In this Heart Week special, we’re joined by Dr Rebecca Luong – Accredited Practising Dietitian, Sports Dietitian and PhD-qualified expert in cardiometabolic health. With a passion for practical, culturally inclusive care, Rebecca shares real-world strategies for supporting heart health across diverse populations.
Hosted by Brooke Delfino
Biography
Dr Rebecca Luong is an Accredited Practising Dietitian and Accredited Sports Dietitian, also known as The Cardiometabolic Dietitian and co-founder of Heartful Flavours. Rebecca worked in various areas of dietetics, including private practice, outpatient hospital, supermarket nutrition and community health, before completing a PhD in nutrition and cardiometabolic health. Her aim is to improve the heart and metabolic health of individuals globally through providing the best practical evidence-based nutrition solutions. Currently, she provides online consultations and launched heart-healthy Asian seasonings on a mission to eliminate excess sodium intake and support heart health. Rebecca was awarded the Dietitians Australia President’s Award for Innovation, 2024.
In this episode, we discuss:
How heart disease risk presents across different cultural groups
Real case studies in cardiometabolic nutrition
How to adapt traditional food practices for heart health
Strategies for overcoming engagement and access barriers
Practical tips for flavourful, heart-smart meals
Additional resources
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Who has not forgotten a name, occasionally misplaced things, or stumbled over the right word during a conversation? However, with growing awareness about dementia, these occasional memory lapses often leave people wondering if it could be an early sign of dementia.
As people get older, you might notice that it takes a little longer to remember things than it once did, but most of the time, there is no cause for concern. This occasional forgetfulness is called age-associated memory impairment and is a normal part of aging. Although it may feel frustrating, it does not mean you have dementia.
Although many people confuse normal aging with dementia, the two are very different. Dementia often begins with mild memory loss but progressively worsens over time. In normal age-related memory changes, forgetfulness tends to be occasional and typically involves memories from the more distant past. In contrast, people with dementia frequently struggle with recent events, such as forgetting a conversation they had earlier that day or not recognizing someone they just met.
Dementia is not just about memory loss. It also brings confusion, difficulty managing everyday tasks, trouble with language and understanding, and noticeable changes in behavior. Over time, these challenges interfere with a person’s ability to perform daily activities and can significantly affect their independence.
However, it is important to remember that noticing symptoms like memory loss or confusion is not enough to diagnose dementia. Only a healthcare professional can make that diagnosis after a thorough evaluation. This typically involves medical history, cognitive tests, physical exams, and sometimes brain imaging to rule out other possible causes.
Memory issues can also stem from a variety of other causes, including head injuries like concussions, brain tumors or infections, thyroid or organ problems, medication side effects, mental health conditions like depression and anxiety, substance misuse, sleep disturbances, or even deficiencies in key nutrients such as vitamin B12 and poor nutrition.
When to see a doctor?
If memory problems start interfering with daily life, it is important to see a doctor. Warning signs include repeating the same questions over and over, getting lost in familiar places, or struggling to manage personal care.
In some cases, older adults may be diagnosed with mild cognitive impairment (MCI), a condition where memory or thinking problems are more noticeable than in others their age. However, unlike dementia, people with MCI can usually manage their daily activities independently, but it can sometimes be an early sign of Alzheimer’s disease.
A pharmaceutical company that allegedly paid doctors kickbacks to push their HIV/AIDS drugs has agreed to pay a fine of more than $200 million to settle a civil lawsuit filed by federal prosecutors.
The government alleged that Gilead had induced doctors to prescribe a slew of HIV/AIDS drugs in exchange for honoraria payments, meals, and travel expenses to healthcare practitioners. Prosecutors said the company created a scheme where healthcare practitioners who spoke at or attended Gilead speaker events, and used the events as a a way to deliver kickbacks.
“For years, Gilead unlawfully sought to increase sales of its HIV drugs, by using its speaker programs to funnel kickbacks to doctors. As alleged, Gilead spent tens of millions of dollars on these programs, including over $20 million in speaking fees and millions more in exorbitant meals, alcohol and travel, all in an effort to induce doctors to prescribe Gilead’s HIV drugs and drive up sales,” U.S. Attorney Jay Clayton said.
“With this settlement, Gilead has taken responsibility for its conduct and agreed to pay a significant financial penalty. The message is clear, companies that illegally drain taxpayer dollars from federal healthcare programs will be held accountable,” he said.
The government also alleged that the scheme led to false claims for the Gilead HIV Drugs being submitted to and paid for by federal healthcare programs. Because of this, more than $176 million of the fine will go as compensation to the government, with the remainder being distributed to several states.
One HIV speaker, who received over $300,000 in total honorarium payments, wrote prescriptions for Gilead HIV Drugs that resulted in over $6 million in Medicare, Medicaid, and TRICARE payments.
The Gilead HIV antiretroviral drugs are expensive, with Medicare paying more than $1,000 for a one-month supply of Complera®, for example. From 2011 to November 2017, the company conducted HIV speaker programs, ostensibly for educational purposes.
However, prosecutors say many of the events had little educational value and that Gilead would invite the same physicians over and over to the same program. The events were often held at fancy restaurants in New York including at James Beard House, Del Posto, Asiate, Palma, Vaucluse, Ilili, and Limani.
Other desirable locations for the events included Hawaii, Miami, and New Orleans. Prosecutors noted that sometimes the location was selected in response to an HIV speaker’s request to be booked for a program in that city.
