The Perfect Kidney Transplant Match
Falls cooler temperatures were approaching and with them another sinus infection. Or so Emery Stone thought. He had been feeling run down for days. Ill just see my doctor, get some antibiotics, and be back to normal in a few days, he thought.
But when Emerys doctor saw his patients extremely elevated blood pressure, he was concerned enough to order blood tests and a urinalysis. The results indicated something much more serious than a sinus infection: Emery Stone was in total kidney failure.
And thats when everything changed. Not only for Emery, but for the entire Stone family.
How Will I Pay For A Transplant
Medicare covers about 80% of the costs associated with an evaluation, transplant operation, follow-up care, and anti-rejection medicines. Private insurers and state programs may cover some costs as well. However, your post-transplant expenses may only be covered for a limited number of years. Its important to discuss coverage with your social worker, who can answer your questions or direct you to others who can help.
Does It Matter If Hla Numbers Are A Good Match Or Not
We prefer a good match, although this is more important for deceased donor kidneys. When a deceased donor kidney becomes available, UK Transplant matches the six numbers that the donor has with the best match for all the potential recipients on the on-call register.One way of thinking of this is that it is very much like the National Lottery. That is, we all have our own six numbers and if the donor had the same six numbers as one of the recipients on the list, they would be offered that kidney.
This is called a 6-antigen match or a full house match. Just like winning the lottery jackpot, this does not happen very often. Five numbers matching is a bit more common, and four numbers matching is a bit more common again. However, we do not like to take less than four numbers matching as far as possible, unless the child has numbers that are extremely uncommon in the population and very unlikely, therefore, to be matched.
If the child is lucky enough to receive a full house 6-antigen matched kidney from a deceased donor, then this is the only match that does as well as a kidney from a parent, even though the parent may only have three numbers in common with their child. This is because the parent may have other things in common that we do not match for or even understand. It is also because the kidney is taken from the parent and very rapidly transferred into the child, with very little wait in between.
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How Do I Know If My Kidney Is A Match For The Recipient
The transplant team will check your blood type as well as the recipient blood type to see if they are compatible. A unique blood test also needs to be done which is called crossmatch.
It is possible that the recipient of the kidney has an allergy to the donated kidney so the recipient’s body may reject the donated kidney. Such allergy is due to some substances called antibodies which are present in the recipient’s blood. In order to make sure that the recipient does NOT have those antibodies against your kidney tissue, the crossmatch test is performed. Briefly, a sample of your blood is combined with a sample of the recipient’s blood. If the recipient has antibodies to the donor, this will cause a “positive” reactivity during the crossmatch test. This may mean your recipient is incompatible to you. In the case that you and your recipient are not compatible, you may participate in UCLA’s Kidney Exchange Program. This program allows the recipient and donor to enter a paired exchange registry, where the donor will donate to another recipient that is matched, and the recipient will recieve a matched kidney from a compatible donor in return.
Why Compatible Pairs Can Benefit From Using The Nkr
Paired exchangewhen a donor donates their kidney to another recipient in exchange for a compatible, or better-matched, kidney for their loved onewas originally created to overcome cases of donor-recipient incompatibility, when the donor could not give directly to the intended recipient.
However, compatible pairsdonor-recipient pairs where the donor can donate directly to the patientcan also greatly benefit from entering paired exchange.
Through paired exchange and the Kidney for Life initiativewhich utilizes the latest generation in DNA sequencing technology to assess the histologic match between patients and donorscompatible pairs can find excellent matches, and the recipient can potentially reduce their immuno-suppression dosage and have a transplanted kidney that lasts longer.
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How Does Unos Save Lives
United Network for Organ Sharing provides a vital link in the organ transplant process. Its policies and computerized network match donated organs with transplant candidates in ways that save as many lives as possible and provide transplant recipients with the best possible chance of long-term survival.
The matching criteria developed by the transplant community, and approved by the OPTN Board of Directors, are programmed into UNOS computer matching system. Only medical and logistical factors are used in organ matching. Personal or social characteristics such as celebrity status, income or insurance coverage play no role in transplant priority.
Incompatible Living Donor Transplant
Ideally, to be eligible for transplantation, kidney donors and recipients should have compatible blood and tissue types. Too often, however, willing live donors do not meet these medical criteria. While it remains preferable to receive a kidney from someone who is fully immunologically compatible, recipients can be successfully transplanted from a donor with mismatched antibodies.
