Introduction
Getting a kidney transplant is often a better alternative to dialysis. Dialysis is not a cure for kidney failure because the blood isn’t “cleansed” as good and its rapid removal of fluid can make people very sick. Here are some of the issues or topics that come up a lot when talking about kidney transplantation.
Source of the Transplanted Kidneys
A kidney is usually obtained from someone who has died (cadaveric donation) but it can also come from a live donor (usually a close relative). Because it is no longer necessary to be genetically related, an increasing number of transplants are involving people who are “emotionally” related instead.- Cadaveric Donation – Used in 75% of kidney transplants.
- Living Donation – No longer required to be close relatives. Increasingly used.
Getting the Kidney
Getting a kidney is not a quick process. It requires careful evaluation of both the person getting the kidney (recipient) and the person giving it (donor). For those getting a cadaveric transplant, the wait can be long. Although the surgery is not complicated, it is not without its risks.- Recipient Evaluation: Not every person is eligible to receive a kidney transplant. They must undergo an extensive workup to assess if there are any medical conditions that would be a contraindication to getting the surgery. Also, because of the patient’s important role in keeping a transplanted kidney working, the recipient should not have non-compliance or psychiatric issues.
- Donor Evaluation: An increasing number of patients are receiving kidneys donated from someone they know. Because not every person is eligible to donate a kidney, there is an extensive workup to assess donor. An independent doctor will look for any medical conditions that would place the donor at risk during the surgery to remove the kidney or by having only one kidney afterwards. Also, a donor cannot be under any pressure to donate and there cannot be an illegal deal to sell a kidney.
- Waiting List: For those getting a living donor transplant, the wait is relatively short after the evaluation is complete. For those getting a cadaveric transplant, the wait can be a long time. There are thousands of people waiting to get a kidney and the average waiting time is 2-3 years. Depending on where you live, your blood type, your tissue type, and whether you have certain “bad” antibodies, it could be much longer or much shorter.
- Surgery / Post-Op: Although the surgery is performed electively or semi-electively, it is a big operation. There are significant risks associated with surgery and there are many potential complications during and afterwards. Fortunately, most people do well and are able to go home after a few days.
Post-Operative Monitoring and Issues
After getting the kidney, the transplantation process if far from over. In addition to the post-operative period, people with kidney transplants require extensive monitoring and care. Some of the more important issues after a transplant include:- Immunosuppressive Drugs: Unless the kidney comes from an identical twin, the immune system must be suppressed to keep the body from rejecting it. This requires the use of very powerful medications, which can have a lot of side effects.
- Complications: There are a number of complications that can occur after the transplant, particularly during the first few months after the surgery. The most common complications involve infections or the kidney failing.
- Rejection: Although there has been a dramatic improvement in the rate of rejection over the last decade, it is still a problem. Episodes of acute rejection can cause the kidney to fail quickly and they are usually treated very aggressively. Chronic or slow rejection is more difficult to treat and can cause the kidney to fail over a period of years.