Once you have found a living donor, we will look at whether a transplant is possible. A transplant will only be successful if your own kidney and the kidney of your donor show similarities in certain areas. The more similarities there are between the kidneys, the lower the chance of rejection.
Your blood group and the donor’s blood group must be a match:
Matching blood groups:
|Blood group A||Blood group A of O|
|Blood group B||Blood group B of O|
|Blood group AB||Blood group A, B, AB of O|
|Blood group O||Blood group O|
If the blood group does not match we will look at whether it is possible for you to undergo a transplant through one of the alternative living donation programmes.
Cross-matching and tissue typing
If your blood group is a good match with the donor’s, we will carry out a cross-match and a tissue typing. During a tissue typing the markers on the outside of the donor’s cells are being checked. The recipient cannot have antibodies against any of the markers on the cells of the donor. We test this through a cross-match. A negative result in the crossmatch means that there is a match.
If the cross-match result is positive, direct donation is not possible. You can consider one of the alternative living donation programmes.
Alternatives to direct donation
There are several options for donating, even if the blood groups do not match or there are antibodies found against the donor.
- Cross-over programme
- Domino-paired kidney exchange
- Blood group incompatible
- Cross-match positive
- Anonymous donor
If you cannot receive the kidney directly from your donor, you can participate in the ‘cross-over programme’. This could be a ‘cross-over transplantation’ or ‘domino-paired kidney exchange’.
- The donor for pair A donates to the recipient of pair B.
- The donor for pair B donates to the recipient of pair A.
As soon as you and your recipient have been medically approved, your doctor will refer you to the programme.
A computer programme is used to search for pairing options once every three months. The exchange can take place between pairs from different transplant centres. The recipient will remain in their own transplant centre. The donor will travel there. The donations and transplants are carried out on the same day. The whole procedure is anonymous. So you will not meet the other pair.
Domino-paired kidney exchange
It is sometimes possible to carry out more transplants through an anonymous donor. This is called domino-paired kidney exchange.
– The anonymous donor gives a kidney to the recipient in the pair.
– The donor in the pair gives a kidney to a recipient on the waiting list.
These donation and transplant procedures also take place anonymously.
Blood group incompatible
If your blood group does not match the blood group of your donor, you may be eligible for a blood group incompatible kidney transplant. This is called ‘ABO incompatible kidney transplantation’. This usually means that the recipient is blood group O and the donor is blood group A or B. Someone with blood group O will have antibodies against blood groups A and B. When a transplant is carried out, the antibodies against the donor’s blood group will need to be removed from the recipient’s blood. Otherwise, the kidney will be rejected immediately. This will require the recipient to undergo a special treatment. This treatment filters the blood. If the antibodies against the foreign blood group are reduced by this treatment, the donor can donate their kidney. If the number of antibodies is too high after the treatment, a blood group incompatible transplant will not be possible.
Cross-match positive (desensitisation programme)
Unfortunately, direct donation or the exchange programme are not the best ways to find a suitable kidney for everyone. If you have a very high number of antibodies in your body, it is often difficult to find a kidney that will be accepted by your body. Due to the presence of the antibodies, the chance that the new kidney will be rejected is very high. This is demonstrated by the non-match crossmatch. In this case, the non-match cross-match does not depend on different blood groups. The desensitisation programme can be used to remove the antibodies from the blood. This is also known as a ‘crossmatch positive transplant’. This will require the recipient to undergo a special treatment one to two weeks before the transplant. After this treatment, the cross-match will be carried out again. If the chance that the kidney will be rejected is small, the transplant can go through. Desensitisation is a similar, but more difficult, method to ‘blood group incompatible transplantation’. Currently, this method is only carried out at the Erasmus MC in Rotterdam. Sometimes, it is possible to be referred to the Erasmus MC. This will take place in consultation with your own nephrologist.
When you are on the waiting list for a kidney from a deceased donor, it is possible that you will be offered a kidney from a living donor. These non-directed donors give one of their kidneys to someone on the waiting list completely altruistically. This donation will take place anonymously. It is also possible for an anonymous donor to give their kidney to a recipient in a pair that has been through the local exchange programme several times. This is called domino-paired kidney exchange.