, then you will get a higher priority on the deceased donor waitlist.
• Diabetes: After donation the chances of developing the diabetes have increased.
• Less Kidney Power: After donating one kidney you will have only one kidney instead of two. And your remaining kidney will do all the work like cleaning the blood and the rest of the things which kidney do.
• Pregnancy Safety: Female donors have a high risk of having high blood pressure during pregnancy.

If you donate a piece of liver:

• Bile Leaks: For digesting the food, the liver makes the fluid which is called bile. Sometimes this fluid can leak from the cut area of your belly.
• Stomach Troubles: You will feel sick and have discomfort in your stomach, be bloated or constipated for some weeks.
• Body Strain: When your liver grows back to its normal full size then for around 2 months of regrowth can make you feel very tired at starting.

Medical Note: The risks described in this section represent published population-level data. Your transplant team will provide a personalised risk assessment before any donation decision is finalised.

Conclusion

At the end of this content, we get to know that there are so many types of living donors and deceased donors. But not everyone can donate their organ; there are some guidelines for both donors. In deceased donors, doctors see how the person died, their age and disease that can have an impact on organs. In living donors, doctors see the person’s blood type, whether they have any transmissible disease and many other things. After the surgery, donors and recipients should take proper care of themselves. At last, we get to know that both living donor and deceased donor are best for a kidney and liver Transplant. It all depends on the person’s health and their organ.

Disclaimer: This blog is just for information purposes only. Before donating your organ you should consult with your loved one and the transplant team.