Find information for patients and families to understand and navigate organ donation and transplantation below:
Questions and answers for transplant candidates about:
The heart
Functions of the heart
The heart is a strong, muscular, cone-shaped organ. It is located behind the breastbone between the lungs. It pumps blood throughout the body.
Blood that no longer carries oxygen flows from the heart to the lungs, where it gives up wastes and gets new oxygen. From there, the blood returns to the heart and is pumped to the rest of the body.
Heart failure happens when the heart cannot pump enough blood to meet the body’s needs. Birth defects, or any condition that damages or overloads the heart muscle, can cause it. Treatment depends on the cause of heart failure and the age and condition of the patient.
Heart transplant procedures
Most heart transplants involve replacing the patient’s heart with the heart from a deceased donor. In rare cases, the patient’s native heart is not removed; this is known as a heterotopic transplant.
There also have been a few transplants involving a living heart donor. This may occur if one patient receives a heart-lung combination transplant but their heart is in good condition. This patient’s heart may then be transplanted into another recipient. This is known as a “domino” heart transplant.
Reasons for heart transplant
Heart diagnosis categories
Heart diagnoses
Cardiomyopathy
Dilated Myopathy: Idiopathic
Dilated Myopathy: Myocarditis
Dilated Myopathy: Other Specify
Dilated Myopathy: Post Partum
Dilated Myopathy: Familial
Dilated Myopathy: Adriamycin
Dilated Myopathy: Viral
Dilated Myopathy: Alcoholic
Hypertrophic Cardiomyopathy
Restrictive Myopathy: Idiopathic
Restrictive Myopathy: Amyloidosis
Restrictive Myopathy: Sarcoidosis
Restrictive Myopathy: Endocardial Fibrosis
Restrictive Myopathy: Other Specify
Restrictive Myopathy: Secondary to Radiation/Chemotherapy
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Your motivations for using tech can also point the way toward developing a healthier relationship with it. In today’s practice, Jay Vidyarthi guides us to identify our motivations and ways to establish more balance and intention in our tech use — without the guilt.
Recent studies have confirmed that the constant presence and use of tech in our lives has become a hazard to our well-being on multiple levels. Yet it’s not going anywhere—so how do we mindfully hold that tension and seek balance in our relationship to technology?
Meditation teacher, mindful tech designer, and self-identified tech lover Jay Vidyarthi observes, “It’s okay to enjoy technology. Tech becomes a problem when we get so attached to it that our lives fall out of balance—and this happens because a certain device or app or game or even your work email might satisfy a specific, lacking, healthy emotional need.”
In today’s practice, Jay leads us through a contemplative practice that can help us dig down and understand our motivations for using tech, while also helping us identify ways to be more intentional about the why, how, and when of our digital consumption.
A Meditation for Clarifying Your Motivations for Using Tech
Read and practice the guided meditation script below, pausing after each paragraph. Or listen to the audio practice.
This is going to be a contemplation. So choose whether you want to meditate with your eyes closed in a certain posture or position, or whether you’d rather journal, in which case you can grab a pen or a paper or even type on your computer.
Hit pause on the audio if you need a little bit more space to get settled. There’s never a need to rush into this kind of thing, so try to find a place that’s quiet, maybe even inspiring, for your contemplation or journaling.
When you’re ready, start by thinking or writing about why you personally might be interested in a better relationship with technology. What’s motivating you here? Is it a general feeling? Are there specific patterns you’re trying to change? Are there specific things that have happened that felt off to you that maybe inspired this idea that you needed to work on your relationship with technology? Are there maybe stories you’ve heard in the media or the press about technology and what it might be doing to us? Are there positive experiences that you have with technology where you find joy or meaning or purpose that maybe you want to get more of, or maybe you want to get back to? Maybe those are memories from an earlier incarnation of technology that feels lost.
Are there positive experiences that you have with technology where you find joy or meaning or purpose that maybe you want to get more of, or maybe you want to get back to?
Consider or write down how a more mindful relationship with technology might positively impact you and the people around you, whether those are family members or friends or roommates or coworkers, or even just the barista at the coffee shop or the clerk at the grocery store.
If you’re having a hard time getting to deeper answers, try asking why over and over again like young children do. It’s a very powerful word. You might start with, Why am I interested in a better relationship with technology? Your mind might answer that with something like, I want to be less stressed. From there you might ask, Why do I want to be less stressed? Maybe your answer is because you want to be more present for the people you care about. You might ask why again, Why do I want to be more present for the people I care about? Keep going with this, and you’ll eventually find yourself at some deeper personal truths.
Now, as you do this, notice if any judgment or shame is coming up. If you’re journaling, you can look back over the page, but if you are contemplating, you can just reflect. If judgment is arising, just let that come and go. So for example, you might ask why and hear your inner voice get self-critical. Like, Why do I want a healthy relationship with technology? Oh, well, because I can’t control myself and I’m addicted and destroying my life with this technology. Our inner voice can go all over the place, as you well know. If that happens, there’s no need to resist it, but don’t give it more energy, either. Try to stay curious and focus on those motivations, those intentions, those answers that feel like they’re encouraging positive growth.
As we approach the end of our session here, see if you can distill what’s come up in this practice into a simple word or phrase. If you’re journaling, you can draw a big line on the page. If you are contemplating, you can clear your palate. Try to find something that captures the essence of what is motivating you, what your intention is to form a more mindful, healthier, better relationship with the technology in your life. Try to be very specific and concise.
