Living Organ Donor Preparation

1. SUPPORT PERSON - You need to find a support person, someone with whom you can discuss anything and express your fears, anxieties and frustrations. Living Organ Donation can be full of frustration while waiting on test results. It is totally normal to have anxiety and fear. You are about to undergo a very serious operation in which there is no physical benefit to you. You will be compromised physically and the goal is to return you to the healthy state you were before donation. There are the "what if's" and you need to be able to express the emotions that accompany donation.

2. Family - Family members can be difficult to cope with at times because you don't know what to say to them at times. The range of emotions is just as vast as there are different families. Some family members are supportive while others are indifferent to the situation. Sometimes family members say things, which seem insensitive because they do not know what to say. There have been family members who do not say anything at all. It is not because they don't support you, they just do not know how. You might need to tell them what you need. There are times when family members are torn in supporting the donor. They feel as though by encouraging you to donate, they might be giving the impression the recipient is more important. Of course there are family members who will be opposed to your donation. This is especially common for donors who are donating to non-family members. Remember your family is concerned for your well being. You must also consider the impact living donation will have on your family, especially if something occurred where you were dependent upon them. This is not something to be ignored, it is necessary to discuss living donation, the risks and other options available.

2. Transplant Center - You need to inform the transplant coordinator of your wishes regarding spiritual needs while in the hospital. If there is a certain ceremony you need performed due to your beliefs and/or religious holiday, you need to make the hospital aware so they can accommodate your needs. If you don't have a particular need but would like clergy to visit you during your stay, please inform them of such. Also, you may want to request a clergy person visit with your family while you are in surgery. This is a very trying time for them filled with anxiety, perhaps a clergy person can assist and support them. We suggest you put your requests in writing and give it to the transplant coordinator. If you request a visit for your family while in surgery, you might want to write down your family's religious beliefs if they differ from yours. For example, if you are a Christian and your family isn't, they might not want a Christian prayer said.

2. Dietary habits - While you would not be able to donate if you are obese, some donors have decided to lose a few pounds before donating. Before you decide to go on any diet, you need to discuss the type of diet with your transplant doctor and personal physician. The focus shouldn't be on a fade diet to lose weight quickly, but on developing healthy dietary habits that would continue to keep you healthy. It is important you maintain a healthy lifestyle so your organs can function in a healthy environment. For example, kidney donors need to insure they don't place the remaining kidney at risk for ESRD. The two main causes of ESRD are diabetes and hypertension. A lifestyle consisting of exercise and healthy eating habits is a preventative measure against obesity which can lead to diabetes and hypertension. You might ask the transplant coordinator if someone from dietary at the transplant center speak with you concerning healthy eating habits. Since most donors don't feel like consuming much food after surgery, now would be the time to develop healthy eating habits when you don't crave certain foods. The American Heart Association has an excellent section on dietary information for the general public. The dietary section is in the form of a book, which even has recipes for different types of food and their preparation. The website is listed on this site under Websites for Donors.

Remember to ask your doctors before starting on any dietary change, but most likely they will be pleased you are taking your health so seriously before and after the transplant. This is a good time to encourage other members of your family to develop healthy eating habits by having them support you.

3. Preparation days before surgery - General anesthesia and various pain medication can slow the bowels and digestive process. Some hospitals have donors consume only clear liquids the day before surgery while others tell donors they can eat anything they want until midnight the night before surgery. You need to discuss your transplant surgeon's desires for you before surgery. If you have experienced problems with constipation or bowel problems in the past, you need to inform your surgeon.

Exercise before and after the donation is very important. This doesn't mean you have to join a gym and get a personal trainer. It also doesn't mean you have to go out and buy a whole gym for your home. There are simple exercises that can be done without major equipment such as walking. Any amount of exercise is better than none.

1. UPPER BODY EXERCISES - Increasing your upper body strength before donation is important. Since most donations involve your abdominal area, you will rely heavily on your upper body to assist you in things like sitting up and lifting. When in the hospital you will most likely use your arms to pull yourself upwards using the rails. When at home, you will use your arms to push yourself into a sitting position in bed. You will need to practice these things before going to the hospital.

While some people lift small weights, other have found push-ups work better. The push ups get your upper body accustomed to balancing and raising your body weight. You can do push-ups on the floor but some people find this too much at first. Some donors have found using the wall better. They stand away from the wall with their arms fully stretched outward and palms flat against the wall. They lower their body towards the wall, then push their body away from the wall. This exercise allows your upper arms to strengthen by using your body weight as resistance.

