FAQ About Transplantation

1.  What do the kidneys do?
The kidneys perform the vital functions of filtering the blood and cleaning it of waste material and excess fluid. The kidneys are essential to human life and survival. They help regulate blood pressure, blood chemistries, and red blood cell count.

2.  Why are the kidneys so important?
The kidneys control levels of calcium and phosphorus, which are important for good bone growth. The kidneys also control the potassium levels in your body, which help your heart and other muscles to work properly. Fluid balance is determined by how much sodium and chloride are retained in the body.

3.  What happens when the kidneys fail?
If the kidneys cease to function, harmful waste products and excess fluids build up in the body, causing uremic poisoning. A person's day to day health and general functioning will be affected depending on the severity and type of kidney disease that develops.

4.  How is total kidney failure treated?
Two methods of treating total kidney failure are dialysis and kidney transplantation.

5.  What is a kidney transplant?
Human kidney transplantation involves surgically implanting a kidney from a donor into a patient whose own kidneys have failed.

6.  How long have kidneys been transplanted?
The first successful kidney transplant was performed in the United States in 1954 at Peter Bent Brigham Hospital in Boston by Dr. John Merrill. It was the worlds first transplant between identical twins

7.  How big is a kidney?
Each kidney is about the size of your fist.

8.  Where do kidneys for transplant come from?
A kidney for transplantation may be obtained from a relative whose body tissues match the patient (living related donor), from a spouse or close friend whose body tissues are a match,or from a person who has died (cadaver donor) and whose body tissues match the patient.

9.  When were cadaver kidneys first used in transplantation?
The first successful cadaver kidney transplant was performed in 1962. This was also the first transplant that was followed by treatment with immunosuppressive drugs.

10.  What are the advantages of a kidney transplant?
Many physicians feel that a transplant leads, for most patients, to a better quality of life than treatment by dialysis. A transplant patient will be subject to close medical supervision but no longer has to be dependent on a machine. A transplant patient will feel better about himself and his life because he no longer will be entering into the chronic state of uremia. A patient whose fluids, sodium, and potassium have been restricted will be able to return to a much more normal diet.

11.  What are some of the disadvantages of having a kidney transplant?
There may be undesirable side effects from the medications given to prevent organ rejection. Potential for infection is the major concern, but there may be individual considerations and possible disadvantages should be discussed with the surgeon.

12.  What is the pre-transplant evaluation?
The patient's personal physician makes a referral to the appropriate transplant program where the patient is evaluated and tested. Using the specific medical criteria of the transplant center, the patient's suitability as a potential transplant recipient is determined.

13.  What is waiting list placement?
The organ transplant center places the potential recipient's name and medical data on the Organ Procurement and Transplantation Network (OPTN) waiting list, which is maintained by United Network for Organ Sharing (UNOS). This computerized waiting list contains the names of all potential organ recipients, as well as the medical data needed to make the best match possible.

14.  What is donor identification?
The vast majority of organs for transplantation come from patients who have suffered a sudden traumatic accident resulting in brain death. The names of these potential donors are referred to the local organ procurement organization for evaluation. If all legal and medical criteria are met, the family is approached to give consent for donation. If the family consents, the characteristics (i.e., age, blood type and weight) and medical background of the donor are registered with the national waiting list, and suitable recipients are identified.

15.  Why are immunosuppressive drugs used after transplant?
The body often wants to reject the newly transplanted organ in the same way as it does other foreign cells and tissues, such as viruses and bacteria. With the careful use of these medications, the immune response or rejection, is decreased.

16.  What is the purpose of the transplant educational session?
The patient and his family must approach the transplant fully aware of procedures, expectations, and the projected outcome. At the educational session, the transplant coordinator will explain the patient's condition and future possibilities for treatment. It is important that as many family members as possible attend this meeting, so that they may all share the same information. This meeting provides the opportunity to ask questions and express concerns.

17.  How do I know if someone in my family can donate a kidney to me?
In preparation for transplantation, the patient and immediate family members (parents, brother, sisters, and children) are asked to come to the Tissue Typing Laboratory or Post-Transplant Clinic. A small sample of blood is taken from each family member to determine the genetic profile of the patient. Tissue typing in no way commits a family member to be a kidney donor.

18.  What is tissue typing?
Tissue typing consists of a series of blood tests that compare the genetic makeup (the natural differences and resemblances among people) of the potential recipient with the donor. Tissue typing enables the donor to be matched closely with the recipient. Blood type must match the recipient exactly. The better the match is, the less chance of rejection and loss of kidney function. A better-matched kidney requires treatment with immunosuppressant drugs following transplant, as well.

19.  What are some of the blood tests for tissue typing?

• ABO grouping is the test that is used to identify blood type, i.e. blood transfusions.
• HLA Typing is used to identify a particular pair of genes within the chromosomes.
• Sensitivity testing predicts transplant success. The recipient’s blood is compared with a random population to record the percentage of sensitivity of the recipient against the population. A high percentage rate indicates a high level of antibodies and a greater chance of rejection.
• Cross-matching combines the blood of the recipient with that of the donor to see if there is any reaction.

20.  What happens if none of my family members are a match?
This sometimes happens, and the patient is placed on a cadaver waiting list. Cadaver kidneys are given to the recipients whose tissue typing best matches the donor. The recipient's tissue typing information is entered into a computer with others on the waiting list for a quick match when a kidney becomes, available for transplant.

Each time a kidney of your blood type is available, your serum will be tested with that potential donor (testing for a reaction of your cells against the cells of the donor). When there is a good match and your physician feels that the kidney would have an optimal chance for success, he will notify you and make preparations for the transplant. Sometimes you may be called to the hospital because there is kidney that matches yours. At that time more blood tests win be performed. The results of those blood tests are very important. If they indicate that there is a reaction between your blood and that of the donor, the transplant is canceled. If the tests results are negative, and there is no reaction between your blood and that of the donor, then preparations for the transplant are continue.

21.  How long will I have to wait on the cadaver transplant list?
Usually from 6 months to a year. However, there are many variables, and the waiting period is impossible to predict.

22.  How does the social worker help?
The social worker will be available to you and your family throughout your medical treatment to provide personal and family counseling and information about community programs for financial, vocational, household, and personal services.

23.  Can a diabetic patient receive a kidney transplant?
Although the complications of surgery itself, including infections, may be greater, diabetic patients tend to have a higher incidence of blood vessel disease, making the chances for success for both dialysis and transplantation lower than for a non-diabetic patient. Control of diabetes is more difficult in transplanted patients because one of the immunosuppressive medications (Medrol) may raise the blood sugar level. A new procedure available to the Type I insulin dependant diabetic is a combined kidney-pancreas operation.

24.  If I have some function to my kidney or a kidney that may resume function, will I be able to have a kidney transplant?
No. Only patients who have irreversible kidney failure will be able to receive a kidney transplant. Patients with temporary kidney problems may be treated with dialysis until normal kidney function resumes.