What Is Kidney Transplant And Why Is It Necessary

Whats The Difference Between Deceased Donor And Living Donor

Weve made quite a few advances in kidney transplant over the last 50 years. Today, you may receive your kidney from a donor who is living, or from someone upon their death:

A is a person who decides to donate a kidney to help people who need transplants. Their family members can also make the decision.

A living donor can be a family member or friend, or someone whom you do not know who makes the decision to donate one of their kidneys.

In The Us Health System

Transplant recipients must take immunosuppressive anti-rejection drugs for as long as the transplanted kidney functions. The routine immunosuppressives are tacrolimus , mycophenolate , and prednisolone these drugs cost US$1,500 per month. In 1999 the United States Congress passed a law that restricts Medicare from paying for more than three years for these drugs unless the patient is otherwise Medicare-eligible. Transplant programs may not transplant a patient unless the patient has a reasonable plan to pay for medication after Medicare coverage expires however, patients are almost never turned down for financial reasons alone. Half of end-stage renal disease patients only have Medicare coverage. This provision was repealed in December 2020 the repeal will come into effect on January 1st 2023. People who were on Medicare, or who had applied for Medicare at the time of their procedure, will have lifetime coverage of post-transplant drugs.

The United Network for Organ Sharing, which oversees the organ transplants in the United States, allows transplant candidates to register at two or more transplant centers, a practice known as ‘multiple listing’. The practice has been shown to be effective in mitigating the dramatic geographic disparity in the waiting time for organ transplants, particularly for patients residing in high-demand regions such as Boston. The practice of multiple-listing has also been endorsed by medical practitioners.

Where Does Your New Kidney Come From

Kidneys for transplantation come from two sources: living donors and deceased donors. Living donors are usually immediate family members or sometimes spouses. Deceased donor kidneys usually come from people who have willed their kidneys before their death by signing organ donor cards. Permission for donation can also be given by the deceased person’s family at the time of death.

All donors are carefully screened to make sure there is a suitable match and to prevent any transmissible diseases or other complications.

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Why Is A Kidney Transplant Recommended

The kidneys are a pair of bean-shaped organs located in the back, just below the rib cage. These organs, which receive blood flow from the large renal blood vessels, perform the life-sustaining job of filtering out harmful waste products and excess fluid, keeping you safe.

When the kidney loses approximately 90 percent of its filtering ability, the person has end-stage renal disease . The kidney may fail to function properly for multiple reasons. Conditions that lead to ESRD include:

• congenital renal disorders, such as dysplastic or hypoplastic kidneys, obstructive nephropathy, vesicoureteral reflux and reflux nephropathy and posterior urethral valves

What Are The Risks For Kidney Transplant

As with any surgery, complications can occur. Some complications mayinclude:

• Bleeding

• Blockage of the blood vessels to the new kidney

• Leakage of urine or blockage of urine in the ureter

• Lack of function of the new kidney at first

The new kidney may be rejected. Rejection is a normal reaction of the bodyto a foreign object or tissue. When a new kidney is transplanted into arecipient’s body, the immune system reacts to what it thinks as a threatand attacks the new organ. For a transplanted organ to survive, medicinesmust be taken to trick the immune system into accepting the transplant andnot attacking it as a foreign object.

The medicines used to prevent or treat rejection have side effects. Theexact side effects will depend on the specific medicines that are taken.

Not everyone is a candidate for kidney transplantation. You may not beeligible if you have:

• Current or recurring infection that cannot be treated effectively

• Cancer that has spread from its original location to elsewhere in the body

• Severe heart or other health problems that make it unsafe to have surgery

• Serious conditions other than kidney disease that would not get better after transplantation

• Failing to follow the treatment plan

There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your transplant team before theprocedure.

More Information About Organ Donation from Johns Hopkins Medicine

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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.