When you are recovering at home, getting out of bed can be a challenge without the rails used in the hospital. When getting out of bed out home it is easier to roll to one side, bend your legs at the hips so they are at a 90 degree angle to your body, then use your arms to push yourself upwards into a sitting position. Remember not to hold your breath when pushing upwards, you need to continue breathing while sitting up. Holding your breath just creates more pressure.

2. WALKING - Before surgery take walks. Walking not only strengthens your legs but it also helps your whole cardiovascular system. A strong cardiovascular system is beneficial in any surgery.

After surgery you will need to get up and moving as soon as you are cleared by the doctor. The longer you are immobile, the more chances you have of being constipated. Walking helps relieve constipation. After surgery, you will not be able to walk far. Take small walks down the hall and build up your stamina a little at a time. DO NOT over exert yourself. When at home, begin by walking around your yard, then walk down the street. Make sure the first week or two someone is with you should you need assistance.

3. ABDOMINAL EXERCISES - Your abdominal area is most likely going to be the area most compromised by surgery. Strengthening your abdomen will help with healing. You don't have to have an abdomen with defined abs in order to gain benefits. Try a small regiment of situps. If you can only do 5, then 5 is better than none.

Also, practice stretching. Some donors have found using a 26 inch exercise ball is a good way to stretch your abdominal and back muscles before surgery. The person kneels in front of the exercise ball and rolls forward onto the ball. Others have have sat on the floor with their backs against the exercise ball. Make sure your hands and feet are touching the floor while your knees are flexed. Slightly roll backwards onto the ball, using your legs to gradually push you onto the ball while your hands remain on the floor for balance.

DO NOT EXERCISE YOUR ABDOMINAL MUSCLES AFTER THE TRANSPLANT. You need to discuss when you will be able to resume any exercise with your doctor. While you might think you are healed, remember the external skin heals more quickly than the internal layers of skin, muscles and organs. There will be internal sutures in places such as major blood vessels that won't withstand strenuous exercise until healed.

While Living Organ Donors do not pay for the medical costs related to the surgery, there are other costs donors incur. Before you donate you need to find out who will pay for transportation costs and medical expenses relate to the donation. In regards to time off work, you will most likely have to rely upon your own savings or employer's plans for time off work. You need to place all this information in a folder and notify your support person(s) and/or family as to it's location.

1. MEDICAL COSTS - Obtain a written letter from the transplant coordinator as to how medical expenses should be billed, in case you have to be medically treated after discharged from the hospital. Not all donors live near the transplant center and they might need treatment at their local hospital in an emergency.

2. TRANSPORTATION - If you need assistance with transportation costs, request a meeting with the social worker at the hospital. Often the social workers know of resources available to assist you with the costs. Angel Flight is an organization that assists people in need of transportation for medical necessities. Check the website listings on this site on how to contact them.

3. LOST INCOME - The loss of income is often the responsibilty of the donor. You need to make sure you have monies to cover the time you will be off work. Also, realize you might be off work longer than anticipated, so you need to make sure your finances are covered. Most donors rely upon their vacation time and Short Term Disability at work to cover their lost wages. You need to check at work regarding their policies concerning Short Term Disability. Some policies have viewed Living Donation as an "elective" surgery and do not cover time off. If you need financial assistance in order to donate, you might be able to have your church or work create a fund in your name or do fund raising events.

4. PAYING BILLS - You will need to make a list of what bills you pay during the month and when they are due. If your stay in the hospital is longer than anticipated, you will need to have someone in charge of paying or arranging your bill payments. Some donors have found it easier to either have the bills directly deducted from their checking account or placed on a credit card. Place the list in the folder with your personal information.

1. FOOD - You will want to purchase individual containers of food and drinks. Depending on the type of surgery, lifting large heavy containers might place a strain on the surgical site. Individual containers of water, juice and other drinks are easier to manage. Most donors don't like to eat large meals when they first come home. Many donors find eating something light like soups or jello easier on their digestive system in the beginning. Later they work up to eating larger meals. If you are taking narcotics, you need to consume fiber when you resume eating larger meals. Constipation is a common side effect of narcotics. If someone prepares meals for you ahead of time, ask them to place the portions in individual containers, instead of large casserol dishes. Some donors prepare individual meals before donation, then freeze them.

