What is a kidney transplant?
A kidney transplant is a surgical procedure done to implant a healthy kidney from
another person. The kidney may come from a deceased donor or from a living donor.
A person receiving a transplant usually receives only one kidney, but, in rare situations,
he or she may receive two kidneys. In most cases, the diseased kidneys are left in
place during the transplant procedure. The transplanted kidney is implanted in the
lower abdomen on the front side of the body.
Why is a kidney transplant recommended?
A kidney transplant is recommended for people who have end-stage kidney disease and
will not be able to live without dialysis or a transplant. In the U.S., the most common
cause of end-stage kidney disease are diabetes and high blood pressure. There are
also many other causes of end-stage kidney disease. Always talk with your healthcare
provider for a diagnosis.
How many people in the United States need kidney transplants?
Visit United Network for Organ Sharing (UNOS) for statistics of patients awaiting a kidney transplant, and the number of patients
who underwent a transplant this year.
Where do transplanted organs come from?
Most kidneys that are transplanted come from deceased organ donors. Organ donors are
adults who have become critically ill and are pronounced dead because their brain
or heart has stopped working permanently. Kidneys are harvested after these adults are
pronounced dead. The family of the deceased person needs to agree to donate the person's
organs. Donors can come from any part of the United States. This type of transplant
is called a deceased donor transplant.
A person receiving a transplant usually receives only one kidney, but, in rare situations,
he or she may receive two. Some experimentation with splitting one kidney for two
recipients is underway. Family members or individuals who are unrelated, but make
a good match, may also be able to donate one of their kidneys. This type of transplant
is called a living transplant (living donor). People who donate a kidney can live
healthy lives with the kidney that remains. A child older than 2 years can generally
receive an adult kidney, as there is usually enough space in the belly for the new
kidney to fit.
According to the latest statistics from the Organ Procurement and Transplantation
Network, there are just under 100,000 people waiting for kidney transplants in the
United States today.
How are transplanted organs allocated?
UNOS is responsible for transplant organ distribution in the United States. UNOS oversees
the allocation of many different types of transplants. These include kidney, liver, pancreas,
heart, lung, cornea, bone, and skin.
UNOS receives data from hospitals and medical centers throughout the country regarding
adults and children who need organ transplants. The medical transplant team that currently
follows you is responsible for sending your data to UNOS, and updating them as your
As of December 4, 2014, the newly revised kidney allocation system (KAS) has been
in place. This new system was designed to improve transplant opportunities for all
candidates and to give better access to patients who often wait longer due to blood
type or other reasons. If you were already on a waiting list before the new KAS was
put into effect, you will not lose your place in line. Talk to your healthcare provider
about the new KAS guidelines.
When a donor organ becomes available, a computer searches all the people on the waiting
list for a kidney and sets aside those who are not good matches for the available
kidney. A new list is made from the remaining candidates. The person at the top of
the specialized list is considered for the transplant. If he or she is not a good
candidate, for whatever reason, the next person is considered, and so forth. Some
reasons that people lower on the list might be considered before a person at the top
include the size of the donor organ and the geographic distance between the donor
and the recipient.
How am I placed on the waiting list for a new kidney?
An extensive evaluation must be completed before you can be placed on the transplant
list. Testing includes:
Blood tests are done to gather information that will help determine how urgent it
is that you are placed on the transplant list, as well as to make sure that you receive
a donor organ that is a good match. Some of the tests you may already be familiar
with, since they evaluate the health of your kidney and other organs. These tests
Blood chemistries. These may include serum creatinine, electrolytes (such as sodium and potassium),
cholesterol, and liver function tests.
Clotting studies, such as prothrombin time (PT) and partial thromboplastin time (PTT).
Tests that measure the time it takes for blood to clot.
Other blood tests will help improve the chances that the donor organ will not be rejected.
They may include:
Your blood type. Each person has a specific blood type: type A+, A-, B+, B-, AB+. AB-, O+, or O-. When
receiving a transfusion, the blood received must be a compatible type with your own,
or an allergic reaction will happen. The same allergic reaction will happen if the
blood contained within a donor organ enters your body during a transplant. Allergic
reactions can be avoided by matching the blood types of you and the donor.
Human leukocyte antigens (HLA ) and panel reactive antibody (PRA). These tests help determine the likelihood of success of an organ transplant by checking
for antibodies in your blood. Antibodies are made by the body's immune system in reaction
to a foreign substance, such as a blood transfusion or a virus. Antibodies in the
bloodstream will try to attack transplanted organs. Therefore, people who receive
a transplant will take medicines that decrease this immune response. The higher your
PRA, the more likely that an organ will be rejected.
Viral studies. These tests determine if you have viruses that may increase the likelihood of rejecting
the donor organ, such as cytomegalovirus (CMV). Many other infectious diseases are
also tested for, including HIV and hepatitis.
