A kidney transplant is often the best treatment option for children suffering from end-stage kidney disease (ESKD) or kidney failure. The procedure involves replacing the damaged or diseased kidney with a healthy kidney from a donor. Finding the right kidney donor is a crucial step in ensuring a successful transplant.

Kidney donors for children can come from two main sources: -

• Living Donors
• Deceased Donors

Both types of donors have their unique benefits and considerations. Understanding each option can help parents make informed decisions about the transplant.

Living Kidney Donor for Your Child

A living kidney donor is a healthy person who voluntarily donates one of their kidneys to the child. Since humans have two kidneys and can live a healthy life with one kidney, living donation is a safe and common practice.

Types of Living Kidney Donors

Related Living Donor

This is when a close family member (like a parent, sibling, or grandparent) donates their kidney to the child.

• High compatibility rate due to shared genetics
• Faster transplant procedure
• Higher chances of long-term kidney function

Unrelated Living Donor

This is when a person who is not biologically related (such as a family friend or a willing donor) offers their kidney. They must get proper permission from transplant authority/doctors of the hospital.

• Slightly lower compatibility, but still highly successful
• Requires tissue and blood compatibility tests
• Can significantly reduce waiting time

Paired Kidney Exchange (Swap Kidney Donation)

If the parent or family member is willing to donate but is not a compatible match, the family can opt for a paired kidney exchange (kidney swap).

• Involves two donor-recipient pairs who are incompatible with each other but cross-matching is possible.
• Allows the child to receive a compatible kidney.

Who Can Be a Living Kidney Donor?

A living kidney donor is usually:-

• A biological parent (father or mother)
• A sibling (if age and health criteria are met)
• Other blood relatives like grandparents, aunts, uncles, or cousins
• An unrelated donor (family friend, spouse, or willing volunteer) (With permission of Transplant Authority)

The donor must be in good physical and mental health and pass a series of medical tests to ensure compatibility.

Advantages of Living Kidney Donation for Your Child

• Reduced Waiting Time- Since the kidney is available immediately, the transplant can be scheduled quickly.
• Better Kidney Function- Kidneys from living donors typically last longer and function better.
• Planned Surgery- The surgery can be planned at a convenient time without delay.

Disadvantages of Living Kidney Donation

• Surgical Risk to Donor - The donor has to undergo surgery to donate the kidney, although it is generally safe.
• Emotional Impact- The donor may experience emotional stress after the procedure.
• Compatibility Issues- Sometimes, even a family member may not be a compatible match.

Deceased Kidney Donor for Your Child

A deceased kidney donor is someone who has passed away (due to an accident, stroke, or other medical condition) and has consented to donate their organs. In the case of kidney transplants, the donor’s family must agree to donate the kidney to a patient in need.

Who Can Be a Deceased Kidney Donor?

A deceased kidney donor can be:-

• Brain-dead patients- Individuals who are declared brain dead but their organs are still functional.
• Cardiac death patients- Patients who pass away and their organs are retrieved within a short period.

How Does Deceased Kidney Donation Work?

• If the child does not have a living donor, they are placed on a kidney transplant waiting list.
• The child’s blood type, tissue type, and medical urgency are recorded.
• When a suitable kidney becomes available from a deceased donor, the hospital performs the transplant.
• The transplant team contacts the family immediately when the kidney is ready.

Advantages of Deceased Kidney Donation

Gives Hope to Families without a Living Donor Children without a compatible living donor still have a chance for a transplant.

• Saves Lives- Using deceased donors helps reduce the organ shortage crisis.
• Can Be Highly Successful- If the kidney is retrieved and transplanted within hours, it can function excellently.

Disadvantages of Deceased Kidney Donation

• Long Waiting Period- Children may have to wait months or years for a deceased donor kidney.
• Slightly Lower Success Rate- Kidneys from deceased donors may have a shorter lifespan than living donor kidneys.
• Time Constraints- Once a kidney becomes available, the child must undergo surgery immediately, causing time pressure.

Key Differences between Living Deceased Kidney Donors

 

Factors	Living Donor Kidney	Deceased Donor Kidney
Availability	Immediate (planned surgery)	Uncertain (dependent on availability)
Success Rate	Higher success and longer lifespan	Slightly lower success and lifespan
Waiting Time	No waiting time (direct transplant)	Long waiting time (dependent on list)
Compatibility	Usually higher (in related donors)	May have compatibility issues
Procedure	Pre-planned, allowing preparation	Unplanned, requires immediate surgery

 

How is the Best Kidney Donor Selected for Child?

The medical team follows strict criteria to select the most suitable kidney donor for your child. The selection is based on:-

Blood Type Compatibility

The child’s and donor’s blood types must match to prevent organ rejection.

Tissue Type Compatibility (HLA Matching)

A tissue match, known as HLA typing, helps reduce the chances of rejection and improves long-term kidney function.

Size and Age Compatibility

The donor’s kidney must be suitable for the child’s body size and overall health. Smaller children may receive smaller-sized kidneys.

Urgency of Transplant

Children with rapidly deteriorating kidney function may receive priority for deceased donor kidneys.

Donor Health Condition

The health of the living donor (or the condition of the deceased donor's kidney) is checked to ensure it is healthy and functional.

Which Option is Better for Child Living or Deceased Donor?

 

Factors	Living Donor	Deceased Donor
Waiting Time	Short (immediate surgery)	Long (depending on availability)
Success Rate	Higher (kidney lasts longer)	Slightly lower success rate
Surgery Planning	Pre-planned	Immediate after availability
Long-Term Outcome	Longer kidney survival	Slightly lower kidney survival

 

In most cases, living kidney donation is preferred as it offers better success rates and allows for a planned procedure. However, if a living donor is unavailable, deceased donor kidney transplantation can still offer a new lease of life to the child.

Finding a suitable kidney donor is a critical part of a child’s kidney transplant journey. Both living kidney donors and deceased kidney donors offer life-saving opportunities for children with end-stage kidney disease. Families should explore all options and make informed decisions in consultation with their child’s nephrologist and transplant team. Regardless of the source, a successful kidney transplant can significantly improve the child's quality of life, allowing them to grow, play, and lead a normal childhood.

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