2. BATHING - Depending upon the type of surgery, many donors are instructed not to get the surgical site wet for a few days until healed. Bathing can be a challenge. Also, a slippery tub is not safe. Try to find a shower chair and a hand held attachment you can place on your shower head or faucet. Place the shower chair in the bathtub so you can rest while bathing. A shower chair enables you to wash without bending over while standing. You can't risk losing your balance and falling. Use the hand held attachment to rinse the different parts of your body if you aren't supposed to get the surgical site wet.

3. ARRANGING YOUR SHELVES - Whether you are in the kitchen, bathroom or bedroom you will need to arrange things for your initial days recovering at home. In the kitchen, move plates, glasses and dishes to a lower shelf. You don't want to be reaching too high or standing on a chair to get items. You also might purchase disposable plates and cups. Buy a small tote for your personal items in the bathroom. Put your deodrant, toothbrush, toothpaste, etc in this tote. Place the tote on a table or back of toliet so you don't have to lift it. Place your towels on a lower shelf. For the bedroom, put the clothing you will be wearing in a drawer about waist high. Put your underwear, PJ's and other things you will be wearing for the first week or two in this drawer.

4. CLOTHING - Many donor have found loose, non-restrictive clothing to be the most comfortable the first few weeks. Your abdomen will be tender, tight clothing will only irritate it. Your skin needs to heal and loose clothing won't restrict the air and blood flow to the skin. Many donors have found lounging bottoms with draw strings to be comfortable because they can loosen the clothing if needed. Baggy tops are comfortable also.

You will need at least one caregiver to assist you when you go home. They should be prepared to stay over night with you for awhile. The number of days they need to stay will depend upon the type of surgery you have. Caregivers duties will vary depending upon the tasks needed. It is a good idea to have a few caregivers available, especially if you are a parent donating to your child. It can be very tiring for your spouse to care for your child and you. People usually want to help, so accept their help and list the duties they can do for you. The best thing to do is have people sign up for various duties/assistance. Keep a list of the duties and the people volunteering, along with their phone numbers. Place the list in the folder along with your other personal information.

1. PERSONAL CARE - This caregiver will need to be someone you are very comfortable with. Depending upon the surgery, the caregiver might need to assist you with getting in and out of the bathtub, dressing, etc. For instance, many mothers offer to assist their sons but the son would probably feel more comfortable with their father or a male friend. Select a time when you would like this person to be available to help you with personal care.

2. HOUSEHOLD CARE - These caregivers will be the persons to assist you with laundry, lawn care, cleaning your home, shopping, etc. While you might be able to do your laundry, you will need someone to carry the basket of clothing. You will not be able to lift or push things like a lawnmower or vaccum cleaner. Before you donate, take a typical week and list all the things you do in one week. Evaluate the list and the things you will need assistance with. You might want to make a grocery list of perishable items you need when you go home. Eggs, milk, fruit won't keep long while in the hospital, ask someone to do the shopping the day before you arrive home so you have fresh items in your refrigerator.

3. MEMBERS OF YOUR HOUSEHOLD - Whether you have children, pets or significant others, they will need to be taken care of also. If you have children their needs will have to be attended to. You need to rest, so someone will need to assist with their care. Have someone come in to babysit, get them off to school or transport them where they need to go. If you have pets, you will need someone to come in to feed them and walk them if necessary. You won't be able to lift heavy food containers or change litter boxes. If you buy large bags of food, you might want to purchase several large containers with lids, then place the items in the large containers along with a scoop. The large popcorn tins many people acquire at the holidays are great for this. You can place food or cat litter in these containers along with a scoop or plastic cup to scoop the item from the container. This way you won't be lifting heavy items.

This is a very demanding time for your significant other. They will be doing more physically and there is an emotional strain also. The ideal situation would be for someone to come in at the end of the week to take them out to eat so they can express their emotions. Also have someone stay with you while they are gone.

1. CLOTHING - You will most likely feel more comfortable the first days in a hospital gown. You will have many tubes, IV's and the snaps make changing clothing much easier. You will need a robe to cover yourself when in the general areas of the hospital. Also, remember to take something loose fitting to wear home. The tight clothing you arrived in will be too uncomfortable to go home in.

3. PILLOWS - You might want to take your own pillows. The hospital pillows can be rather stiff because they have a plastic covering. Remember not to take your good pillows or pillow cases in case you vomit or bleed on them. You will need your own pillows if you have a long drive home.

6. ENTERTAINMENT - Some hospitals allow you to bring your own CD's and player. Other hospitals have video or DVD players. Check with the hospital regarding their policies. If they allow music, bring comforting, mellow music to help you relax. If they have video or DVD players, bring something upbeat. Don't bring horror movies.