Diagnostic tests that are performed are necessary to understand your complete medical
status. The following are some of the other tests that may be performed. Many of these
tests are decided on an individual basis:
Renal ultrasound. A noninvasive test in which a transducer is passed over the kidney producing sound
waves that bounce off the kidney, transmitting a picture of the organ on a video screen.
The test is used to determine the size and shape of the kidney, and to find a mass,
kidney stone, cyst, or other obstruction or abnormalities.
Kidney biopsy. A procedure in which tissue samples are removed (with a needle or during surgery)
from the kidney for examination under a microscope. This is done to determine if cancer
or other abnormal cells are present.
Intravenous pyelogram (IVP). A series of X-rays of the kidney, ureters, and bladder with the injection of a contrast
dye into the vein to find tumors, abnormalities, kidney stones, or any obstructions.
The transplant team will consider all information from interviews, your medical history,
physical exam, and diagnostic tests in determining whether you can be a candidate
for kidney transplantation. After the evaluation and you have been accepted to have
a kidney transplant, you will be placed on the United Network for Organ Sharing (UNOS)
If you are receiving a kidney donated by a living donor, the donor will undergo a
The transplant team
During the evaluation process, you will be interviewed by many members of the transplant
team. The following are some of the members of the team:
Transplant surgeons. Healthcare providers who specialize in transplants and who will be doing the surgery.
Nephrologist. A healthcare provider who specializes in disorders of the kidneys. Nephrologists
will help manage your condition before and after the surgery.
Transplant nurse coordinator. A nurse who organizes all aspects of care provided to you before and after the transplant.
The nurse coordinator will provide education, and coordinates the diagnostic testing
and follow-up care.
Social workers. Professionals who will help your family deal with many issues that may arise including
lodging and transportation, finances, and legal issues.
Dietitians. Professionals who will help you meet your nutritional needs before and after the
Physical therapists. Professionals who will help you become strong and independent with movement and endurance
after the transplantation.
Pastoral care. Chaplains who provide spiritual care and support.
Other team members. Several other team members will evaluate you before transplantation and will make
recommendations to the team. These include, but are not limited to, the following:
How long will it take to get a new kidney?
There is no definite answer to this question. If you have a compatible and healthy
living donor, you may be able to get a transplant within a few weeks or months. If
no living-related donor is available, it may take months or years on the waiting list
before a suitable donor organ is available. During this time, you will receive close
follow-up with your healthcare providers and the transplant team. Various support
groups are also available to assist you during this waiting time.
How am I notified when a kidney is available?
Each transplant team has its own specific guidelines regarding waiting on the transplant
list and being notified when a donor organ is available. In most instances, you will
be notified by phone or pager that an organ is available. You will be told to come
to the hospital immediately so that you can be prepared for the transplant.
What is rejection?
Rejection is a normal reaction of the body to foreign tissue. When a new kidney is
placed in a person's body, the body sees the transplanted organ as a threat and tries
to attack it. The immune system makes antibodies to try to kill the new organ, not
realizing that the transplanted kidney is beneficial. To allow the organ to successfully
live in a new body, medicines must be given to trick the immune system into accepting
the transplant and not thinking it is a foreign object.
What is done to prevent rejection?
Medicines must be given for the rest of your life to fight rejection. Each person
is individual, and each transplant team has preferences for different medicines. The
antirejection medicines most commonly used singly or in combination include:
New antirejection medicines are continually being approved. Healthcare providers tailor
medicine regimes to meet the needs of each individual.
Usually several antirejection medicines are given initially. The doses of these medicines
may change often as your response to them changes. Because antirejection medicines
affect the immune system, persons who receive a transplant will be at higher risk
for infections or even certain types of cancer. A balance must be maintained between
preventing rejection and making you very susceptible to infection. Blood tests to
measure the amount of medicine in the body are done periodically to make sure you
do not get too much or too little of the medicines. White blood cells are also an
important indicator of how much medicine you need.
This risk of infection is especially great in the first few months because higher
doses of antirejection medicines are given during this time. You will most likely
need to take medicines to prevent other infections from happening.
What are the signs of rejection?
The following are some of the most common symptoms of rejection:
Your transplant team will instruct you on who to call right away if any of these symptoms
Long-term outlook for a person after a kidney transplant
Living with a transplant is a lifelong process. Medicines must be given that trick
the immune system so it will not attack the transplanted organ. Other medicines must
be given to prevent side effects of the antirejection medicines, such as infection.
Frequent visits to and contact with the transplant team are essential. Knowing the
signs of organ rejection and watching for them on a daily basis are critical.
Every person is different and every transplant is different. The new antirejection
medicines that are being approved are very exciting. Results improve continually as
healthcare providers and scientists learn more about how the body deals with transplanted
organs and search for ways to improve the success of transplantation.