Live-Related Kidney Transplantation Procedure

Due to the unique nature of live-related kidney transplantation (hereinafter referred to as “living donor kidney transplantation”), it is essential to ensure that the living donor is healthy and that the recipient does not have any contraindications for kidney transplantation. Therefore, preoperative examinations and assessments must be comprehensive and meticulous.

(I) Donor Evaluation
The health of the donor is paramount. Protecting the donor is the fundamental ethical principle of living donor kidney transplantation, and the donor’s well-being takes precedence over that of the recipient. A comprehensive health assessment of the donor is necessary. If significant health issues are identified, the individual is not suitable to be a donor. Given the extensive list of preoperative examinations, tests should be conducted in a stepwise manner, starting with simpler and less expensive procedures. If health issues are detected in the initial stages, further testing will not be pursued.

⑴ Initial Screening
Blood type, complete blood count (CBC), liver and kidney function, electrolytes, ion concentration, lipid profile, fasting blood glucose, and urinalysis (if proteinuria is detected, a 24-hour urine protein quantification should be added).
Ultrasound: thyroid, liver, gallbladder, pancreas, spleen, kidneys + ureters, bladder, adrenal glands, retroperitoneum, prostate and scrotal contents for males, and breast, uterus, and adnexa for females.

⑶ Final Examinations
HLA typing, radionuclide renal scan, kidney vascular CT (CTA, CTV).

(II) Recipient Evaluation
Recipients of kidney transplantation must undergo a comprehensive medical assessment to exclude contraindications for kidney transplantation. The evaluation process for recipients of living-related kidneys is similar to that for deceased donor (DCD) kidneys. The assessment items for kidney transplant recipients are as follows:
Routine Laboratory Tests
CBC, liver and kidney function, electrolytes, ion concentration, fasting blood glucose, lipid profile, blood typing (once at our hospital and once at an external hospital), complete coagulation profile, pre-transfusion panel, ESR, T-spot, PTH, lymphocyte typing, cytokines.
Virology-Related Tests
HBV DNA (for hepatitis B patients), HCV RNA (for hepatitis C patients), CMV antibody, rubella virus antibody, Toxoplasma antibody, EB virus antibody, BK virus nucleic acid quantification (blood and urine).
Tumor-Related Tests
PSA + fPSA (for males ≥50 years old), AFP, CEA, CA199, CA724, NSE, CA125, CA153 (for females), cervical cytology test (TCT for females ≥40 years old).
Imaging Studies
ECG, non-contrast chest CT, ultrasound (thyroid, liver, gallbladder, pancreas, spleen, kidneys, ureters, adrenal glands, retroperitoneum, breast and gynecological organs for females, scrotal contents and prostate for males), vascular ultrasound (iliac artery and vein), echocardiogram.
Tissue Typing Tests
HLA typing, panel reactive antibody (PRA), lymphocytotoxicity test.
After the above examinations and evaluations, if the kidney supply is healthy, and the recipient does not have the contraindications of kidney transplant surgery, you can enter the second stage of preparation before the relative kidney transplantation, that is, the ethical preparation and review stage.

(III) Ethical Preparation
Living donor kidney transplantation requires strict ethical approval. According to China’s “Regulations on Human Organ Transplantation,” living organ donors must be citizens aged 18 years or older; recipients of living organs are limited to the donor’s spouse, direct blood relatives, or collateral blood relatives within three generations.
The Department of Kidney Transplantation at Zhongshan Hospital, Fudan University, requires the following ethical materials and approval process for living donor kidney transplantation:
Identity Card Copies
Copies of the identity cards of the donor (donor), donor’s father and mother (biological parents), donor’s spouse, and donor’s children (hereinafter referred to as “donor and related parties”). Identity card copies are not required for minor children of the donor.
Copies of the recipient’s identity card (both sides). If the identity card is lost, a population information certificate must be issued by the local public security authority.
Proof of Relationship
Copies of the household registration books of the donor and related parties and the recipient, including the front page of the household registration book.
Household Registration Certificates and Requirements for Donor and Related Parties and Recipient
Must be issued by the local public security authority; relationship certificates issued by neighborhood committees or village committees are not accepted.
The household registration certificate must include the name and ID number of the person being certified.
The certificate must state the relationship between the donor and the recipient, the parent-child relationship between the donor and their parents, the marital relationship between the donor and their spouse, and the parent-child relationship between the donor and their children.
The certificate must be printed or photocopied, not handwritten, and must bear the official seal of the local public security authority (police station). The heading should原则上 be “Household Registration Certificate” (though it may vary according to local police station regulations), and it must include the signature of the handling officer, contact phone number, and date. The health commission will contact the officer to verify the authenticity of the certificate.
If the donor’s parents are deceased, a death certificate can be issued by the neighborhood committee or village committee, stating the relationship between the donor (name and ID number) and their parents (names), as well as the time of death, and bearing the committee’s seal. The death certificate may be handwritten.
For spousal kidney donation, a copy of the marriage certificate is required.
If the donor and related parties are in the same household registration book (and the donor and recipient are not separated), the household registration book can be photocopied, stamped by the police station, signed by the officer, and the phone number left. For related parties not in the same household registration book, the household registration certificate must be issued according to the above requirements 3 and 4.
Two-inch Individual Photos
One 2-inch individual photo for both the donor and the recipient.
Blood Type and Tissue Typing Reports
Blood type reports for both the donor and recipient from the Blood Transfusion Department of Zhongshan Hospital.
HLA, PRA, and CDC reports issued by the tissue typing laboratory of Zhongshan Hospital.
Required Examination Reports for Donor and Recipient
Donor: CBC, urinalysis, liver and kidney function, coagulation profile, fasting blood glucose, lipid profile, hepatitis B surface antigen and e antigen, hepatitis C antibody, HIV antibody, RPR, ECG, chest X-ray, abdominal ultrasound, CTA, ECT, and height and weight.
Recipient: recent CBC, liver and kidney function, coagulation profile, hepatitis B surface antigen and e antigen, hepatitis C antibody, HIV antibody, RPR reports.

After preparing all the required materials, the donor and recipient should bring the above documents, as well as the original identity cards, household registration books, and marriage certificate (for spousal donation) of all related parties, to Room 709, 7th Floor, Building 1, Zhongshan Hospital, Fudan University, every Tuesday from 2:00 PM to complete the procedures.
Upon verification of the materials, the following steps must be completed: signing the intention letter and informed consent form, and electronic chip verification of the original identity cards of the donor, related parties, and recipient.
After completing these steps, all materials will be submitted to the Zhongshan Hospital Ethics Committee for review. The committee will hold regular meetings to examine the cases. The donor, related parties, and recipient will be interviewed. Subsequently, the hospital will submit all materials to the Shanghai Municipal Health Commission’s Medical Management Department for further review. Upon approval, the department will send the approval letter back to our hospital, and the donor and recipient will wait for the notification to be admitted for surgery.

Note: The above items may vary based on the patient’s medical history.