Expertise:Kidney transplantation, critical care nephrology
For patients facing
advanced kidney disease, the mentioning of dialysis is certainly overwhelming
and full of worry. Fortunately, kidney transplant is another treatment option
that offers hope. A successful transplant doesn’t just improve survival of the
patient—it also brings a much better quality of life, freeing patients from the
physical and emotional burden of receiving dialysis.
In Taiwan, there are
two main sources of kidney transplants. One is from a deceased donor, often
called a “cadaveric” or “brain-dead” donor, and the other is from a living
relative who voluntarily donates one of their kidneys. The waiting time for a
deceased donor kidney can be very long, and patients must begin dialysis before
they can even get on the waiting list. In contrast, living donor transplants
don’t require a long wait, and the long-term function of the kidney is
generally better. That’s why, if a healthy family member is willing and
physically suitable, doctors usually recommend going ahead with a living donor
transplant as early as possible—often before dialysis ever begins.
Of course, not every
patient is eligible for a transplant. Certain health conditions—like cancer or
infections—need to be under well-controlled first. The heart and lung functions
also need to be fit enough for the surgery. Patients must fully understand the
risks of the transplant and be willing to follow their doctors’ instructions
for post-surgery care and long-term follow-up. During the evaluation process,
doctors will review the patient’s medical history thoroughly—this may include
asking women about past pregnancies—and will conduct several tests. These may
include heart and lung assessments, abdominal ultrasound, cancer screenings, stool
tests for occult blood, tests for viral infections, and an evaluation by a
psychiatrist and social worker to ensure the patient has good mental health and
family support.
Because the immune
system naturally tries to reject anything it sees as foreign, transplants
require special immunological evaluation. Before the transplant, both donor and
recipient must undergo compatibility tests. These include blood type matching,
HLA (human leukocyte antigen) testing, panel reactive antibody screening, and
checking for any pre-formed donor-specific antibodies. Finally, a cross-match
test is performed, which mixes a sample of the donor’s cells with the
recipient’s blood to see if the immune system attacks the cells. This helps
predict the risk of rejection after surgery.
In Taiwan, laws are in place to protect the
health and rights of living kidney donors. A donor must be at least 18 years
old, give fully informed consent, and sign a written agreement. In addition, at
least two of the donor’s family members must also provide written consent. By
law, the donor must be within five degrees of kinship (blood relatives) or be a
spouse. In-law or unrelated donors are not currently allowed. If the donor is a
spouse, the couple must have either been married for at least two years or have
children together. However, if the patient is diagnosed with kidney failure at
least one year after getting married, these restrictions may be waived.
When assessing a potential donor, the medical
team puts their health and safety first. The donor must have two healthy
kidneys with good function. Ideally, their glomerular filtration rate (GFR)
should be above 80 mL per minute per 1.72 m2 body surface area
(BSA), and their urine tests must show no proteinuria or recurring kidney
stones. Donors with diabetes are not eligible, since they are at higher risk
for kidney disease themselves. However, people with well-controlled mild high
blood pressure may still be considered, as long as they can provide consistent
home blood pressure records. Most importantly, donation must be completely
voluntary. Every case is reviewed and approved by the hospital’s ethical
committee.
Some people worry about whether donating a
kidney will affect their health. In reality, the human body has a built-in
backup—just one kidney is enough to support daily life. After donation, the
remaining kidney gradually increases its function to compensate, typically
reaching about 70% or more of what two kidneys would normally do. In fact, many
donors feel perfectly fine after surgery. But because early changes in kidney
function aren’t always noticeable, some donors skip follow-up visits. That’s
why it’s important for donors, just like recipients, to have regular checkups,
monitor their blood pressure at home, and maintain a healthy lifestyle to
protect their long-term health.
Among all the organs in the human body, the
kidney is one of the few that can be donated while the donor is still alive.
When a family member chooses to give a kidney to help a loved one regain their
health, it is a powerful act of love. For the recipient, it’s more than just
receiving an organ—it’s a second chance at life. And for the donor, it’s a
meaningful way to show care, offering the most precious gift one can give.