1. HAND WASHING - This can not be stressed enough. The number one and easiest prevention of infection is hand washing. There are many visitors and people in the hospital who have germs you can catch. If you are out in the general area, remember to wash your hands when arriving in your room. Many people touch the railings, elevator buttons, etc and germs can be passed along. You might want to purchase a small pocket container of hand sanitizer to place in your robe pocket. Your caregivers should wash their hands when assisting with your care.

2. HOSPITAL STAFF - While the hospitals insist the staff should wash their hands before administering care for each patient, sometimes they don't. If they don't wash their hands, then ask them to do so before touching you. The best way to prevent the passing of hospital acquired infections is for the staff to wash their hands before and after caring for each patient. If they become upset at your request, then it is their problem, not yours.

Request they cleanse their stethoscope with an alcohol wipe, if they don't do so. Stethoscopes can pick up germs too. You wouldn't want the hospital to place a therometer under your arm after it has been placed under the arms of other patients without a protective sheath. Since stethoscopes don't have protective sheaths, it is a good practice of health care staff members to clean them before and after each patient.

Advanced directives should be considered for everyone before any type of surgery, not just living organ donation. In some states hospitals are required to ask if you have advanced directives. Some hospitals are even able to provide the documents for you to sign and bring to the hospital the day of surgery. In some hospitals the social worker is able to obtain the documents and you won't need to go to an attorney to obtain them. Make sure the documents are witnessed according to the instructions. Place the original papers in a folder along with your other information. Bring copies of the documents to the hospital the day of surgery for them to place in your medical chart. You might want to give support persons copies too.

1. Living Will - While Living Wills can vary from state to state, the main purpose of the Living Will is to direct family members and health care providers regarding your personal wishes concerning life-sustaining treatment when you are in a terminal condition or permanently unconscious state. While family members might know your wishes, this is a very difficult time for them. Some family members might challenge the statements of another family member regarding your personal wishes. A Living Will provides clear written documentation of your wishes concerning life-sustaining treatment. A Living Will is for health care measures only and does not address financial or personal possession concerns.

2. Durable Power of Attorney for Health Care (DPOA) - The purpose of this document is to designate one person and an alternate to make decisions concerning your health care, if you are unable to do so. If you are in a terminal condition or unconscious state, the DPOA will be able to sign medical documents in your behalf. It also gives the DPOA rights to obtain your medical information, documents, employ and discharge health care personnel as they deam appropriate. A DPOA does not have to be a blood relative or spouse. Some people have found designating a DPOA is beneficial when they are in the mist of divorce or separation from a spouse. Other have found it beneficial if they have a significant other, in which they are not legally married, but would like that person to make health care decisions.

1. Personal physician - After you have been released from the hospital you will have follow-up appointment(s) with your surgeon. Make a written request for your surgeon to give a report to your personal physician. Request in writing your surgeon write any suggestion of protocols to be administered during your yearly physical exam such as lab tests, medications to avoid, treatment protocols, etc.

2. Medical Alert - Some donors have chosen to purchase medical alert jewerly or cards for their wallet. Even though you are healthy and don't have a medical health issue, it could be beneficiary for health care providers to be aware you have been a Living Organ Donor. Place on the alert system "LIVING DONOR - (name the organ)" . The reason for an alert system is so health care providers take precautionary measures regarding the organ remaining. For instance, if you are a kidney donor, they might need to avoid drugs toxic to the kidneys or if in an automobile accident they might want to make sure the remaining kidney wasn't injured. While any alert emblem would be beneficial, some paramedics suggest a bracelet, since one of the first things they do is look at the arms for a place to start an IV.

The medication list should be current and updated each time you receive a new medication. This list can be tricky to keep updated. If you find yourself frequently being treated for things like infections, it might be good to list the treatments so the health care provider is alerted to a pattern. Even if you don't take certain medications every day but on a "as needed basis" they should be listed. Any over the counter medications, vitamins, minerals and/or herbs should be listed. The medication list should list the name of the product/medication, the strength and frequency it is taken.

A list for the medical tests/treatments should be done. Tests such as Cat Scans can provide valuable information and a baseline for them to compare current test results. You need to list the test/treatment done, when it was done, where it was performed, why it was done and the known results. You might want to also provide on this list any baseline information such as blood pressure, heart rate, and other items pertinent to your own health. For instance, many people who are atheletic, have heart rates lower than the general population. A heart rate of 40's or 50's might alarm a health care provider, unless they know this is your normal baseline.