What Are The Requirements For A Kidney Transplant
If you have advanced kidney disease, you may be eligible for a transplant. You will need to be evaluated by a transplant center, which will do a number of tests to determine whether you are a good candidate for a kidney transplant. In general, qualifications for kidney transplant include having chronic irreversible kidney disease, being on dialysis now or being close to needing dialysis. You may be ineligible for a kidney transplant if you have an additional life-threatening disease, a history of chronic drug or alcohol abuse, or a serious psychiatric disorder.
Comparison Of Living Donor And Deceased Donor Kidney Transplantations
The timeframes in this table are average estimates. Please speak to your kidney care team for more detailed information about how long your transplant might last and possible waiting times.
|What’s being compared?|
|Sometimes, but this is less likely due to the waiting time|
|Transplant surgery times can be planned in advance?||Yes surgery is usually during the day||No surgery often takes place at night|
|Chance of the transplanted kidney working within a day of the surgery||Higher. The kidney has come from someone who is fit and well, so it almost always works straight away.||Lower. The kidney has come from someone who has died, so it takes longer for the kidney to wake up and start working.|
|Risk from the donated kidney||Lower. The health of the donor is easier to thoroughly check before donation. The donor is unlikely to have had major health issues.||Higher. It is more difficult to thoroughly check the health of the donor, and because the donor is more likely to have had major health issues.|
Answers To Common Questions
The team looking after you is not able to contact living donors on your behalf. If you would like a kidney transplant from a living donor, you will need to talk to family and friends and ask if they are interested in giving you a kidney.
Your doctor can advise on ways to do this.
- Living donors are often blood relatives. But they can also be a friend, family member, or partner
- They do not need to be the same age, blood group or tissue type as you
- Living donors must be aged 18 years or older, and be in good health
Yes. If you have a living donor but they have not yet finished all their tests , you can join the transplant waiting list for a deceased donor kidney.
However, usually once you have been given a date for your transplant operation from the living donor your name will be taken off the national waiting list.
If you are offered a deceased donor kidney but you have a potential living kidney donor who is close to completing their tests, you will need to discuss your options with your kidney transplant team. They will advise you on the best thing to do.
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What Does A Kidney Transplant Surgery Involve For The Recipient
Before the transplant, the patient will be put under general anesthesiathey will be asleep for the entire procedure. The surgeon then makes an incision in the recipients abdomen and places the donated kidney inside. The new kidney is then connected to the recipients blood vessels and bladder. Once this is done, the surgeon closes the incision. The patients original kidneys are usually left in place unless there is a medical reason to remove them. The operation typically takes three to five hours.
Kidney transplantation is a fairly common surgical procedure, with over 20,000 performed in the United States every year. This type of surgery generally has a high success rate and a low rate of complications. Kidney transplants from living donors generally last two to three times as long as those from deceased donors. Furthermore, those facilitated by the National Kidney Registry have superior outcomes at three, five and seven years compared to average U.S. living donor transplant outcomes. Having the largest donor pool allows the NKR to find better matches for recipients.
What Are The Advantages Of Living Donation Over Deceased Donation
Kidney transplants performed from living donors may have several advantages compared to transplants performed from deceased donors:
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Selection Criteria For Living Donation
A standard set of selection criteria are used to determine if it is safe or appropriate for a person to be a living kidney donor. The following conditions must be met for a patient to be considered as a living donor at our Transplant Center.
- Body Mass Index less than or equal to 35.
- Normal blood pressure.
- Normal results of tests such as chest x-ray, EKG, and routine age appropriate testing.
- Acceptable crossmatch results.
- Normal cardiac stress test if over 50 years of age.
- Normal lab values.
- Normal/ acceptable CT angiogram .
- Adequate psychosocial and financial support.
The following may prevent a candidate from being eligible for living donation:
- Less than age 18 or over age 65.
- Blood pressure outside an acceptable range.
- Abnormal glucose levels: fasting value greater than 100 or two hour tolerance greater than 140.
- History of gestational diabetes, cancer, autoimmune disorder such as lupus.
- Abnormal results from any requested testing.
- Infections or infectious diseases identified on work up such as hepatitis or tuberculosis.
- Unstable mental health conditions.
- Social or financial concerns identified by transplant team.
- Substance abuse.
The Recovery And Aftermath
Recovery from a kidney donation operation can take from two to 12 weeks depending on the persons individual progress.
Traditional open surgery
If the operation was an open nephrectomy, you may be in hospital for five to seven days, but you should be out of bed the day after the operation. Surgeons use either stitches or clips to close the incisions they made during the operation and these will be removed around 10 days after the procedure.
Before you leave hospital, a follow-up clinic appointment will be made, usually for four to six weeks later. The scars from the operation may be sensitive or sore for several weeks, and some numbness around the scar is common. There will be a permanent scar. There may also be twinges or a drawing sensation around the scars for some months, but most people feel back to normal by about 12 weeks after the operation.
If the operation was keyhole surgery, recovery time is shorter and there is usually less pain afterwards. After this type of surgery you will normally need four to six weeks of recovery time at home before resuming your normal activities. Painkillers may be needed for a while, depending on an individuals symptoms. You will be asked to come in for a follow-up appointment four to six weeks after the operation.
Getting back to normal life
You should return to exercise gradually and gently and build up any exercise routine slowly.
