Kidney Transplantation
Except in certain cases of acute disease, kidney damage is usually progressive and irreversible. Individuals who have the most advanced stage of the disease (stage 5) with little kidney function remaining (less than 25 percent of normal) have kidney failure or end-stage renal disease. To survive, they must undergo kidney transplantation – or regular dialysis, a treatment that stands in for the blood-filtration role of the kidneys. Dialysis, though, is expensive and time consuming, and is only a partial replacement for the role of the kidneys. Kidney transplantation alone provides a cure for renal failure, extending a patient's lifespan significantly beyond that typically possible from remaining on dialysis indefinitely. Kidney transplant is also superior in restoring health and quality of life.
Patients who have a living donor are most likely to be able undergo transplantation before dialysis becomes essential. Either way, for best outcomes the goal is to have transplant candidates undergo as little dialysis as possible prior to receiving a kidney transplant.
Broad Success with An Established Operation
Kidney transplant is the most common type of major-organ transplant operation in the United States. Lourdes has a depth of experience in the field stretching across decades of providing successful kidney transplantation, a service that has saved lives and returned health and function to many recipients. A point of pride in the Lourdes Health System, the kidney transplantation program at Lourdes works hard to provide as many eligible candidates as possible with this life-renewing operation.
A single donor kidney has enough capacity to restore more than adequate kidney function to the recipient. However, finding enough donor organs for transplant candidates remains a major challenge nationwide. The Lourdes kidney team evaluates all interested stage-5 kidney disease patients that it treats for listing for kidney transplant. Assessment for this list may require additional testing and takes into considerations other existing conditions. For all those accepted to the list, the Lourdes team guides each individual on important care points during the waiting period.
While many factors determine who is better suited for this operation, the best candidates for kidney transplant are patients with:
- adequate heart, lung and liver function;
- a reasonable body-mass-index not indicative of severe obesity;
- a strong record of self-care and compliance with their medical regimen, as well as an adequate system or circle of support services and care;
- and the medical coverage necessary to pay for a life-long course of immunosuppressive drugs needed after surgery, or supplemental sources of coverage for these medications.
Bringing Patients Together with a Donor Organ
Learn about paired kidney donation.
Lourdes Performs Region’s First Successful “Double Swap” Kidney Transplant
In the paired exchange approach, two kidney patients whose living donors are not compatible with them in blood and tissue type each receive a kidney from the other's living donor.
Lourdes nephrologists work closely with transplant surgeons, Lourdes Regional Organ Transplantation Center and the UNOS system to match those on the transplant list with available donor organs (for those who do not have a family member or friend willing to donate a compatible kidney to them). The criteria used for prioritizing and selecting patients from the list ensure that all individuals on the list are judged fairly as to the severity of their illness and the urgency of their receiving a transplant. The wait for a deceased donor kidney can sometimes be long, extending to months or years.
But today, immunosuppressive drugs that prevent the body from rejecting the donor kidney are so effective that the donor organ need not always be a match for blood type and tissue for the recipient, although such matches are desirable and sought by the team. In addition, the innovative paired exchange program can speed up finding a match for recipients who have an incompatible living donor.
Because the exchange network tracks and assists multiple patients waiting for specific organ matches, organ swaps can result in more than just a paired exchange, instead initiating a domino exchange in which a simultaneous chain of operations take place.
In April, 2010, Lourdes became the first kidney transplant center in the South Jersey/Philadelphia/Delaware Valley area to participate in such an exchange involving multiple centers – in this case four centers across three states. An altruistic donor made it possible to initiate the change, which involved three other donors and four kidney transplant recipients.
Lourdes’ program looks forward to conducting more of these multi-center transplants, including by working with transplant centers closer in Philadelphia.
Read more about this pioneering four-way kidney swap.
Partly for this reason, living non-related donors are now almost as common as living genetically related donors. And, with the ability today to remove a kidney from a donor with less invasiveness, via laparoscopic surgery, the number of willing living donors has increased.
A Proven System with Full Support
Patients who have a living donor can schedule the operation in advance. Donation and transplantation for the procedure will happen at the same time and place, usually in adjacent operating rooms. However, the majority of kidneys transplanted come from deceased donors, and those waiting for such kidneys must be ready to arrive quickly to the transplant center when an organ becomes available.
For safer outcomes from the operation, the patient's existing kidneys, now minimally functioning, are usually left in place (unless they are causing complications) and the team implants the donor kidney in a different location with its own points of access to the circulatory system. The surgeon then connects the ureter from the new kidney to the recipient's bladder. The patient remains in the hospital for at least the several days it normally takes for the new kidney to reach normal functioning.
Lourdes transplant coordinators work with the team nephrologists, transplant surgeons, nurses, social workers and other medical staff to assure a smooth transition to surgery and beyond, including advising on financial coverage, follow-up care and home-health services. Unless their identical twin donates the kidney, patients remain for their lifetime on drugs to prevent the immune system from rejecting the donor kidney.
Learn more about Lourdes Regional Organ Transplantation Center.
Learn more about kidney transplant at Lourdes.
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