Transplant



Kidney transplants are one of the most common transplant operations in the United States.
One donated kidney is needed to replace the work previously done by your kidneys.

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The donated kidney may be from:
  • Living related donor - related to the recipient, such as a parent, sibling, or child
  • Living unrelated donor - such as a friend or spouse
  • Deceased donor - a person who has recently died and who has no known chronic kidney disease

Kidney transplantation is vastly preferred to dialysis in nearly every case. Transplants have many advantages. A transplant kidney can revitalize the patients and improves their kidney function as compared to dialysis. (Dialysis can only make up for approximately 8% of one kidney's function). A person with a kidney transplant that is well maintained can lead a remarkably "normal" life. No dialysis is needed and the patient only needs to take medication and keep up with doctor appointments. Many transplant patients have full-time careers and live full, healthy lives.

Getting a transplant can be a long and involved process however and can take years before a suitable kidney can be found. Most renal failure patients will be on dialysis for long periods of time before they can be matched to a kidney.

In order to find a suitable kidney, it must be a match for the patient's body tissue and antibodies. In order to find such a match, the patient must either find a suitable living donor or must wait on the kidney transplant list.

The List:
"The List", as referred to by patients and kidney transplant doctors. Is a system of organization used to match cadaver kidneys to respective patients.

"The List" is a bit of a misnomer in that it really isn't a list at all. Many people who are unfamiliar with the list will ask questions such as: "How far up are you on the list?" or "What number on the list are you?". This is a common misconception. The list actually functions to match newly available kidneys with the best prospective patients. This is achieved through the use of  a "points system". 

Each patient who is placed on the list is assigned a certain amount of points. These are a way for the transplant center to match incoming kidneys to the most deserving patients. Different factors give patients different points. For example, points are rewarded due to antibody levels, previous transplants, age, severity of the condition, and time spent already waiting on the list. The more time you spend on the list the more points you accrue.

When a new kidney becomes available it is matched against all patients on the list and assuming that the kidney isn't a direct match to any particular patient (in that case it goes straight to that patient regardless of points) the kidney will go to the patient who has the best match combined with the highest number of points. So each kidney is on a strictly case by case basis instead of a lateral moving-up in the list.


Before the Procedure

Once your doctor refers you to a transplant center, you will be seen and evaluated by the transplant team. They will want to make sure that you are a good candidate for kidney transplant. You will have several visits over the course of several weeks or even months. You will need to have blood drawn and x-rays taken.
Tests done before the procedure include:
You will also want to consider one or more transplant centers to determine which is best for you.
  • Ask the center how many transplants they perform every year and what their survival rates are. Compare these numbers to those of other transplant centers.
  • Ask about support groups they have available and what type of travel and housing arrangements they offer.
If the transplant team believes you are a good candidate for a kidney transplant, you will be put on a national waiting list.
  • Your place on a waiting list is based on a number of factors. Key factors include the type of kidney problems you have, how severe your heart disease is, and the likelihood that a transplant will be successful.
  • The amount of time you spend on a waiting list is usually not a factor in how soon you get a kidney, except maybe for children.
Most, but not all patients waiting for a kidney transplant are on dialysis. While you are waiting for a kidney, follow these steps:
  • Follow any diet your transplant team recommends.
  • Do not drink alcohol.
  • Do not smoke.
  • Keep your weight in the range that has been recommended. Follow any recommended exercise program.
  • Take all medicines as they have been prescribed for you. Report changes in your medications and any new or worsening medical problems to the transplant team.
  • Follow up with your regular doctor and transplant team on any appointments that have been made.
  • Make sure the transplant team has the correct phone numbers so they can contact you immediately if a kidney becomes available. Make sure, no matter where you are going, that you can be contacted quickly and easily.
  • Have everything ready in advance to go to the hospital.

    After the Procedure

    If you received a donated kidney, you will need to stay in the hospital for about 3 - 7 days. Afterwards, you will need close follow-up by a doctor and regular blood tests for 1 - 2 months.
    The recovery period is about 6 months. Often, your transplant team will ask you to stay fairly close to the hospital for the first 3 months. You will need to have regular check-ups with blood tests and x-rays for many years.


    Advanced Options For Transplantation

    Finding a match for a suitable kidney can be a long and difficult ordeal. Because of this there are more and more options being made available to potential transplant patients. 
    • Living donor transplants - Living donors are always the best option for kidney transplants. If at all possible, find a willing friend or family member who is willing to donate. 
    • Altruistic kidney donors - Some people decide to donate their kidneys just for the sake of helping someone. These amazing people put sacrifice their own organs to help someone just for the sake of doing good. They are truly heroes. 
    • Paired Exchange or Domino Transplants - A relatively new procedure to come to the field of transplants is paired exchange transplants. If a patient has a willing donor, but that donor is not a match for the patient, they can be matched against another willing pair, and another, until the chain is complete and everyone gets a suitable kidney. For more information on paired exchange transplants visit the Johns Hopkins Paired Exchange Transplant Program
    • Many patients, especially repeat transplant patients are sensitized to new kidneys, which means that they have antibodies built up as a natural resistance to a new kidney. There are new methods available for treatment of sensitized kidney transplants.  
    • For a growing number of patients, plasmapheresis is becoming a cornerstone of transplantation. Plasmapheresis is the process of filtering out the blood into it's separate components and then having the options to treat those components individually. In kidney transplant patients for example the blood plasma is removed and replaced with a plasma substitute in order to cleanse the blood of the antibodies stored in the blood plasma.





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