Once you have something, commit that to memory or write it down. Then, let go of all the effort that we’ve put into this practice and let’s take a few moments to just be as we are. There’s nothing more to do, yet we’re not yet moving into the next thing. We’re enjoying this transition, this moment of emptiness and non-doing.
When you’re ready, you can gradually open your eyes if they were closed. Have a little stretch or a sip of water, whatever you need. And if you haven’t yet, you can write down the word or phrase you came up with, put that in a visible place, and let that be a reminder of your intention, your motivation, your commitment to an improved relationship with technology.
It’s important to remember that this doesn’t necessarily mean only setting boundaries around problematic use patterns. It also means setting yourself up to fully enjoy the parts of technology you enjoy and to find authentic connection online and to allow any meaning or purpose that you get from technology to fully flourish into your life. I hope this was helpful. See you next time.
Cardiologists can criminally game the system by telling patients they have much more serious, unstable diseases than they really have—fraud that results in unnecessary procedures, unnecessary costs, and unnecessary patient harm.
“The history of medicine abounds with dogmas assumed and later overcome”—sometimes, much later. The Women’s Health Initiative study showed that giving women Premarin, a hormone replacement therapy, increased the risk of the number one killer of women, heart disease, as well as breast cancer risk. Millions of women stopped taking it, and breast cancer rates came down.
Another such reversal of an established medical practice is percutaneous coronary intervention (PCI)—angioplasty and stents for stable coronary artery disease. Billions of dollars are spent on procedures shown “unequivocally” to offer no benefits.
So, why are cardiologists still doing them? Researchers did some focus groups and concluded: “Although cardiologists may believe they are benefiting their stable patients with CAD [coronary artery disease] by performing PCI, this belief appears to be based on emotional and psychological factors rather than on evidence of clinical benefits.”
“The sense of irrationality surrounding this practice is so strong that the phenomenon has been coined the oculostenotic reflex (I see a stenosis; I stent it).” They see a narrowing and stent it as though they can’t even help themselves.
Since the procedure carries some risks, including death, there’s an argument that stents should only be used for individuals who are actively having heart attacks and are in an emergency or unstable situation. Thankfully, there are now published, appropriate-use criteria in place to help guide cardiologists, and the good news is that 82 percent of stents are “reported to be performed in emergency or unstable situations.” So, we can disregard that ORBITA study that showed there was no benefit in stable patients since it’s now almost always performed only in unstable patients, right? Well, that’s how it’s almost always reported. “There are 2 ways a physician can become compliant. One is to do fewer unnecessary procedures”—which is the whole point (but where’s the money in that?)—“and the other is to make unnecessary procedures seem necessary.”
Is the implication that a doctor would try to game the system by telling a patient that they had a much more serious, unstable disease than they actually had, so the procedure could be carried out anyway? This is referred to as “upcoding.” Another word for it would be “fraud.” Researchers found that “some of that decline [in inappropriate use] may be driven by upcoding, falsely and intentionally misclassifying patients with stable angina as UA,” having unstable angina. As soon as those appropriate-use criteria went into effect, suspiciously, there was a four- to tenfold greater increase in rates of stents for acute coronary syndromes like heart attacks. “In New York, the proportion of PCIs labeled as acute, but performed as outpatient procedures, increased 14-fold…” There’s no biologically plausible reason why that would happen, so they were unnecessary procedures with unnecessary cost and unnecessary patient harm. And harm not only from the risk of getting an unnecessary stent but also from lying to the patient by exaggerating how bad their heart disease is. “This practice, at best, damages the credibility of the profession, increases health care spending, violates patient autonomy, puts the patient at risk of procedural complications and, at worse, may cross the threshold into criminal activity…”
What’s the solution? There could be an independent review panel to protect patients. “Simpler might be to remove the financial incentive to perform more procedures.”
“How many established standards of medical care are wrong? It is not known.” Bloodletting was the standard of care for thousands of years, for example. “Rigorous questioning of long-established practices is difficult. There are thousands of clinical trials, but most deal with trivialities or efforts to buttress the sales of specific products. Given this conundrum, it is possible that some entire medical subspecialties are based on little evidence.”
In the landmark COURAGE trial that showed stents were useless for extending life, what did seem to determine longevity? Ironically, in the case of heart stents, it was how many risk factors the patients were able to control. Those who achieved all six by lowering their blood pressure, cholesterol, weight, and smoking, while improving their diets and activity, had five times the survival over the subsequent 14 years than those who didn’t, as shown below and at 4:36 in my video Heart Stents and Upcoding: How Cardiologists Game the System.
Should we be surprised that angioplasty and stents fail to improve prognosis? After all, they do nothing to modify the underlying disease process itself. In other words, it doesn’t treat the cause. Even if stents helped with symptoms beyond the placebo effect, they would still just be treating the symptoms and not the disease. So, it’s no wonder the disease continues to progress until the patient is disabled to death. Dr. Esselstyn wrote, “Thus, the leading killer of men and women in Western civilization is being left untreated. What is being practiced is ‘palliative cardiology’: nontreatment of heart disease leading to disease extension and frequently an eventual fatal outcome.”
Deaths by the planeload every week, are “regarded as unfortunate,” rather than a national, preventable tragedy. “It is as though in ignoring this dairy, oil, and animal-based illness, we are wedded to providing futile attempts at temporary symptomatic relief”—rather than the cure.
