JOY CYTRYN
Living Donor Transplant
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A living-donor kidney transplant is when a kidney from a living donor is removed and placed into a recipient whose kidneys no longer function properly.
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Only one donated kidney is needed to replace two failed kidneys, which makes a living-donor kidney transplant an alternative to a deceased-donor kidney transplant.
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About one-third of all kidney transplants performed in the U.S. are living-donor kidney transplants. The other two-thirds involve a kidney from a deceased donor.
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Why it's done
Compared with a deceased-donor kidney transplant, the benefits of a living-donor kidney transplant include:
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Less time spent on a waiting list, which could prevent possible complications and deterioration of the health of the recipient
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Potential avoidance of dialysis if it has not been initiated
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Better short- and long-term survival rates
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Your transplant may be scheduled in advance once your donor is approved versus an unscheduled, emergency transplant procedure with a deceased donor kidney.
The risks of a living-donor kidney transplant are similar to those of a deceased-donor kidney transplant. They include risks associated with the surgery, organ rejection, and side effects of anti-rejection medications.
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What you can expect
Living-donor kidney transplant usually involves a donated kidney from someone you know, such as a family member, friend or co-worker. Genetically related family members are most likely to be compatible living kidney donors.
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A living kidney donor may also be someone you don't know, a non-directed living kidney donor.
Both you and your living kidney donor will be evaluated to determine if the donor's organ is a good match for you. In general, your blood and tissue types need to be compatible with the donor.
However, even if your donor isn't a match, in some cases a successful transplant may still be possible with additional medical treatment before and after transplant to desensitize your immune system and reduce the risk of rejection.
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If your living kidney donor isn't compatible with you, your transplant center may offer you and your donor the chance to participate in the paired donation program. In paired living-organ donation, your donor gives a kidney to someone else who is compatible. Then you receive a compatible kidney from that recipient's donor.
Once you've been matched with a living kidney donor, the kidney transplant procedure will be scheduled in advance. The kidney donation surgery (donor nephrectomy), and your transplant typically occur on the same day.
Deceased Donor Transplant
A deceased-donor kidney transplant is when a kidney from someone who has recently died is removed with consent of the family or from a donor card and placed in a recipient whose kidneys have failed and no longer function properly and is in need of kidney transplantation. The donated kidney is either stored on ice or connected to a machine that provides oxygen and nutrients until the kidney is transplanted into the recipient. The donor and recipient are often in the same geographic region as the transplant center to minimize the time the kidney is outside a human body. Only one donated kidney is needed to sustain the body's needs.
Overall, about two-thirds of the approximately 20,000 kidney transplants performed each year in the U.S. are deceased-donor kidney transplants, and the remaining are living-donor kidney transplants. The demand for deceased-donor kidneys far exceeds the supply. The waiting list has grown from nearly 58,000 in 2004 to more than 92,000 in 2017.
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Why it's done
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People with end-stage kidney disease need to have waste removed from their bloodstream via a machine (dialysis) or a kidney transplant to stay alive.
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For most people with advanced kidney disease or kidney failure, a kidney transplant is the preferred treatment. Compared with a lifetime on dialysis, kidney transplant offers a lower risk of death, better quality of life and fewer dietary restrictions than dialysis.
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The health risks associated with kidney transplant include those associated directly with the surgery itself, rejection of the donor organ and side effects of taking immunosuppressive medications needed to prevent your body from rejecting the donated kidney. These risks include higher rates of infection and some types of cancer.
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What you can expect
If your doctor recommends a kidney transplant, you may be referred to a transplant center or select a transplant center on your own. You will be evaluated by the transplant center to determine if you are accepted as a kidney transplant candidate. Each transplant center has its own eligibility criteria. If a compatible living donor isn't available for a kidney transplant, your name will be placed on a kidney transplant waiting list to receive a kidney from a deceased donor.
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Everyone waiting for a deceased-donor organ is registered on a national waiting list maintained by the Organ Procurement and Transplantation Network (OPTN). The United Network for Organ Sharing (UNOS), a private nonprofit group, administers OPTN through a contract with the U.S. government.
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Additional factors used in matching deceased-donor kidneys include blood and tissue type matching and how long the candidate has spent on the waiting list. The federal government monitors the system in an effort to ensure that everyone waiting for an organ has a similar chance. Some people get a match within several months, and others may wait several years. While on the list, you will have periodic health checkups to ensure that you are still a suitable candidate for transplantation.
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When a compatible deceased-donor kidney becomes available, you will be notified by your transplant center. You must be ready to go to the center immediately for final transplant evaluation. If the results of the final transplant evaluation are satisfactory, the kidney transplant surgery can proceed immediately.
Preemptive Kidney Transplant
A preemptive kidney transplant is when you receive a kidney transplant before your kidney function deteriorates to the point of needing dialysis to replace the normal filtering function of the kidneys.
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Currently, most kidney transplants are performed on people who are on dialysis because their kidneys are no longer able to adequately clean impurities from the blood.
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Preemptive kidney transplant is considered the preferred treatment for end-stage kidney disease, but only about 20% of kidney transplants are performed preemptively in the U.S.
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Several factors have been linked to the lower than expected rate of preemptive kidney transplants, such as:
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Shortage of donor kidneys
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Lack of access to transplant centers
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Low rates of physician referrals for the procedure among candidates of lower socioeconomic status
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Lack of physician awareness of current guidelines
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Why it's done
The benefits of preemptive kidney transplant before dialysis for people with end-stage kidney disease include:
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Lower risk of rejection of the donor kidney
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Improved survival rates
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Improved quality of life
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Lower treatment costs
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Avoidance of dialysis and its related dietary restrictions and health complications
These benefits of preemptive kidney transplant are especially significant among children and adolescents with end-stage kidney disease. Risks of preemptive kidney transplant include early exposure to the risks associated with surgery and potentially wasting native kidney function.
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What you can expect
If your doctor recommends a preemptive kidney transplant, you will be referred to a transplant center for evaluation. You're also free to select a transplant center on your own or choose a center from your insurance company's list of preferred providers.
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At the transplant center, your transplant team will conduct several tests to determine if a preemptive kidney transplant is appropriate for you. Your team will consider a variety of factors, including:
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Level of kidney function
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Overall health
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Any chronic medical conditions that might affect the success of transplant
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Availability of donor kidney
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Ability to follow medical instructions and take anti-rejection medications for the rest of your life
If you are approved for a preemptive kidney transplant and a living-donor kidney is available, the living-donor kidney transplant procedure will be scheduled. If a living-donor kidney is not available, you will be placed on a waiting list for a deceased-donor kidney transplant.
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