Legal Formalities for Kidney Transplant: Things You Need To Know

Within the last few years, the specialty of organ transplantation has shown tremendous improvement in terms of the use of surgical, medical, and pharmacologic techniques to meet the objective. Different type of organ transplantation, including kidney transplant, liver transplant, and heart transplant are now more successful than it ever was in the past.

However, despite these improvements and the soaring success rates, there are some apprehensions in the mind of people regarding the medical, social, and legal side of organ transplantation. They are worried about how much ethical the whole procedure is, how it would affect their health, or whether they are eligible for it. One of their major concerns is the legal rules surrounding organ donation and transplant. People are not even familiar with the laws of organ donation in their own country, let alone foreign countries.

There is a shortage of organs worldwide since the need for different organs such as lungs, heart, kidneys, and liver is considerably higher than the supply. Hence, it is important to address critical issues such as legal and social ethics and people’s doubts by promoting organ donation and providing people with the correct information about all the aspects of organ donation.

With such an aim in mind, countries all over the world are formulating organ donation laws and are collaborating to optimize the process of donor matching to save critically-ill lives. This article talks about some of the aspects associated with kidney transplantation. It also provides some insights into the basic formalities that donors and recipients are required to complete before they undergo the surgery.

Why is kidney transplant a challenge?

The major complication leading to a kidney transplant is end-stage kidney disease (ESKD) and renal failure. One of the biggest challenges is the shortage of donors and there is a huge gap between the demand and supply. Some of the other challenges that are encountered with kidney donation and transplantation include the following:

• Ethical considerations in living donor donation causing no or little harm to the donor

• The use of cadaveric donors is not allowed or socially accepted in some parts of the world

• Questions raising the legal definition of death in cadaveric donors

• Loosely governed laws and regulations towards living-unrelated transplantation

What is done in a kidney transplant?

During a kidney transplantation, a surgery is done to replace a non-functioning or diseased kidney with a healthy kidney from a donor. The healthy kidney can come either from a cadaveric organ donor or a living donor. Family members who are a good match can donate one of their kidneys as it is possible for a human to survive on just one kidney. This type of transplant is called a living transplant.

A person who gets a transplant usually receives one kidney. In a rare case, he or she might receive two kidneys from a cadaveric donor. The non-functioning kidneys are usually left in the place where they are. The transplanted healthy kidney is placed in the lower abdomen on the front side of the body.

Kidney Donation Legal Formalities

Below mentioned are some of the legal formalities that must be fulfilled for a successful organ donation:

• The donor should have a matching blood type so that the chances of organ rejection is minimized. Living donors can be blood relatives such as brother, sister, the parent or genetically unrelated such as husbands, wives, or friends. People can also donate a kidney even if they don’t know the patient. The main point is that the blood type of donor and recipient should match. The decision as to whether a person (living or dead) is a suitable donor match lies with the results of the blood tests, the doctor’s decision, and the information given by the organ registry.

• Overweight and pregnant donors are not suitable for living kidney donation. However, a person who has lost weight can donate a kidney.

• A person should be 18 or above to become a living donor. The upper limit of age for donation varies in different countries. However, there are fewer chances that a much older person will pass the medical examination to be judged as safe for donating a kidney.

• A donor should be in good health with no current or history of any major illness. Also, it is necessary for a person to stay away from smoking for at least 6 weeks before the surgery.

• A woman donor taking a contraceptive pill should stop taking the pill one month before the operation. This is because to reduce the risk of thrombosis. She may use an alternative contraceptive method during this time.

• It is compulsory for the donor to be in sound mental health to give consent for organ donation. He or she should be able to understand all the instructions and be capable of undergoing all kinds of preparation needed before the surgery.

Cadaveric and Living Kidney Donation

• For a cadaveric kidney donation, there must be proof in the organ donor registry or physical documentation certifying that the brain-dead person is a registered donor. In the case of non-registered brain-dead patients, the immediate family members must give their written consent for organ donation.

• Doctors determining that a potential donor has died should not be directly involved in the removal of the organ from the donor or subsequent transplantation process.

• For a living donor transplant, the donor must undergo a thorough medical examination after the evaluation of the recipient. The surgery takes place when the transplant team approves the person for the donation.

• The evaluation includes a complete medical examination including the confirmation of the blood type, tissue type, and many other tests. These may include an X-ray, CT scan, electrocardiogram (ECG or EKG), renal angiogram, and CT renal angiogram. The donors must fill in the forms that have questions about their lifestyle, family medical history, and current medical conditions.

• It is mandatory for the donor to undergo an evaluation from a doctor assigned by the hospital. The doctor should not be a member of the transplant team. For legal reasons, the same doctor continues to act as a “donor advocate” during the procedure and later.

• Live donors must know all the possible risks, benefits, and consequences of the donation in a complete and understandable fashion. The donor should be legally competent and capable of understanding and weighing the information and should be able to act willingly, free of any kind of undue influence or pressure. He or she should be able to give his or her informed voluntary consent for organ donation.

Related versus Unrelated Donors in Kidney Transplantation

Kidney transplant from a related donor is simple and only involves the screening tests and doctor’s approval. A kidney transplant from an unrelated donor is a bit complex, especially when the patient is from abroad.

The donor and the recipient are required to appear before the Ethics Approval Committee of that particular country. The committee usually sits twice a month to personally meet and question the donor and the recipients. The committee comprises of not just the doctors but also a state police officer, a psychologist, a psychiatrist, and in some cases, a magistrate.

The personnel asks a few sets of questions from the donor and the recipient separately. The intention is to evaluate whether the donor genuinely wants to donate his or her kidney or whether there is any force involves. In case of an unrelated donor, having an emotional bond with the recipient is an added advantage. The ultimate objective of the committee is to see that it is nor a case of illegal organ transplant or organ trafficking. The donor and the recipient should be aware that if they try to hide any information and at the end it if proved that it is an organ trafficking, there are very serious law penalties including imprisoning.

Legal Documents Needed Before Kidney Transplant

• Attested birth certificate of the patient and the donor

• Attested family records of the patient and the donor

• Passport copies of the patient and the donor

• In case of a married donor, an attested consent of the donor’s husband/wife

• All medical reports of the patient and the donor

Important Medical Reports Needed (For Patient and Donor Both)

• Blood tests

• Blood group

• Urinalysis

• Kidney function test

• Liver function test

• Electrolytes

• Renal ultrasound

• Whole abdomen ultrasound

• Doppler ultrasound of the kidney vessels

• Tissue compatibility tests (HLA)

• Serology for contagious tests such as HIV, Hepatitis C, and Hepatitis B

It is important to know that each country has its own separate set of laws to govern organ donation. Hence, it is best to research and gain a wider perspective of the country-specific rules and regulations.

Reference Link: Kidney Transplant by Cleveland Clinic