Kidney Transplant As An Option

Not everyone is suitable for a transplant. Sometimes, other medical problems make dialysis or supportive care better treatment options.Factors that affect the suitability for a transplant include:

• agreement with the idea of transplantation and acceptance of the risks involved
• general good physical health, apart from kidney failure
• willingness to go through with the tests and operation
• willingness to take lifelong anti-rejection medication.

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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.

The kidneys:

• 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

• Obstructions

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.

What Happens During The Kidney Transplant Procedure

Kidney transplantation involves placing a healthy kidney into the body, where it can perform all of the functions that a failing kidney cannot.

The new kidney is placed on the lower right or left side of your abdomen where it is surgically connected to nearby blood vessels. Placing the kidney in this position allows it to be easily connected to blood vessels and the bladder. The vein and artery of your new kidney are attached to your vein and artery. The new kidney’s ureter is attached to your bladder to allow urine to pass out of your body.

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What Happens Before A Kidney Transplant

If your child needs a kidney transplant, your first step is to visit a transplant center. The health care team will check to make sure that your child is healthy enough to have surgery and take the medicines needed after the transplant. This will include blood tests, X-rays, and other tests, and can take a few weeks or months.

If the transplant team decides your child is a good candidate, the next step is to find a kidney. In most cases for living donor transplants, a kidney comes from a close relative or friend who has a compatible blood type.

If a living donor isn’t found, your child’s name will go on a waiting list until a kidney from a deceased donor is matched to your child. The need for new kidneys is far greater than the number donated, so this can take a long time.

You’ll stay in close touch with the doctors and the rest of the health care team. Make sure they know how to reach you at all times. When a kidney is located, you’ll need to go to the transplant center at a moment’s notice.

While you wait for a transplant, keep your child as healthy as possible. That way, he or she will be ready for transplant surgery when the time comes. Help your child:

• eat healthy foods and follow any special diet recommendations from the doctor, nurse, or dietitian
• take all medicines as directed
• keep all medical appointments

Tell your doctor and the transplant center right away if is any change in your child’s health.

When Can I Return To My Regular Activities

You can resume your previous activities as soon as you feel better and you might even feel good enough to add some new activities. A daily exercise program will continue to improve your health and help you maintain a positive attitude.

You will not injure yourself or your new kidney if you follow some of these general guidelines:

• Avoid lifting heavy objects and strenuous physical work for at least six to eight weeks following surgery. It is important that you do not lift anything heavier than 20 pounds for two to three months, and nothing heavier than 40 pounds for four to six months from the date of your surgery.
• Avoid driving for at least six weeks following surgery. Plan ahead so a friend or family member can help out during this time. When you are in a moving vehicle, always use your seat belt.
• Exercise is encouraged. We recommend beginning with stretching exercises and walking. Other excellent exercises include jogging, hiking, bicycling, tennis, golf, swimming and aerobics. All of these can help you regain your strength and may be started gradually after your incision has healed.
• As a general rule, rough contact sports should be avoided since they might cause injury to your transplanted kidney. If you have doubts about any activity, please ask the Transplant Team.

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Living Donor Kidney Transplantation

Living donor kidney transplants are the best option for many patients for several reasons.

• Better long-term results
• No need to wait on the transplant waiting list for a kidney from a deceased donor
• Surgery can be planned at a time convenient for both the donor and recipient
• Lower risks of complications or rejection, and better early function of the transplanted kidney

Any healthy person can donate a kidney. When a living person donates a kidney the remaining kidney will enlarge slightly as it takes over the work of two kidneys. Donors do not need medication or special diets once they recover from surgery. As with any major operation, there is a chance of complications, but kidney donors have the same life expectancy, general health, and kidney function as most other people. The kidney loss does not interfere with a woman’s ability to have children.