Thankfully, “we are on the cusp of a seismic revolution in health…not another pill, procedure, or operation,” but instead treating the underlying cause of heart disease with whole food, plant-based nutrition, “the mightiest tool medicine has ever had in its toolbox.”
To get there, we need to fight a key nutrition deficiency in education. A study found that 90 percent of cardiologists reported receiving no or minimal nutrition education during their cardiology training, leaving fewer than one in ten feeling confident in their nutrition knowledge. So, maybe it’s a good thing that most spend just three minutes or less discussing nutrition with their patients. Only one in five cardiologists themselves even ate five servings of fruits and vegetables a day.
Thankfully, this lifesaving information is slowly but surely getting out there. “Medical education has focused on being the ambulance at the bottom of the cliff rather than a fence at the top. Money talks, and there’s very little money in promoting eating broccoli and going for a walk, despite them being much more effective.” I was so eager to see the citation they used for that and was so honored when I did, as shown below and at 7:14 in my video.
In a study conducted by an internationally recognised association of hair restoration surgeons, doctors specialising in hair transplantation reported that 6 out of every 100 procedures are corrective surgeries for transplants previously conducted at black market clinics.
Considering that not every individual who underwent a transplant at a black market clinic seeks a second operation, the actual rate of hair transplants performed in black market clinics appears to be significantly higher.
This situation highlights an evaluation process that is far from scientific standards and lacks transparency.
In an effort to improve transparency and scientific structure in hair transplantation, DK Klinik has introduced a new clinical evaluation system: the Hair Donor Index.
The Hair Donor Index, created by analysing thousands of hair transplantation cases performed at the clinic over the years, was developed by DK Klinik—operating in the field of dermatology and hair transplantation in Turkey for 23 years—to grade the donor area quality of patients in preparation for hair transplantation.
Unlike traditional approaches that often rely heavily on subjective visual inspection, DK Klinik’s Hair Donor Index scores the donor area based on four critical parameters: follicular density, donor area size, follicular unit distribution, and hair thickness.
Each factor has a different level of influence on donor site suitability. Therefore, each score is multiplied by a specific weight, and the patient’s donor area is ultimately scored between 20 and 100 based on the weighted results.
‘Many hair transplant evaluations focus on how much area needs to be covered, but they rarely assess whether the donor area can sustainably provide enough grafts,’ said Prof. Dr. Ümit Kemal Şentürk, a senior executive at DK Klinik and added:
‘While the Norwood-Hamilton classification helps estimate how many grafts may be needed to restore coverage, it does not measure whether the donor area can supply them without risk. There has been no standardised methodology for evaluating donor sufficiency — until now. Our Hair Donor Index addresses this critical gap with a structured, data-based system.
We have long used the Hair Donor Index to classify patient candidates in our internal case evaluations, and it has been highly beneficial. However, I believe it is important to note that this methodology is only semi-standardised, as in some cases, individual patient factors can override the four main parameters we consider.’
Another persistent challenge for hair transplant candidates is inconsistent graft number estimations between clinics.
While traditional scales can approximate the recipient area’s needs, the donor area’s capacity has primarily been left to subjective interpretation. This often leads to exaggerated promises and a confusing environment where clinics compete over inflated graft numbers. The Hair Donor Index aims to replace guesswork with measurable, realistic evaluations.
Raising Global Standards
Hair transplantation has grown increasingly global, with countries like Turkey becoming major destinations for affordable, high-quality procedures. As more patients seek multiple opinions across clinics, tools like the Hair Donor Index provide a critical layer of transparency, helping patients avoid misleading promises and make better-informed decisions.
DK Klinik’s initiative not only sets a new benchmark for donor area evaluation but also reinforces its long-standing commitment to patient-centred, evidence-based care.
Welcome to our question and answer page on living donation.
Below is commonly requested information regarding living organ donation. We hope you find it helpful.
If you have other questions or comments, contact the Organ Procurement and Transplantation Network (OPTN) Patient Services line at (888) 894-6361 or submit them online here.
What is living organ donation?
Living organ donation is when a living person donates their organ or a part of their organ to transplant into another person.
Most living donors donate one of their kidneys or a part of their liver. Other organs can be donated by living donors, but are much rarer.
Living organ donors make thousands of transplants possible every year. There is a lot to learn before you decide whether donating an organ is right for you. This brochure contains information about living kidney and liver donation. Talk to staff at a transplant hospital if you would like to learn more about other types of organ donation.
As a living donor, you can shorten the wait for a transplant patient
In the United States, the demand for organs exceeds the supply of donated organs. Many people wait years for an organ from a deceased donor.
Only about half of the people in the United States sign up to donate their organs when they die. This number is different in every state and region, so the wait can be longer depending on where someone lives.
Every year, thousands of people get removed from the waitlist because they have become too sick to have a successful transplant.
To shorten the wait, family, friends, co-workers, and even strangers can offer to be living organ donors.
Living donor transplants can help shorten or eliminate the wait for an organ by:
Giving transplant candidates more options to plan.
Helping kidney transplant candidates get an organ transplant before they need to begin dialysis.
Living organ donors make thousands of additional transplants possible each year.
Living organ donors can improve the changes of transplant success
Kidneys from living donors generally have high success rates:
More than 98% of transplanted kidneys from living donors are still working one year after transplant.
On average, living donor kidney transplants work longer than kidney transplants from deceased donors.
Living donor liver transplants also have as good or better outcomes compared to liver transplants from deceased donors.
Only you can decide whether living donation is right for you
No one can make the decision to donate for you, and no one should pressure you.
