Most people are born with two kidneys, located behind the abdominal organs and below the rib cage. They perform several important functions including:
- Filtering blood to remove waste products, passing the waste from the body as urine and returning water and chemicals back to the body as necessary
- Regulating blood pressure by releasing several hormones
- Stimulating red blood cell production by releasing the hormone erythropoietin
The kidneys are two bean-shaped organs that produce urine. Urine is carried to the bladder and when the bladder is full, urine is excreted from the bladder through the urethra.
When the kidneys stop working, the condition is referred to as “end-stage renal disease.” Toxic waste products accumulate in the body and either dialysis or a kidney transplant is required to sustain life.
The most common causes of kidney failure include:
- Diabetes mellitus
- High blood pressure
- Polycystic kidney disease
- Severe defects of the urinary tract
Treatments for kidney failure are hemodialysis, a mechanical process to clean the blood of waste products; peritoneal dialysis, in which toxins are removed by passing chemical solutions through the abdomen; and kidney transplant. None of these options is a cure for kidney failure. But a transplant offers the best prospects, given that the transplanted kidney functions successfully.
You may qualify for a kidney transplant if:
- You have end-stage renal disease
- You are a child with end-stage renal disease and severe growth retardation
People who are 60 years of age and older are considered for transplant on an individual basis after medical and cardiovascular evaluation. People with anatomically abnormal urinary tracts may not qualify until appropriate reconstructive surgery is completed.
You may not qualify for a kidney transplant if you:
- Recently had cancer
- Recently had a heart attack
- Recently abused drug or alcohol
- Have an active infection
If you qualify for a kidney transplant, you will go through a series of tests to assess your treatment options. You’ll be evaluated for potential medical problems such as heart disease, infections, bladder dysfunction, ulcer disease and obesity.
Regardless of the type of kidney transplant you may undergo — living or cadaveric — special blood tests are needed to determine your blood and tissue type. These test results help match a donor kidney. The tests consist of:
- Blood Type
- Human Leukocyte Antigens (HLA) – tissue typing
- Crossmatch – antibodies
- Serology – potentially transmissible diseases
When the transplant evaluation is complete, you will be placed on a transplant waiting list.
Kidneys for transplant come from a living donor or a deceased (cadaver) donor. When a kidney is transplanted from a living donor, the donor’s remaining kidney enlarges to take over the work of two. As with any major operation, there is a chance of complication. But kidney donors have the same life expectancy, general health and kidney function as others.
Any healthy person can safely donate a kidney. The donor must be in excellent health, well informed about transplantation and able to give informed consent.
If you have a potential living donor, he or she will undergo an evaluation and discuss the possibility of organ donation. Tests will be performed to ensure that the donor and recipient are compatible. In some families, several people are compatible donors. In other families, none are suitable.
The procedure will be described in detail by the surgeon prior to surgery. The operation usually takes three hours. Most patients undergoing laparoscopic surgery for kidney donation require a hospital stay of only two to three days.
After discharge from the hospital, the donor is seen for follow-up care. Donors who undergo laparoscopic surgery often return to work within three to four weeks after the procedure.
A cadaveric kidney comes from a deceased donor. All donors are carefully screened to prevent disease transmission.
If you decide to undergo a cadaveric kidney transplant and you’re medically eligible, your name will be placed on a cadaver waiting list. A blood sample for antibody level will be sent monthly to the medical center. The waiting period for a cadaver kidney depends upon the availability of a cadaver donor compatible with your blood type and your antibody level.
Your surgery may last from two to four hours. During the operation, the kidney is placed in your pelvis rather than the usual kidney location in the back. (Your own kidney will not be removed.) The artery that carries blood to the kidney and the vein that removes blood from it are surgically connected to two blood vessels in the pelvis. The ureter, or tube that carries urine from the kidney to the bladder, is transplanted through an incision in the bladder.
After the operation, you will remain in the recovery room for a few hours and then return to the Kidney Transplant Unit.
You will be encouraged to get out of bed 12 to 24 hours after surgery and walk as much as you can. Nurses will instruct you in taking your medications, explain the side effects and discuss making lifestyle changes.
A cadaver kidney transplant sometimes will be temporarily slow in functioning, a condition called a “sleepy” kidney or acute tubular necrosis (ATN). You may need to undergo dialysis a few times. A “sleepy” kidney usually starts working in two to four weeks.
Most transplant recipients must take medication called immunosuppressants to prevent rejection of the transplanted organ. One of the side effects of these anti-rejection drugs is an increased risk for cancer, particularly skin cancer and lymphoma. You should be closely monitored for these conditions.