Kidney transplantation is the preferred treatment for people with end-stage renal disease (ESRD). Although dialysis can help maintain kidney function, it only performs about 10% of the work a healthy kidney does, and can result in long term health problems such as anemia, heart disease and infection. A successful kidney transplant is about five times more effective than dialysis in replacing kidney function.
Freedom from dialysis, improved life expectancy and a better quality of life
The life expectancy of someone living on dialysis is about half of someone who receives a deceased donor transplant. If you receive a kidney from a living donor, your life expectancy could be three times higher. Having a properly functioning kidney also means freedom from the time and travel restraints of dialysis. Most people that have had a transplant say they feel better and have more energy and stamina than they did on dialysis. They are able to return to a more normal and active lifestyle and most are able to return to school or work full time. However, a kidney transplant is not a cure for kidney disease. The decision to have a kidney transplant means that you are willing to make a life-long commitment to take care of yourself and your new kidney.
Frequently Asked Questions
The transplant team will take a number of factors into account to determine if kidney transplantation is right for you. We will consider lifestyle choices such as controlling your weight, quitting tobacco and sticking with your dialysis and medication treatments. Other health conditions such as cancer or heart disease may mean that you will not be able to receive a transplant. We will discuss the benefits and risks with you and determine together if kidney transplant is right for you.
Kidney transplantation risks include:
- Uncertainty of success (the transplanted kidney may fail)
- Risk of anesthesia and surgery
- Risk of post-transplant complications and possible hospitalization
- Need for frequent follow-up and testing
- Risk of infection, malignancy and cardiovascular disease
After your transplant, you will be required to take a combination of drugs designed to suppress your immune system and prevent rejection of your new kidney. These drugs are called immunosuppressants. They must be taken for the rest of your life or for as long as the kidney functions. Immunosuppressants are powerful drugs that can produce a number of side effects, including cancer, infection and cardiovascular disease.The transplant nephrologist will determine the particular combination of drugs you will take after your transplant and discuss the side effects of each. Some of the most frequently prescribed are:
Donor kidneys come from two sources: living people or from someone that has died and whose family has consented that their organs be used for transplantation (also called a deceased organ donor).
In a living donor transplant, a family member, spouse or a friend donates a kidney to the recipient. Any potential living kidney donor is thoroughly evaluated to make sure that he or she is healthy enough to donate. The steps to living kidney donation can be found here.
If a patient has a family member or friend who would like to donate but they are not the same blood type, it is possible to arrange a swap through the Kidney Paired Donation Program.
The process begins when your nephrologist refers you to the Maine Transplant Program for evaluation as a potential transplant candidate. The transplant team consists of all the people that work together to make your transplant a success. The members include a transplant nephrologist, a transplant surgeon, a transplant coordinator, nurse practitioner, social worker, clinic/dialysis nurse, immunologist, dietitian, financial coordinator and pharmacist. Each has a role in determining if you are a suitable candidate for renal transplantation. The steps to receiving a kidney transplant can be found here.
Once your kidney doctor refers you to our program for kidney transplant evaluation, you will have to come to our clinic at least three times:
- Kidney Transplant education class – Through the course of 1.5 hours you will learn about kidney transplantation, including what to expect before and after transplant
- Visit 1 – If after the class, you are interested in proceeding with transplant evaluation, we will arrange a visit 1 appointment. During your visit 1 you will meet the following team members:
- Transplant Coordinator who will give you a list of tests to complete
- Social Worker
- Financial Coordinator
- Visit 2 – During this visit you will meet the following team members:
- The transplant doctors (Surgeon and Kidney Doctor) who will determine if you need additional testing
The transplant evaluation consists of a review of your medical records and a complete physical examination by the transplant nephrologist and surgeon. You will have a chest X-ray and EKG if you have not had one in the past year. Blood work will be drawn for routine studies and infectious disease testing. Further testing is performed as necessary depending on underlying medical conditions.
You will be given information concerning the transplant process, and have an opportunity to ask questions. You are encouraged to learn as much as possible about transplantation before making a decision about having a kidney transplant. The members of the transplant team will explain the benefits and risks of transplantation.
The members of the transplant team will also discuss any special medical problems you have that may require additional evaluation. These conditions could include diabetes, heart disease, infections, bladder dysfunction, ulcer disease, gallstones, or a neurological problem such as a stroke. If you have any of the above, additional testing may be needed to determine that you are healthy enough to have the transplant surgery. Female candidates will need to have documentation of an annual Pap test and mammogram.
After your evaluation, members of the transplant team will meet to review your case. They will decide as a group if further testing is necessary before any decision regarding transplantation can be reached. If you are a suitable candidate, you will be placed on the waiting list for a transplant or scheduled for transplant if you have an approved living donor.
You can receive a living donor kidney from a spouse, a relative, a friend, or as part of a kidney swap if you and your donor are incompatible. Kidneys received from living donors bring with them many benefits for recipients.
- Because it is an elective procedure, the transplant surgery can be scheduled at the convenience of the living donor and the recipient.
- The recipients are able to avoid prolonged time on dialysis, and may be able to avoid dialysis altogether.
- Depending on the donor-recipient match, the recipient may need less immunosuppression.
- Kidneys from living kidney donors last longer.
- Recipients of living donor kidneys live longer.
We know it may be difficult to ask family and friends if they are interested in donating a kidney to you. Here are some suggestions to help you with your search:
- If anyone offers to give a kidney, thank them and tell them how to contact the transplant program.