Before you decide, learn as much as possible about living donation so you know the risks and benefits. This brochure gives basic information about living donation. The best place to learn is at a transplant hospital. Talk to transplant hospital staff to learn more.
When you learn about living organ donation at a transplant hospital, bring family or friends with you.
Including your family or friends will:
Help you remember what the transplant hospital staff teaches you.
Help you think of questions to ask.
Let your family and friends know the best way to help you.
Can I be a living donor?
To be a living donor, you must:
Be an adult (over age 18) able to make an informed decision
Be in good physical and mental health
Understand the risks and benefits of living donation
Decide for yourself whether living donation is right for you
Both you and the transplant hospital staff have to decide whether living donation is right for you. The transplant hospital staff will need a lot of information about you to make sure you are healthy enough to donate.
To help decide whether donation is right for you, transplant hospital staff will:
Give you a full physical examination and medical tests
Ask about your medical history
Ask about your social support
Assess your mental health
Ask about your finances and whether you can take time off from your commitments
Inform you about the risks and benefits of living donation
Make sure that your decision to donate is yours alone
Certain health issues may cause the transplant hospital staff to decide you should not donate an organ. This is for your health and safety. Here are some examples of such health issues:
Uncontrolled high blood pressure
Untreated psychiatric condition
Cancer
Diabetes
Certain infections
Do I have to know the person to whom I donate an organ?
Giving an organ to a specific person is called directed donation
In directed donation, a donor who is medically compatible may be:
A blood relative of the transplant recipient, such as a parent, brother, sister, or adult child
Someone close to the transplant recipient, such as a spouse, a friend, or a co-worker
Someone who the donor has heard about but does not know personally
Non-directed donation is when you want to donate but do not know – and may never know – the person to whom you will donate
In non-directed donation, the donor may be:
Someone wishing to donate to a stranger on the transplant waitlist
Someone who begins the process to donate to a friend or family member but later decides to donate to a stranger after the friend or family member gets an organ from someone else
A transplant hospital can match a non-directed donor to a transplant candidate who is a match. Sometimes, a match happens through a paired kidney exchange. Kidney paired donation helps more transplants happen. That process will be explained later.
Some non-directed donors wish to meet their transplant recipient. Sometimes that happens and sometimes it does not. It is a personal choice. The transplant hospital will help make a meeting happen only if the living organ donor and the recipient both wish to meet.
What if I want to donate my kidney to a specific person but we do not match?
Sometimes, someone wants to donate a kidney to a specific person but tests show the two people are medically incompatible. That can happen because of different blood types or other test results that show the kidney has a high risk of rejection. There are still ways you can donate, including:
Kidney paired donation (KPD) is when a computer matches donors and recipients to create compatible pairs. Think about it as a swap or an exchange. Here’s how it works:
You want to donate a kidney to someone, but you are not medically compatible.
Another person wants to donate a kidney to someone, but they also do not match.
A computer matches you with a compatible recipient, and their donor matches with the person you want to help.
Swapping donors allows both transplants to happen.
KPD allows hundreds of people to get a transplant each year. The person you want to help may get a transplant more quickly in an exchange.
How do I start the process to become a living donor?
The process starts at a transplant hospital.
If you want to donate to someone you know, such as a family member, friend, or co-worker, ask that person to put you in touch with their transplant hospital.
If you want to donate to someone you know but want to get tested before telling the transplant candidate, talk to their transplant hospital. Many transplant hospitals will test you without telling the transplant candidate.
If you want to donate an organ to someone you do not know, call a transplant hospital near you to talk about it.
Will someone at the transplant hospital help me with the process?
If you and the transplant hospital staff agree that it makes sense for you to be evaluated, the transplant hospital staff will put you in touch with an independent living donor advocate.
An independent living donor advocate’s job is to protect you. Their job is not to think about what the transplant candidate needs or make transplants happen. The independent living donor advocate will:
Protect you and your best interests
Support your rights, such as making sure you have the time and information you need to decide whether donating is right for you
Make sure you know the risks and benefits of living donation
Help you walk away if you decide living donation is not right for you
The independent living donor advocate will make sure you have information about:
Consent: When you agree to give medical information and undergo testing
Evaluation: What tests you need to take and why
Medical and psychosocial risks: Possible problems you may have during or any time after donating, including coverage for childcare or eldercare
Financial risks: Issues with expenses, work, or insurance
The surgery: What to expect the day of the operation and the risks
Recovery: What to expect after surgery and getting back to normal activities
Medical follow-up: Tests you are required to have after you donate
Independent living donor advocates want you to share anything that is on your mind. If you have fears, concerns, or second thoughts, your living donor advocate wants to know. Sharing your thoughts is the best way to help your living donor advocate support you and help you decide what is right for you.
The advocate will not share your medical or other information with the transplant candidate.
Step 1: Consent to be tested and provide health information
When you call a transplant hospital, a living donor staff member will briefly explain the donation process and ask if you agree to give some information about your health. Your consent begins the evaluation process.
Different transplant hospitals might ask you about your health in different ways:
Online
Over the phone
In person
Your answers help the transplant hospital team decide whether to continue to the next step. Some health issues are minor and donation may still be possible.
Transplant hospitals may have different opinions about certain health issues and their risks. Transplant hospital staff will explain their opinions to you.
Step 2: You and the transplant hospital start a careful evaluation process
If you and the living donor team both decide to continue, you’ll start a wide-ranging evaluation process. The purpose is to protect you and the potential transplant recipient. It also helps to make sure a transplant is likely to have a good outcome.