When antibodies are present, the blood of the recipient and donor react to each other, much like an allergic reaction. In the past, this reaction has caused the recipient’s body to reject the donor organ. Today, we can successfully transplant from an incompatible donor if the recipient’s blood is first “cleaned” of antibodies through a process known as plasmaphereis.
First, the amount of antibodies present must be quantified. This level helps to determine the number of treatments required. Next, the recipient’s blood is separated into cells and plasma . The plasma is removed and replaced with a commercially available plasma substitute. Removing the plasma removes the antibodies. In essence, plasmapheresis is similar to dialysis it removes antibodies just as dialysis removes waste products.
Depending on the level of antibodies present, plasmapheresis may be performed anywhere from 2-10 times. Most patients receive the treatment every other day, for up to three times a week. Once the quantity of antibodies drops to a low enough level, the recipient can undergo the transplant.
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Are There Any Side Effects Of Donating A Kidney
Donating a kidney is an amazing gift. Living donors are having an operation they dont need – it is mainly to benefit someone else. The risk of death is quoted as 1 in 5000. Of course, it involves a hospital stay and pain associated with an operation, and in the longer term, there is a small increased risk of high blood pressure and a small increased risk of kidney failure. These are explained in detail during medical consultations.
What Is A Paired Kidney Exchange
Since 2001, Johns Hopkins Comprehensive Transplant Center has participated in paired kidney exchanges. A paired kidney exchange, also known as a kidney swap occurs when a living kidney donor is incompatible with the recipient, and so exchanges kidneys with another donor/recipient pair. Two live donor transplants would occur. Suppose there were two donor/recipient pairs, Donor and Recipient 1 and Donor and Recipient 2:
- Donor 1 would give a kidney to Recipient 2.
- Donor 2 would then give a kidney to Recipient 1.
This kidney paired donation transplant enables two incompatible recipients to receive healthy, more compatible kidneys. All medically eligible donor/recipient pairs may participate in the paired kidney exchange program.
In more complex cases, additional donor/recipient pairs may be used. Participating in the paired kidney exchange program allows for a recipient to receive a better matched kidney, and helps other individuals who would otherwise continue to wait for a matched donor. Approximately 45% of donor/recipient pairs could find a perfectly matched donor by entering the national paired kidney exchange program.
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Am I Eligible To Become A Kidney Donor
You need to undergo a comprehensive evaluation if you decide to donate one of your kidneys to a family member such as your spouse, children, siblings, and parents or to a friend or altruistically to a stranger. You are NOT eligible to become a kidney donor if the doctors assessment suggests that kidney donation is not safe for you.
Waiting For A Kidney Transplant
While you are waiting for a kidney transplant:
- Do not miss appointments with your transplant team, primary doctor, and other doctors.
- If you are on dialysis, do not miss your dialysis sessions.
- Let your transplant team know if you experience any changes in your health, even if you feel like you just caught a cold.
- Take all medicines prescribed to you by your transplant team. Let the transplant team know if you are taking medicine from another doctor.
- Carefully follow the eating and exercise plan given to you by the transplant team. You may be asked to see the dietitian or physical therapist.
- Manage your health care by keeping all of your medical papers in a folder or binder so they are all available in one place.
- If you are a woman, talk to your transplant team about birth control, and what you should know about having children before and after your transplant.
- Immediately let your transplant team know if any part of your contact information changes, especially your address or phone number.
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Finding A Kidney Donor
Once your doctor has determined that youre a good candidate for a kidney transplant, youll need to be matched with a kidney donor who is compatible with you in tissue and blood type. There are several ways to go about finding a kidney donor.
Why Might I Need A Kidney Transplant
You may need a kidney transplant if you have end stage renal disease. This is a permanent condition of kidney failure. It often needsdialysis. This is a process used to remove wastes and other substances fromthe blood.
Remove urea and liquid waste from the blood in the form of urine. Urea is made when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the blood to the kidneys.
Balance salts, electrolytes, such as potassium and sodium, and other substances in the blood
Produce erythropoietin, a hormone that aids the formation of red blood cells
Regulate blood pressure
Regulate fluid and acid-base balance in the body to keep it neutral. This is needed for normal function of many processes within the body
Some conditions of the kidneys that may result in ESRD include:
Repeated urinary infections
Polycystic kidney disease or other inherited disorders
Glomerulonephritis, which is inflammation of the kidney’s filtering units
Hemolytic uremic syndrome, a rare disorder that causes kidney failure
Lupus and other diseases of the immune system
Other conditions, such as congenital defects of the kidneys, may result inthe need for a kidney transplant.
