About Kidney Transplants

The goal of kidney transplantation is to improve the health and quality of life for people with end stage renal disease. Transplantation is not a cure, but rather is an alternative to dialysis. The goal is for the transplant recipient to achieve a level of activity and health comparable to a person of their age who does not have kidney disease.

Renal transplant does involve risk. Each patient must consider their own circumstances and the recommendations of their physicians when making the decision to pursue transplantation as a treatment option.

Who is a good candidate for transplantation?

Kidney transplant recipients must be free of infection or cancer and have no major health problems that would negate the benefit of kidney transplantation. To make transplantation safer and more successful, a complete medical evaluation is performed. In some cases, the risk of taking the transplant medications (immunosuppressives), in combination with other health problems, is so great that the patient and physician decide that transplant is not the best treatment for that individual. (Read about Kidney Disease)

What testing will be done?

The recipient, family and close friends will be invited to an informational session to help decide whether transplant is the best treatment option. To proceed with the evaluation for transplant, a thorough general examination and a series of tests will be performed. These tests will inform the transplant team about the potential recipient’s current health. If there are special risks for the recipient they will be discussed. It is important that the recipient be in the best health possible at the time of transplant. If treatments or interventions are identified that will improve the recipient’s health, these may be implemented (ie, weight loss, smoking cessation) before proceeding with transplantation.

The following exams are completed as part of the evaluation:

• History and physical exam
• Lab work and testing for hepatitis and HIV
• Blood tests to determine blood type and tissue type for organ matching
• A chest x-ray
• An EKG
• Cardiac evaluation including cardiac stress test, echocardiogram if over 45 years or a diabetic
• An abdominal ultrasound to evaluate gallbladder, liver, pancreas, and kidneys for any abnormalities
• Pulmonary function tests may be required in smokers and patients with known lung disease
• Colonoscopy if over 50 years old
• Mammogram in women over 40 years old
• Pap smear and pelvic examination for women
• A dental x-ray or dental exam to check for any infections
• TB skin test

Additional testing may be required, depending on the patient’s medical history. Patients can expedite the transplant evaluation by scheduling their own mammogram, gynecologic evaluation and dental check-up as soon as they have an appointment to be seen in the Transplant Office.

When the evaluation has been completed and it is decided that kidney transplant is an appropriate therapy, the recipient with either be placed on the waiting list for a deceased-donor kidney or possible living donors will begin evaluation.

Where your new kidney comes from

There are three sources of donors for kidney transplantation.

Living Related Donors: These are immediate family members, who are without kidney disease, high blood pressure or diabetes, and who are willing to donate. Examples include a mother, father, sister or brother.
Living Unrelated Donors: These are individuals such as a spouse, brother-in-law, sister-in-law or very close friend. These people must also be without kidney disease, high blood pressure and diabetes. They must be willing to donate and must prove that they are doing so freely and unselfishly. Evaluation of potential donors can take as little as one month but may take longer, depending on circumstances. The transplant date will be set after both recipient and donor have been accepted for the procedures. In some cases, the surgery is delayed to meet the donor’s work schedule or for other considerations.
Deceased Donors: The third type of kidney donor is a deceased donor. These are individuals who have met with a tragic, sudden death and whose families have donated their organs for transplantation. The United Network of Organ Sharing (UNOS) manages the national waiting list and organ distribution. There is a national “point system” that takes many factors into consideration, including length of time on the waiting list and compatibility with tissue antigens in determining possible recipients. This system helps make organ distribution as fair and equitable as possible.

The Waiting List

Once you have completed your tests, if you are not receiving a living related or unrelated kidney transplant, your name will be added to the waiting list. The waiting time for a transplant can range from a few months to a few years. During this time it is very important that Transplant Services be notified of any changes in your health status, as well as any address, phone number or insurance changes. You will also need to have your blood drawn monthly in order to run a blood test called a cross match, for use when a donor becomes available. A cross match test mixes a small sample of your blood with the potential donor’s blood in a tube. If no reaction occurs, you should be able to accept the kidney. If you are on dialysis your dialysis team will draw this blood monthly. If you are not on dialysis you will receive blood tubes in the mail. You will need to bring the tubes to the lab to have your blood drawn on the designated draw dates.

What if I have a living donor?

If you know family members or friends that would like to donate a kidney for you, they need to call Transplant Services at 309-655-4101, or toll-free at 1-800-635-1440. A transplant coordinator will talk with a potential donor and then arrange a blood test to determine blood type compatibility. If the blood type is compatible with yours, we will make an appointment for your potential donor to be evaluated further. The donor then undergoes medical tests to make sure the donor is healthy enough to live with only one kidney and that the kidney identified as a match is functioning well enough to help you. If your potential donor lives out of state, we may be able to do some of the tests at a hospital near the donor’s home. However, there are a few tests that must be done at OSF Saint Francis Medical Center. Medical expenses associated with living donor evaluation are covered by the Transplant Center. The living donor will not incur any expenses for the evaluation. However, expenses related to another health concern that may be identified during the evaluation process will not be covered.

If you have several people that would like to donate they can call in and we will check their blood type to see who matches. However, we will only perform one donor evaluation at a time. Therefore, if you have more than one potential donor that has the same blood type, they will need to decide who will come forward first to be evaluated.

About your surgery

You will be under general anesthesia during the surgery. The surgery usually last about 4 hours. The kidney is placed in either your right or left lower abdomen. The incision will be approximately 7 to 9 inches long at an angle on your lower abdomen. If you still have your kidneys they will not be removed at this time. Your kidneys are usually not removed unless they are causing you pain or infections. If they need to be removed that operation will usually occur after you have completely recovered from your transplant surgery. After surgery you will be taken to the recovery room until the anesthesia wears off. You will then be transferred to the Transplant Unit or the Intensive Care Unit. You will have a central line (an IV tube) near your collarbone or neck to provide you with fluids and medication after surgery. You will have a catheter in your bladder to help you pass urine. You may be connected to a heart monitor. The hospital stay is usually 5 to 7 days depending on your recovery process. If the kidney does not produce urine right after surgery, you may need dialysis for a short time. The transplanted kidney can sometimes be “asleep” for a few days. Please do not view this as a setback or complication.