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What Is Paired Kidney Exchange
When a person is in need of a kidney and has a willing donor , but that Donor A is either a poor match to Recipient A or not a match at all, the NKR can find a recipient who is in need of a kidney and has a donor who is willing to donate, but is either a poor match or not a match at all to Recipient B, but is a match to Recipient A and have them swap. In traditional KPD, Donor A is a match and gives to Recipient B and Donor B is a match and gives to Recipient A. This is a swap. In a paired exchange chainthe most common form of NKR paired exchangea Good Samaritan Donor , most likely a family voucher donor, gives to Recipient B, Donor B gives to Recipient C and Donor C gives to someone else in a similar situation to Donor and Recipient B and C. Many donor-recipient pairs are choosing to participate in the Voucher Program instead of the traditional paired exchange process because it is more convenient, especially when the donor will be the recipients caretaker after the transplant.
Is There An Age Limit For Being A Living Kidney Donor
There is no official maximum age limit for becoming a living kidney donor. It is harder for an older donor to qualify for donation surgery but the National Kidney Registry has had donors who were in their late-70s when they donated. The minimum age for donation is 18-25 depending on the transplant center.
If you are considering donating a kidney in the future, but are concerned your age may be an issue, the National Kidney Registry Voucher Program lets potential donors donate a kidney now and give vouchers to up to five family members. If any of the voucher holders need a kidney in the future, they can activate their voucher to receive priority consideration for a well-matched kidney from a living donor through the NKR. Only one voucher can be redeemed per voucher donor.
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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.
Living Donor Kidney Transplants
The first successful live donor kidney transplant was performed in 1954. The donor and recipient were identical twins. Since then, our understanding of donor compatibility and the development of immunosuppressant medications have greatly advanced living donor procedures. Today, approximately 75% of people who receive a kidney transplant from a living donor maintain their kidney function for 10 to 20 years.
Living donor programs allow a relative or a compatible unrelated donor to donate a kidney. Siblings have a 25% chance of being an “exact match” for a living donor and a 50% chance of being a “half-match.” Donor compatibility is established through blood tests that look for matching blood types and antigens. The overall health of the potential donor is also of critical importance.
Kidneys from perfectly matched sibling donors on average can function for over 35 years. Live donor procedures of all types, however, offer better outcomes than deceased donor procedures:
- Live donor recipients spend less time waiting for a donor organ. The wait for a deceased donor kidney in New York averages five to seven years.
- Immediately upon transplantation, 97% of live donor kidneys are fully functional, versus 50-60% of deceased donor kidneys.
- Live donor recipients face less risk of organ rejection.
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How Long Do Kidney Transplants Last
There are a number of factors which affect how long a transplanted kidney lasts.
These include whether or not the kidney came from a living donor, how well the kidney is matched in terms of blood group and tissue type, and the age and overall health of the person receiving the donation.
If you have a kidney transplant that fails, you can usually be put on the waiting list for another transplant. You may need dialysis in the meantime.
What Are Antibodies And How Does Rejection Occur
Antibodies are proteins your immune system makes when it comes into contact with something foreign to your body. When you get an infection, such as a cold or an infection from a wound, your body makes antibodies to fight that infection. Antibodies protect your body. When you have an organ transplant, your body reacts as it would to an infection. Thus, your antibodies try to destroy the organ. Some people have a lot of antibodies, and it is harder to find an organ match.
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What Happens During The Kidney Donation Surgery
You will be given a general anesthetic and will be asleep for the entire procedure. Most kidney removals are done using laparoscopic surgery, which is a minimally invasive surgery that uses small incisions and a special camera. In this case, the surgeon will make one or more incisions in your abdomen, carefully remove one kidney, then close the incision. Laparoscopic surgery typically results in a shorter hospital stay, less pain and scarring, faster recovery time, and fewer post-operative complications. In cases where laparoscopic surgery is not possible, you may have open surgery to remove your kidney. Your transplant center can give you the most current medical information about the specific surgery you will undergo.
Becoming a living kidney donor through a National Kidney Registry swap gives you additional protections including coverage for any uncovered post-surgical complications, kidney donation life insurance, donation disability insurance, legal representation, travel and lodging reimbursement, lost wage reimbursement, and prioritization for a living donor kidney in the unlikely event that you ever need a kidney transplant.
How Do I Find A Living Kidney Donor
If you need a living kidney donor, you can sometimes find a donor by asking friends and family members. If you are unable to find a donor among people you know, we recommend finding a transplant center that participates in our Champion Microsite Program, which is a free service that helps kidney patients build a simple website to tell their story and find a donor. The site is sharable via social media and comes with 250 free business cards with the patients name and microsite URL that can be given out by the patient.
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What Should I Expect From Surgery And Kidney Donation Recovery
Kidney donation surgery is done under general anesthesia and typically takes about 2 to 3 hours. During the surgery, your medical team will monitor your heart rate, blood pressure, and blood oxygen level. Surgeons usually do laparoscopic surgery, which is less invasive. This type of surgery uses smaller incisions, causes less scarring, and can mean a shorter kidney donation recovery time. Afterward, its common to stay in the hospital for a few days.
Paired Kidney Donation Program
Many patients in need of a kidney transplant may have individuals in their lives willing to donate a kidney, but unfortunately their friends or loved ones cannot donate because they are not compatible. The Kidney Paired Donation program is offered to patients who have donors that do not match their blood type or who cannot accept a kidney from a donor because there is a strong chance they would reject the kidney. This type of kidney donation is called a “paired kidney exchange” or “kidney swap.” Visit our Paired Kidney Exchange page for more information about University of Michigan Transplant Center’s Paired Kidney Donation Program.
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Kidney Donation Process Overview
Living donors are free to confidentially withdraw at any time during the donation evaluation process and are not obligated to donate.
To learn more about testing and living donation or learn more with our living donor education booklet and .