Domino kidney donation
When a patient requires or requests a nephrectomy for therapeutic reasons (e.g. haematuria-loin pain syndrome) they may choose to donate that kidney to a patient awaiting a transplant. This is known as domino donation and does not require Human Tissue Authority (HTA) approval.
It was agreed at Kidney Advisory Group (KAG) in May 2011 that such kidneys should be allocated locally because:
- Domino donation is uncommon and equity of access to such kidneys is unlikely to be affected by local rather than national allocation.
- Domino donation carries a potentially higher risk of uncertainty about the viability of the retrieved kidney for transplantation in comparison with other living donor kidney scenarios; the retrieval surgery may be complicated by the patient's underlying condition.
- National allocation prior to planned domino donation may not be in the best interests of either donor or recipient in terms of managing both the clinical scenario and the expectations of the potential recipient, particularly if the retrieval and recipient centres are different and/or geographically remote from each other.
- Local allocation provides a better environment for managing the uncertainty associated with domino donation and potentially facilitates improved patient and graft outcomes because:
- An assessment of the kidney can be made at the time of retrieval to ensure that it is viable to transplant
- The logistics of subsequent transplantation/not proceeding to transplantation is easier to manage, both in terms of informing the potential recipient in the context of local knowledge and minimising cold ischaemic time.
Summary of Arrangements for Domino Donation
Patient requires/requests therapeutic nephrectomy and expresses wish to donate the kidney. Donor assessment and preparation for donation initiated as per UK Guidelines and local transplant centre protocol. See Active BTS Standards and Guidelines
Date of surgery scheduled according to clinical/patient need but with advance planning time if possible. If suitable to donate, domino donor is registered with Organ Donation and Transplantation (ODT), NHS Blood and Transplant (NHSBT) and a local kidney matching run is performed in advance (ideally ~ 7days prior to surgery to avoid protracted suspension from the national transplant list for recipient) by the Duty Office to identify a local recipient.
Once recipient has been identified, special considerations relating to the donor, donor surgery and donated kidney that are relevant to the acceptance of kidney by the recipient are discussed with him/her. This includes the possibility that the transplant may not proceed if the kidney is not considered viable at retrieval.
- Compatibility is confirmed between donor and recipient by performing crossmatch testing.
- Suspension of the recipient from the national transplant list is advised but is at the discretion of the recipient and recipient transplant centre.
- Anonymity between donor and recipient respected throughout unless all parties wish to break it via the clinical team after surgery.
The donor must be recorded as a 'Domino Donor' with NHSBT to ensure that these donors are not included in the Living Donor Registry for the purposes of outcome monitoring and follow-up.
If the transplant cannot proceed
- Provide appropriate support for both donor and recipient
- Reinstate recipient on national transplant list immediately