Kidney Transplant

Visit the United Network for Organ Sharing (UNOS) Web site for statistics of patients awaiting a kidney transplant, and the number of patients who underwent a transplant this year.  

The majority of kidneys that are transplanted come from deceased organ donors. Organ donors are adults who have become critically ill and will not live as a result of their illness. Parents or spouses can also agree to donate a relative's organs. Donors can come from any part of the United States. This type of transplant is called a cadaveric transplant.

A person receiving a transplant usually receives only one kidney, but, in rare situations, he/she may receive two from a cadaveric donor. 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. Individuals who donate a kidney can live healthy lives with the kidney that remains.

According to the United Network for Organ Sharing, there were over 13,000 kidney alone transplant procedures performed in 2002.  

The United Network for Organ Sharing (UNOS) is responsible for transplant organ distribution in the United States. UNOS oversees the allocation of many different types of transplants, including liver, kidney, pancreas, heart, lung, and cornea.

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 the data to UNOS, and updating them as your condition changes.

Criteria have been developed to ensure that all people on the waiting list are judged fairly as to the severity of their illness and the urgency of receiving a transplant. Once UNOS receives the data from local hospitals, people waiting for a transplant are placed on a waiting list and given a "status" code. The people in most urgent need of a transplant are placed highest on the status list, and are given first priority when a donor kidney becomes available.

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/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.  

An extensive evaluation must be completed before you can be placed on the transplant list. Testing includes:

• Blood tests
• Diagnostic tests
• Psychological and social evaluation
  

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 ensure 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 may include:

• 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 occur. The same allergic reaction will occur 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, persons who receive a transplant will take medications 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).

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, although many of the tests are decided on an individual basis:

• Renal ultrasound - a non-invasive test in which a transducer is passed over the kidney producing sound waves which bounce off of 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 detect 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; 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 detect tumors, abnormalities, kidney stones, or any obstructions, and to assess renal blood flow.

The transplant team will consider all information from interviews, your medical history, physical examination, 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) list.

There is no definite answer to this question. Sometimes, people wait only a few days or weeks before receiving a donor organ. 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 physicians and the transplant team. Various support groups are also available to assist you during this waiting time.

Each transplant team has their 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.  

Living with a transplant is a life-long process. Medications must be given that trick the immune system so it will not attack the transplanted organ. Other medications must be given to prevent side effects of the anti-rejection medications, 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 anti-rejection medications that are being approved are very exciting. Results improve continually as physicians and scientists learn more about how the body deals with transplanted organs and search for ways to improve the success of transplantation.