The transplant staff members ask questions about all areas of your life, such as:
Why do you want to donate?
How do you think donating will affect your life? Your family?
Can you afford the non-medical expenses, like travel?
Who will help you afterwards?
Can you afford time away from commitments?
Do you have any risky habits or behaviors?
Some of the questions are really personal. The purpose is to make sure donation is safe and right for you.
Be sure to ask any questions you have. There is no such thing as a bad question or too many questions. Answering all of your questions is one of the most important jobs of the living donor team. Bring a family member or friend with you to help you remember everything you need to know.
What tests will I have during my evaluation?
To make sure you are healthy enough to donate, you will take a lot of tests. The purpose of testing is to protect you.
Some of the tests also give information about the likelihood of a good transplant outcome if you become a living donor. Your medical information and test results are confidential. By law, transplant hospitals cannot share your medical information with the transplant candidate without your permission.
Here is a list of the kinds of tests living donors have to take. Each test will be described below.
Psychosocial evaluation
Blood tests
Heart and lung tests
Tests of the organ to be donated
Routine health tests
Psychosocial evaluation
Living donor team members will ask you questions about your life. This helps you and the transplant hospital staff decide whether living donation is right for you. Here are some examples of the questions:
Why do you want to donate?
Do you feel pressure from anyone to donate?
How well do you understand the process, risks, and benefits so that you can make an informed choice?
Will donating affect your job? Your finances?
How might donating affect other parts of your life, such as caring for a child or a parent?
Who will help you during recovery?
What are your family’s views about your donation?
Do you have any mental health issues that could be made worse by donating?
How do you think you will feel after donating?
How do think you will feel if things do not go as you hope they will?
Blood tests
Some blood tests give the transplant hospital staff information about your health. Other blood tests show the staff whether you are a match with a transplant recipient.
Blood type compatibility: Blood tests let the transplant hospital know whether you and a transplant recipient have compatible blood types.
Donor blood type
Recipient blood type
O compatible with:
O, A, B, and AB
A compatible with:
A and AB
B compatible with:
B and AB
AB compatible with:
AB
Tissue typing: This blood test checks the tissue match between you and a transplant candidate. Transplant hospital staff use this information in caring for the transplant recipient. Even if you and the recipient are not tissue matched, the recipient can still have a successful transplant because of medications to combat organ rejection.
Cross-matching: This blood test checks for factors associated with increased risk of organ rejection by the transplant recipient.
Transmissible diseases: These blood tests look for infections or conditions that a living donor could spread to the transplant recipient. The law requires medical staff to report certain infections confidentially to public health officials.
Heart and lung tests
A chest x-ray, an electrocardiogram, and other tests will be conducted to make sure your heart and lungs are healthy enough for you to be a donor.
Tests of the organ you wish to donate
CT or MRI scan to let the transplant hospital staff look at the organ you wish to donate.
Kidney donors have blood and urine tests that give information about their kidney health.
For liver donors, some transplant hospitals use a small needle to take a tiny piece of the liver to make sure it is healthy enough to donate.
Routine tests depending on your age and the tests you have had in the past
A colonoscopy
Skin cancer screening
Gender-specific exams
Not all transplant hospitals require the same tests. Your transplant hospital staff will explain what tests you need. They also will explain why the tests are important.
Getting through all the tests takes time. If you are donating to someone whose hospital is far away, you may be able to do some of the medical tests closer to your home. Talk with the transplant hospital staff about options.
Who decides if I may donate?
If you pass the evaluation process, the final decision about whether you will donate is yours.
Your decision must be informed and voluntary.
An informed decision means you understand:
The donation process
The risks and benefits of donation
The other options a transplant candidate might have, such as dialysis or transplant from someone else, living or deceased
A voluntary decision means you:
Feel no pressure from anyone to donate
Know you may decide not to donate at any time
Are not expecting a promise of money or anything of value
When you think about whether to donate, it is helpful to talk with people
The decision to donate is not easy. There is a lot to think about. Donation could impact your health, your family, and your work. Sometimes people offer to donate an organ before they learn about the risks and benefits. After learning more, some people decide that donating is not right for them. They may worry about letting someone down.
Talking through your thoughts can help. Talk with family members, close friends, or anyone you know who is a good listener. You may also want to talk with living donors. Transplant hospital staff can help find living donors who would be happy to share their experience with you.
Other organizations, like the National Kidney Foundation, can put you in touch with a donor. Call the National Kidney Foundation’s PEERS Program at (855) 653-7337 (855-NKF-PEER) or email nkfpeers@kidney.org.
The most important thing is that you do what you feel is right for you.
People may decide not to donate for many reasons. Your decision to donate or not, and the reasons for your decision, are yours to make.
If you decide not to donate at any point, for any reason, talk with your transplant hospital social worker, donor coordinator, or your independent living donor advocate. These staff members are there to help you. They want to hear your thoughts, concerns, and feelings. The transplant hospital staff will keep your reasons for deciding not to donate private. They can help you think about what to say if people ask questions about why you are not able to donate.
What are some of the risks if I donate?
When someone donates any organ, there are different kinds of medical risks.
Immediate risks: During or right after surgery
Short-term risks: In the year or so after surgery
Lifetime risks: Anytime during your life
The transplant hospital staff will explain all the different risks of living donation.
