Kidney transplantation offers patients with end-stage kidney disease a treatment option that gives them an improved quality of life compared to dialysis. Any person on dialysis or approaching dialysis can be evaluated for a kidney transplant. Physicians, nurses or other healthcare professionals can refer patients or patients may self-refer. Lourdes invites patients and their families to learn more about this life-altering treatment option.
Individuals who have the most advanced stage of chronic kidney disease with little or no remaining kidney function need dialysis on a regular basis. An important , valuable form of care, dialysis is a treatment that stands in for the blood-filtration role of the kidneys. Dialysis, though, is expensive and time consuming—typically requiring three visits per week—and is only a partial replacement for the role of the kidneys. It can place a limitation on an individual’s ability to work and travel, may fail to ensure that patients feel well enough to enjoy life and can take its own an emotional and physical toll. While dialysis is an essential and life-saving service, transplant is an alternative treatment that can restore health and quality of life much more fully.
|If current trends continue, the number of people nationwide who are in kidney failure and on dialysis will soon reach one-half million – the primary cause being high blood pressure and/or diabetes.|
Moreover, kidney transplantation extends a patient’s lifespan significantly beyond that typically possible from remaining on dialysis indefinitely.
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.
Patients can receive a kidney transplant from two types of donors:
Most donor kidneys have traditionally come from deceased donors (cadaveric organs). These are individuals who have designated themselves as organ donors and who have passed away from natural or accidental causes. The medical team determines whether the deceased donor had adequate kidney function to be able to donate a healthfully functioning kidney, and tests ensure that the organ is disease free.
After an organ donor passes away, the transplant team must harvest the donor kidney quickly. The team tissue types the organ, and the UNOS system matches it with a patient on the kidney transplantation waiting list. The transplant system often transfers the donor kidney from one hospital or medical center to the nearest transplant program that is accessible to the selected recipient. Listed recipients waiting for such kidneys must be ready to arrive quickly to the transplant center when an organ becomes available. The surgery will occur within 24 hours of the organ becoming available.
|In 2014, about 16,000 kidney transplants took place in the U.S. Approximately 11,000 kidneys came from cadavers and about 6,000 from living donors.|
Unfortunately, because of the limited number of available organs, patients can spend years waiting on the waiting list to get a suitable deceased-donor kidney. Each year the wait list for such kidney transplants grows faster than the pool of available organs. For this reason and others, an increasing number of patients find a family member or friend, or benefit from an anonymous living donor, who offers to donate an organ as a gesture of love or altruism to transform another’s life. Today, immunosuppressive drugs that prevent the body from rejecting a donor kidney are so effective that the donor organ need not always be a match in tissue type from a related donor recipient, although such matches are desirable and sought by the team (and the donor must be of the same blood type as the patient).
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.
The Lourdes transplant staff educates kidney transplant patients on the benefits of having a living kidney donor transplant compared to receiving a kidney from a deceased donor:
- Living kidney donors are healthy individuals known in advance, and after evaluation, to be suitable to donate.
- Living kidney donor surgery shortens the time the kidney is outside the body, increasing the quality of the organ at the time of transplant and enhancing long-term survival of the organ.
- Living kidney donor transplant also allows for transplant before dialysis, also known as preemptive transplant.
- Transplant recipients who have a living kidney donor can avoid having to wait years to receive a deceased donor transplant from the national waitlist.
|Paired-donor transplants. A special approach to achieving a living-donor transplant, the innovative paired exchange program, can speed up finding an organ match for recipients who have a living donor that is not the same blood type. Recipients swap donors, to trade their living donor organ in order to find a matched kidney, compatible in blood type. Learn more about paired exchange.|
A specially-designated portion of Lourdes transplant staff is organized as the living donor team, to evaluate, care for and support the living kidney donor. Living donors are tested to make sure that they have adequate capacity in both kidneys to be able to safely donate one and to confirm that the donor organ is disease free. Patients who have a matched living kidney donor can schedule the kidney transplant operation in advance. Donation and transplantation for the procedure will happen at the same time and place, usually in adjacent operating rooms.
|Altruistic donation. Lourdes invites individuals who desire to donate a kidney, but have no intended recipient, to learn about the process of altruistic donation. Altruistic donation allows for a kidney failure patient who has no living donor to receive a living kidney donor transplant instead of continuing to wait for a deceased donor transplant. Altruistic donation also sometimes allows kidney chains to start in paired exchange registries, thus initiating multiple kidney transplants. Lourdes takes pride in providing the utmost in care and service to all living donors throughout the donation process.|
Living kidney donor evaluation: Just as a kidney transplant candidate goes through a process to be deemed suitable to receive at transplant, a living kidney donor goes through an evaluation process to be deemed suitable to donate. The living kidney donor and recipient have two separate teams who perform comprehensive evaluations and follow them through the process of donation and transplant. Prospective donors first go through a basic health screening that reviews:
- body mass index
- current health maintenance
- medical history, with attention to high blood pressure, diabetes, cancers, and kidney disease
- current medications.
The team checks the donor’s blood pressure, tests his or her blood type, and addresses any concerning issues in the health history. Once donors pass this screening, the team reviews with them The Living Kidney Donor Informed Consent. This is not consent to donate, but detailed education and information regarding the evaluation process, testing, surgery, potential short- and long-term risks associated with donation and education on the overall process and risks for the patient. Potential donors can then decide if they wish to proceed with additional testing and evaluation with members of the transplant team who work with living donors.
Anyone interested in evaluation as a living kidney donor can call 856-796-9370.
Living kidney donor surgery: Once a donor completes the medical testing, the surgical evaluation process begins. Based on the donor’s anatomy, the transplant team decides which kidney is to be removed. In most cases, the surgery is performed laparoscopically with minimal incisions and shorter recovery time than with open surgery. Donors usually remain in the hospital for two to three days after surgery. Some of the most frequent post-surgical concerns are pain, constipation and fatigue. Donors generally return to normal activities within four to six weeks after surgery and demanding activities after eight weeks.
Life after living kidney donation: In part because the transplant team evaluates donors for good health prior to living kidney donation, these donors generally do very well over the long term after donation. Continued health maintenance and preventive care, and having access to quality healthcare, is key. Donors do not have to take any specific medications after donation, although they should avoid certain medications in excess amounts. For this reason, each donor is educated individually by a transplant pharmacist. Donors should follow-up regularly with their primary care doctor, eat healthfully, exercise, wear their seatbelt, and avoid any high-impact activity that would potentially harm the remaining kidney. The transplant center continues to follow the patient for up to two years after donation and is always available for additional support.
|The choice to donate a kidney is a very personal, individualized decision.|
Finances for kidney transplant and donation
The transplant recipient’s medical expenses associated with both deceased- and living-donor kidney transplants are generally covered by the recipient’s insurance. A living donor’s medical expenses related to evaluation, hospitalization and follow-up care are also fully covered by the recipient’s insurance. Unfortunately, donors are not reimbursed for lost income, transportation costs or personal expenses. Financial support may be available, though, through the National Living Donor Assistance Program. The Lourdes transplant team’s finance manager can advise on insurance coverage and assist patients and donors in developing a financial plan.