There may be other reasons for your healthcare provider to recommend akidney transplant.
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Who Donates Kidneys For Transplantation
There are two sources for kidney transplants. One is from a living donor, and the other is from a non-living donor. Patients who have had kidneys donated from living donors usually enjoy higher success rates than those who receive organs from non-living donors, since there is less chance for rejection.
A living donor must be in good health and free from diabetes, high blood pressure, cancer, kidney or heart disease. Living donors usually are between 18 and 60 years old. The living donor must undergo a series of tests to determine if they are truly compatible with the recipient. The decision to become a living donor is completely voluntary, and the donor can change his or her mind at any time. Living donors sometimes feel pressure from their families or guilty if they are reluctant to go through with the procedure. They also may feel angry if the recipients body rejects the donated organ. Living donors should discuss their feelings with a transplant professional before making a final decision.
Typically, the donor is admitted to the hospital the day before the kidney donation for all the necessary tests.
There are risks involved in any surgery. All patients have some pain after the operation, and it is possible for donors to develop infections or bleeding. Living donation also may have long-term risks, and its important for both the donor and recipient to know what these are.
Insurance typically covers 100 percent of the donors expenses.
Where Would The Transplant Take Place
The transplant will take place at the hospital where you currently receive care. You can choose to travel to your matched donors hospital, if they are unable to travel and their kidney cannot be shipped.
There are two options.
- You can have your surgery at the hospital who entered you into the KPDPP. Your kidney will be shipped to your matched candidate.
- You could travel to your matched candidates hospital for surgery.
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Benefits And Risks Of Kidney Transplant
For people with kidney failure, a kidney transplant can increase your chances of living a longer, healthier life. Because dialysis can only do part of what healthy kidneys do for your body, people who have a kidney transplant usually live longer than those on dialysis. A kidney from a transplant will not work as well as kidneys in a healthy person. But your health may be almost as good as a person with healthy kidneys as long as you closely follow your doctors orders after the transplant surgery.
Also, when you get a kidney transplant, you may avoid some of the complications that people on dialysis often have, such as bone problems and heart disease.
A kidney transplant can improve your quality of life. After your kidney transplant, you may have:
- More energy
- Fewer limits on what you can eat
- More free time from not having to go to dialysis
- More flexibility to travel
- Greater ability to work and hold a job
Risks with a kidney transplant are the same as with any major surgery. Risk does not mean these things will happen, it means they could happen. Some of the risks are infection, bleeding, or damage to other organs. Also, the three connections between your new kidney and your body the artery, vein, and ureter , might leak or become blocked. Read more about the kidney transplant surgery here.
What Are The Common Matching Factors
Blood type and body size factor into a match.
Other factors include:
- how bad the patients medical condition is
- the distance between the donor’s and the patients hospital
- the patient’s waiting time and
- if the patient is available. For example:
- If they cant contact the patient.
- If the patient has an infection or other reason that they cant do the transplant.
The most important factor is the organ itself. Some organs can survive outside the body longer.
Theres a different policy for each organ. Read about how the system decides who gets which organs.
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Choosing A Transplant Center
You will need to choose the transplant center where you want to be listed. In the United States there are more than 250 transplant centers. For a full list click here. You may want to consider the following when choosing a transplant center:
- Distance of the transplant center to your home: When you are on the national waiting list, you may get a call any time that a kidney match is available for you, and will need to reach the hospital in a short amount of time. The specific amount of time depends on the hospital, and you should talk to the transplant team about this before getting listed. Usually you will need to reach the hospital within 24 hours after you are contacted about an available kidney.
- Your insurance coverage: Some hospitals accept only certain insurances for transplant surgeries. Discuss your health insurance with the transplant coordinator before choosing a hospital.
- The experience of the transplant team: You may want to know whether the transplant center is new or whether it is well established. This is a personal preference that may matter to some, and not as much to others. For more information about the performance information of a certain transplant center, visit this website.
How Long Does The Process Take
The donation process depends on how many tests are required of the donor and how quickly he or she is able to complete them. The average donor work up may take six months or more for completion and may depend on test results, which may indicate additional evaluation is required. A transplant date cannot be set until the donor has completed the entire work up and has been evaluated by the surgeon. The transplant center does its best to accommodate the needs of the donor and recipient, but appointment times may be limited.
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