Your transplant hospital staff will talk with you about:
How likely the risks are to happen
Whether the risks are serious
Whether the risks are in the short-term or could happen at any time
Whether and how the problem would be treated
Risks differ from person to person.
Every surgery has risks. Here are some examples of the problems that are possible during or right after kidney or liver donation surgery:
Pain
Infection
Bleeding
Blood clots
Injury to tissue or other organs
Pneumonia
Allergic reaction to anesthesia
Death
When someone donates a kidney, they live with one kidney for the rest of their life. With one kidney instead of two, living kidney donors have reduced kidney function. Here are some of the possible risks of kidney donation:
Hernia
Organ failure (needing treatment or possibly transplant)
New or ongoing high blood pressure
High blood pressure after pregnancy
When someone donates a part of their liver, the part they keep and the part they give to a transplant recipient both grow to almost full size. Here are some of the risks of liver donation:
Wound infections or hernia
Bile leakage
Intestinal problems (blockage)
Organ failure (needing treatment or possibly transplant)
Remember, the best place to learn about risks is from your transplant hospital staff. If you hear about other possible risks, always go back and talk to your transplant hospital staff. When you make your decision, you need facts. Your transplant hospital is the best place to get them.
Not every possible lifetime risk is known
Your transplant hospital staff will give you some information about the lifetime risks of living organ donation. However, transplant hospital staff cannot tell you every possible long-term risk. Based on the best information known so far, overall risks to health are considered to be low for those determined to be healthy enough to donate.
Donating is a lifetime decision. All living donors should commit to a lifetime of healthy habits and healthcare. Living donors need to have medical follow-up care after donating. Living donors also should go to their local doctor for a health check-up every year. You can manage health risks by taking good care of yourself and controlling things like your blood pressure and weight. Your doctor can help you.
How might I feel after living organ donation?
About 90 to 95 out of every 100 donors say they would not change anything about their decision to donate.
They would make the same decision to help someone. They would go through all the screenings, tests, and surgery. They would take time away from their lives, jobs, and other commitments to recover. They would do all of that to help someone.
They feel good about extending the transplant recipient’s life. They feel satisfied about improving the transplant recipient’s quality of life.
Sometimes, living donors feel regret or resentment. Some say they feel depressed. This can happen even years after donating. Some examples are when:
A donated organ does not work well in the recipient after transplant surgery
The donor or the transplant recipient has medical problems after surgery
The donor’s scars do not fade as much as the donor expected
If this happens to you, you may need support from a professional to work through these feelings. Be sure to talk with the transplant hospital staff in advance about these and other risks. If you donate and have concerns afterward, ask your transplant hospital or independent living donor advocate to help you find support.
How long does it take to get back to normal life after donating?
After surgery, living donors need time and help from family and friends before getting back to routine activities. Here are some tasks and the average time living donors take to return to each.
Kidney donors
Liver donors
Stay in the hospital
about 2-3 days
about 5 days
Drive a car
about 2 weeks
about 2-4 weeks
Get back to pre-donation activities
about 4-5 weeks
about 8 weeks
Lift heavy items
about 6-12 weeks
about 8-12 weeks
Every donor is different. Some donors get back to their lives quickly. Others say they feel tired for quite a while after donation. Since you do not know how you will feel, it is important to have family and friends ready to help you for as long as you need. If you take more time than other donors, let your transplant hospital staff know.
Will I need follow-up medical care after I donate?
After you donate an organ, you need to take good care of yourself and have yearly medical check-ups with your doctor.
“Everyone says I gave the gift of life when I donated. Doing my follow-up and seeing my doctor every year to make sure I’m ok is also a gift. It’s a gift I give to myself and my family.” – Ron
All living donors need certain tests six months, 12 months, and 24 months after surgery, but these may vary according to the transplant hospital. Ask the transplant hospital staff:
What tests will be done
Where the tests will happen – at the transplant hospital, a local lab, or at your own doctor’s office
Who will pay for follow-up
Sometimes, even if you feel well, tests may show you need treatment. Follow-up is very important. Transplant hospitals must track and report to the OPTN whether you get the tests you need after you donate.
Check-ups help the transplant hospital staff make sure you are healthy. They give you a chance to talk about how you feel and what you might do to be as healthy as you can be. Your follow-up also gives transplant hospitals information that can help future donors.
Commit to your required follow-ups after donation and see your family doctor every year.
Who pays the costs if I decide to donate?
Before you decide whether to donate, learn about all the possible costs and which, if any, you may have to pay. Transplant hospital staff will talk with you about living donation expenses and how they are usually paid.
A transplant candidate’s insurance generally covers a living organ donor’s medical expenses.
These expenses include a donor’s evaluation, tests, and surgery. Talk to your transplant hospital staff if you need help paying for other tests you may need to have done (colonoscopy, or a mammogram for women, or a prostate exam for men).
The transplant candidate’s insurance is not likely to cover other costs, such as:
Medical care if your evaluation shows that you have a disease that needs to be treated
Long-term medical care if the donation causes you problems
Follow-up care for the rest of your life
Every insurance policy is different. Be sure to ask questions about what medical costs may not be covered by insurance.
Some transplant patients have Medicare. Sometimes Medicare may help living donors who have donation-related complications. For more information, contact Medicare at 1-800-MEDICARE or at medicare.gov.
Think about your health insurance situation
Some transplant hospitals require living donors to have health insurance.
Most living donors do not have problems with insurance because of donating. After you donate, an insurance company may consider you to have a pre-existing condition. If that happens, it is possible that:
It could be harder to get new health, disability, life, or long-term care insurance.
