Transplantation
Transplantation is the closest relation to a cure for kidney failure. However, transplantation is not a cure; it's an ongoing treatment that requires medicine intake for most of the patient's life. In addition, the wait for a donated kidney can be years long. For further information, visit the Kidney Transplant Program.
The Procedure
A successful transplant takes a coordinated effort from the entire health care team, including a nephrologist, transplant surgeon, transplant coordinator, pharmacist, dietitian, and social worker. In this procedure, a surgeon places a healthy kidney in the child's body. The surgeon places the new kidney inside the lower abdomen and connects the artery and vein of the new kidney to the artery and vein. Blood flows through the new kidney, which makes urine, just as the original kidneys did when they were healthy. Unless they are causing infection or high blood pressure, the original kidneys are left in place.
The kidney may come either from a living donor or from someone who has just died.
Living donor
Most people can donate a kidney without hurting their health. Many children receive a kidney from one of their parents, but the donor does not have to be a family member.
Deceased donor
If no living donors are available, a child may be placed on a waiting list to receive a kidney from someone who has just died. The United Network for Organ Sharing (UNOS) maintains a computerized system for matching kidneys with appropriate recipients. People who have transplants must take drugs to keep the body's immune system from rejecting the new organ. These immunosuppressive drugs can help maintain good function in the transplanted kidney for many years. However, they may have some undesirable side effects such as making a child vulnerable to infections.
The Transplantation Process
Under certain situations or patient conditions, transplantation cannot be considered an option. Provided that a doctor has approved transplantation as an option, the next step is a thorough medical evaluation at a transplant hospital. The pre-transplant evaluation may require several visits over the course of several weeks or even months. Pre-transplant procedures include blood drawings, x-rays, blood type testing and testing of other factors that determine whether your body will accept an available kidney.
Placement on the Waiting List
If the medical evaluation reveals candidacy for a transplant but there is no family member or friend who can donate a kidney, the patient be put on the transplant program's waiting list to receive a kidney from a deceased donor-someone who has just died.
Every person waiting for a deceased donor organ is registered with the Organ Procurement and Transplantation Network (OPTN), which maintains a centralized computer network linking all regional organ gathering organizations (known as organ procurement organizations, or OPOs) and transplant centers. The United Network for Organ Sharing (UNOS), a private nonprofit organization, administers OPTN under a contract with the Federal Government.
UNOS rules allow patients to register with multiple transplant centers. Each transplant center will probably require a separate medical evaluation, even if a patient is already registered at another center.
Observers of OPTN operations have raised the concern that people in certain regions of the country have to wait longer than others because allocation policies for some organs give preference to patients within the donor's region. Kidneys, however, are assigned to the best match regardless of geographic region. The Federal Government continues to monitor policies and regulations to ensure that every person waiting for an organ has a fair chance. The key to making waiting times shorter is to increase the number of donated organs.
Waiting Period
The length of the waiting period depends on many things but is primarily determined by the degree of matching between the patient and the donor. Some people wait several years for a good match, while others get matched within a few months. Constant communication with the transplant center is necessary - they will need to be notified of changes in health or residency. In addition, once a kidney becomes available, the patient will need to be notified immediately.
OPOs are responsible for identifying potential organs for transplant and coordinating with the national network. The 69 regional OPOs are all UNOS members. When a deceased donor kidney becomes available, the OPO notifies UNOS, and a computer-generated list of suitable recipients is created. Suitability is initially based on two factors:
- Blood type: the patient's blood type (A, B, AB, or O) must be compatible with the donor's blood type.
- Human Leukocyte Antigen (HLA) factors: HLA is a genetic marker located on the surface of white blood cells. A separate set of three antigens are received from both parents. A higher number of matching antigens increases the chance that a kidney will last for a long time
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If selected on the basis of the first two factors, a third is evaluated:
- Antibodies: The immune system may produce antibodies that act specifically against something in the donor's tissues. To see whether this is the case, a small sample of the patient's blood will be mixed with a small sample of the donor's blood in a tube. If no reaction occurs, the kidney should be accepted by the patient's body. The transplant team might use the term "negative cross-match" to describe this lack of reaction.
Transplant Operation
If the donor is living, the operation will be scheduled in advance. The patient and donor will be operated on simultaneously, usually in adjacent rooms. One team of surgeons will perform the nephrectomy (the removal of the kidney from the donor), while another prepares the recipient for placement of the donated kidney.
If the patient is on a waiting list for a deceased donor kidney, he or she must be ready to hurry to the hospital as soon as a kidney becomes available. Once there, a blood sample will be taken for the antibody cross-match test. If the cross-match is negative, your antibodies don't react and the transplantation can proceed.
A general anesthetic will be used so as the patient will sleep during the operation, which usually takes 3 or 4 hours. The surgeon will make a small cut in the lower abdomen. The artery and vein from the new kidney will be attached to the patient's artery and vein, and the ureter from the new kidney will be connected to the patient's bladder.
Often, the new kidney will start making urine as soon as your blood starts flowing through it, but sometimes a few weeks pass before it starts working.