Potential Barriers to Living Donation

• Age < 18 years unless an emancipated minor
• Uncontrollable hypertension
• Bilateral or recurrent nephrolithiasis
• Chronic Kidney Disease stage 3 or less
• Proteinuria > 300 mg/d excluding postural proteinuria
• HIV infection

• Shorter recovery time in the hospital
• Quicker return to normal activities
• Very low complication rate

The operation takes 2-3 hours. Recovery time in the hospital is typically 1-3 days. Donors often are able to return to work as soon as 2-3 weeks after the procedure.

Treatment Locations For Haemodialysis

Haemodialysis can be done by you at home. Or, for people who need extra medical support, it can be performed at a dialysis unit in a hospital or a satellite centre. Your healthcare professionals will advise you of your available options. Haemodialysis is needed at least three times a week. At a dialysis unit, you will have permanent regular appointments for a four-to-five-hour dialysis session. If you are dialysing at home, your schedule will be tailored to your needs and may include shorter or longer sessions, with three to six treatments each week. The extra treatments will help you to feel better.If you choose to have haemodialysis at home, special plumbing will be installed and the machine will be provided, along with all the supplies you need. You will learn to manage your own dialysis. A spouse, friend, carer or partner can be trained to help you, but some people dialyse by themselves. Having dialysis at home means you can choose to dialyse when it suits you at any time during the day, or overnight while you sleep. At home, it is also possible to dialyse more often, which has health benefits.

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The Nhs Organ Donor Register

In the UK, consent is required before organs can be donated. A person can give their consent to become an organ donor after death by joining the NHS Organ Donor Register or by discussing their wishes with loved ones.

Alternatively, a person’s organs can be donated if consent is obtained after their death from an authorised person, such as a relative or friend.

Joining the NHS Organ Donor Register is quick and simple, and will only take a few minutes of your time. You can remove yourself from the register at any time, and you can specify what you’re willing to donate.

Page last reviewed: 20 August 2018 Next review due: 20 August 2021

The Top 8 Cons Of A Kidney Transplant

1. A kidney transplant requires major surgery, which can cause further health problems if not done successfully. Also, this process is usually expensive.

2. Donated kidneys are not always available. Some patients will need to wait for potential donors.

3. One of the most unfortunate things about kidney transplant is that, the body of the patient who needs a new kidney might reject the new kidney. Thus, one kidney transplant may or may not last for a lifetime.

4. In undergoing kidney transplant, the patient will need to use or take immunosuppressant, which can actually cause some complications.

5. Kidney transplantation is not recommended for those who have severe obesity, heath disease, mental disorders, and chronic illness.

6. Should take anti rejection medicines the rest of patients life or the kidneys life.

7. Higher risks for infections from anti rejection medicines.

8. Frequent labs and tests to be drawn as well as doctors visits.

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What Is Done To Prevent Rejection

To allow the transplanted kidney to survive in your body, you will be givenmedicines for the rest of your life to fight rejection. Each person mayreact differently to medicines.

New antirejection medicines are continually being developed and approved.Your healthcare team will tailor medicine regimes to meet your needs.

Usually several antirejection medicines are given at first. The doses ofthese medicines may change often, depending on your response. Becauseantirejection medicines affect the immune system you will be at higher riskfor infections. A balance must be maintained between preventing rejectionand making you very susceptible to infection.

Some of the infections you will be especially at risk for include oralyeast infection ,herpes, and respiratory viruses. Avoid contact with crowds and anyone who has aninfection for the first few months after your surgery.

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Supportive Care For Kidney Failure

Supportive care is the treatment choice for kidney failure for people who have decided that dialysis and transplant are not appropriate for them. For many, this is because they are already very frail and they do not want complex treatments. Some people have the complex treatment for a while and then wish to stop.For many who are already frail, their lifespan with kidney failure, with or without dialysis, is very similar. Supportive care means that the person’s care continues to be supervised and supported by health professionals. They may have medication and a restricted diet to improve their quality of life. Supportive care, however, will not artificially prolong life when your kidneys fail completely. If a person is unsure about choosing a treatment option, it is always possible to try dialysis for a short while to see how things go.

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