It could be harder to increase your life insurance coverage.
Your premiums might be higher than they would be without a pre-existing condition.
Federal law may protect living donors from problems with health insurance. Talk with a social worker at the transplant hospital about risks and ways to protect yourself.
Check with your employer about other benefits that may help you
If you are employed, talk with your employer about other benefits that could be helpful. These include:
Vacation time
Disability pay
Sick time
Leave of absence
Talk with your transplant hospital staff if you need help with non-medical costs, such as travel and lodging.
You may be able to get help with costs for travel expenses, lost wages, and dependent care during testing or surgery. The National Living Donor Assistance Center (NLDAC) helps some donors with these kinds of expenses based on eligibility. Contact the NLDAC toll-free at 1-888-870-5002 or go to livingdonorassistance.org for more information.
A transplant recipient, family members, a transplant hospital, or charities also may be able to help you with certain non-medical expenses.
Ask your transplant hospital social worker to explain what kind of help you can accept. It is illegal to give or take money or anything else of value, such as a gift or a vacation, in exchange for donating an organ.
Can I get information about living donors?
The OPTN collects data about living donors from transplant hospitals across the country. Looking at data may help as you think about whether or not to donate.
Talk with your transplant hospital staff about the data to find out what it really means for you.
Transplant hospitals give the OPTN information about medical problems living organ donors have in the two years after surgery. Serious problems are rare.
Here are a few examples of living organ donor data:
The Department of Health and Human Services required the OPTN to develop living donor guidelines and policies in 2006. Find policies that impact living donors on OPTN’s Policies page. You also can submit your feedback on current policy proposals on the Public Comment page.
Useful websites
Acronyms and terms
Colonoscopy – An examination of the colon using a flexible fiber-optic device inserted through the rectum.
CT scan – A procedure using a computer linked to an X-ray machine to make a series of 3-D images of areas inside the body.
Electrocardiogram – A test that measures the electrical activity of the heartbeat.
Immunosuppression medications – A class of drugs that reduce the strength of the body’s immune system, making it less likely to reject a transplanted organ.
Mammogram – An X-ray picture of the breast.
MRI scan – Uses a large magnet, radio waves, and a computer to create detailed images of internal organs and structures.
Prostate – A gland in men that surrounds the urethra, the tube through which urine passes out of the body.
Types of living organ donors
Compatible donor – A person whose blood and tissue type and other medical factors match with the recipient.
Deceased donor – A person who has been declared dead by brain death or cardiac death and whose organs are healthy enough to be used for organ transplant.
Incompatible donor – A person whose blood type or other medical factors do not match with the recipient. An incompatible donor may still be able to donate through exchange programs (kidney paired donation) or incompatible transplantation programs.
Living donor – A person who is alive when they donate an organ, usually a kidney or a part of their liver. Living donors are healthy and undergo many medical tests before they are allowed to donate an organ.
Non-directed donor – A person who wants to donate an organ but does not have a specific recipient in mind. A non-directed donor expresses interest in donating to a transplant hospital. Non-directed donors are sometimes called anonymous donors or altruistic donors.
Paired donor – A person who donates an organ to someone he or she does not know through a kidney exchange program so that, in turn, another living donor will give a kidney to someone that donor knows. Kidney exchange enables medically compatible donor-recipient combinations.
Other transplant words
Blood type – One of four groups (A, B, AB, or O) into which blood is classified.
Dialysis – A method of filtering the blood that tries to do the job of the kidneys. This includes removing extra fluid from the blood (which would usually leave the body as urine) and balancing chemicals (electrolytes) in the blood.
Family doctor – The doctor a person sees when he or she does not feel well or for annual medical check-ups. This kind of doctor is also called a primary care physician.
Independent living donor advocate (ILDA) –
A person who understands the organ donation process and who is not part of the transplant team. This person will:
Promote your best interests
Check that you have received information about:
The informed consent process
The tests needed to be a living donor and the risks of these tests
The surgery, and the care you will get after the surgery
The need to have follow-up care after donation
Help you get more information about these topics as needed; the ILDA should not be involved with the transplant candidate
Informed consent – When a person has information about a test or procedure, understands the information, and then agrees to participate in the test or procedure.
Living donor team – The transplant hospital staff whose job is to talk with, evaluate, and protect the interests of living donors.
Medical follow-up – The requirement that living donors have medical tests a minimum of six months, 12 months, and 24 months after donation. The purpose is to make sure the donor is healthy even if the donor feels well. The transplant hospital should talk with the living donor about how and where to do medical follow-up.
Organ rejection – When a transplant recipient’s body recognizes the transplanted organ as foreign and attacks it. Acute rejection is when a person’s body mounts a sudden attack on the transplanted organ. Chronic rejection is when a person’s body slowly damages the transplanted organ over time. Both can result in organ failure.
Transplant – Surgery to take an organ from one person’s body and put into another person’s body.
Transplant candidate – A person who needs an organ transplant and who has been approved by a transplant hospital to have one.
Transplant hospital – A hospital where experienced surgeons perform organ transplants. Not all hospitals perform organ transplants.
Transplant recipient – A person who had an organ that was not working and who got an organ from a living or deceased donor.
Waitlist – Medical information about people who have been approved to get a transplant and who are waiting for an organ from a deceased donor. When an organ becomes available, a computer matches the organ with waitlist candidates based on rules designed to be fair to everyone who is waiting for an organ.