- Bring family or friends to your transplant evaluation and re-evaluation appointments.
- Recruit an advocate who can talk to people for you about donating a kidney.
- Tell your family and friends the truth about your health problems and expected survival without a transplant.
- Spread the word at work (perhaps through Human Resources) and your church.
- If someone is uncertain about kidney donation, let us know and we can put them in contact with someone who has already donated.
- Let us decide if someone is healthy enough to be a donor.
- Do not rule someone out if they have the wrong blood type. We can sometimes arrange a living donor kidney swap.
- Keep your options open. Someone may offer to donate when you least expect it.
If you need a kidney transplant, a kidney from a living donor is the best option for many reasons:
- You will not have to wait as long for a transplant
- You might be able to avoid going on dialysis
- Kidneys from living donors last longer
Unfortunately about 1/3 of patients who have someone willing to donate a kidney cannot receive it because they are not a medical “match” (or compatible). The Maine Transplant Program belongs to two national "kidney exchange programs” which exist to help these people. If someone needs a kidney transplant and has a living donor who is not medically compatible, they can register with these programs so that an “exchange” can be arranged with other living donor/kidney patients.
The Kidney Paired Donation (KPD) Program is run by the United Network for Organ Sharing (UNOS). The Maine Transplant program was a founding member of the original regional exchange program that was the model used by UNOS to develop the current national program.
The National Kidney Registry(NKR) is a non-profit organization based in New York dedicated to the saving and improving the lives of people facing kidney failure by increasing the quality, speed, and number of living donor transplants in the world. This group has been more successful than UNOS in matching donors with recipients and promoting transplantation. The Maine Transplant Program joined the NKR in October 2013.
For your new kidney to work properly, you and the donor's kidney must be "compatible." To determine compatibility, three tests are done:
- ABO (blood type) Compatibility
- Crossmatch Compatibility
- Human Leukocyte Antigens (HLA) Tissue Typing
ABO (blood type) Compatibility
Initially, your blood is tested to be sure that you are the same or a compatible blood group with the donor. In the case of kidney transplants, matching is done for blood group (O, A, B, AB). An O donor can donate to an O, A, B, or AB patient, whereas an O patient can only receive an O kidney. The Rh factor (positive or negative) is not a consideration in transplantation.
The second absolute immunological requirement for transplantation is a negative crossmatch test. This test detects antibodies directed against the donor cells. In the laboratory, a small amount of blood from the recipient is mixed with a small amount of blood from the donor. If the cells live, the crossmatch is negative. If the cells die, this is a positive crossmatch. If the crossmatch is positive, the transplant cannot occur. ABO compatibility and a negative crossmatch test are the minimum immunologic requirement for transplantation. Approximately one third of potential donors are incompatible with their intended recipients. If this happens, we will explore Kidney Paired Donation options.
Human Leulocyte Antigens (HLA) Tissue Typing
This test identifies which genetic markers we inherit from our parents. A comparison is then made between the number of shared donor and recipient genetic markers called antigens. Recent improvements in the anti-rejection medications have made this number less important short term. Long term, HLA matching still has an important impact, with better-matched kidneys lasting longer. A kidney from a living donor may last twice as long as a deceased donor kidney, even if there are no common antigens.
Once you have been accepted, your name will be added to the National Kidney Transplant waiting list. The Maine Transplant Program is a member of the New England Organ Bank, a regional Organ Procurement Organization, and the United Network for Organ Sharing (UNOS). When a kidney becomes available, it is matched with a recipient according to a point system. The waiting time depends on many factors. If you do not have a living donor, you can expect to wait several years for a kidney. Learn more about the Kidney Allocation System.
When you are on the waiting list, a sample of your blood must be sent to the Maine Medical Center Immunogenetics Laboratory at certain times every month. If you are on hemodialysis, your unit will send the sample automatically. If you are not yet on dialysis, or you are doing home dialysis, we will help you arrange for the blood testing to be performed. The purpose of this test is to monitor your antibody level and use the blood to perform a crossmatch should a donor kidney becomes available for you. It is absolutely essential to keep this testing current as you will not receive a kidney offer if the sample is out of date.
When a kidney becomes available for you, one of our transplant coordinators will call you to come to Maine Medical Center without delay. You will first be called at home, then we will use the alternate numbers you have provided. Therefore, it is critical that your contact information as well as your insurance information be accurate and up-to-date. Please call your transplant coordinator if:
- You change your name (marriage), address, or telephone number;
- Your insurance coverage changes;
- Your dialysis schedule changes;
- You receive a blood transfusion; or
- You are hospitalized for any reason.
Please do not assume that the dialysis unit or your local doctor will call the transplant program. The toll free number is 1-800-870-5230. You may call your transplant coordinator at any time and leave a confidential voice mail message.
A number of complications are possible after surgery. There is no way to predict for sure which patients will have which problems. Your transplant team will do their best to reduce your chance of having complications and to treat them right away if you have any. Following instructions carefully and keeping your transplant team informed of any problems will help you return quickly to a normal, active life. Some possible complications are:
- Delayed graft function, which may briefly lead to the need for dialysis after transplant
- Anxiety and depression
- High blood pressure
- Weight gain
What is rejection?
Your body's immune system protects you from infection by recognizing certain foreign material, like bacteria and viruses, and destroying them. Unfortunately, the immune system sees your new kidney as a foreign substance also. To prevent rejection, you must take anti-rejection medications, as prescribed, for the rest of your kidney's life.
Rejection is one of the more important concerns for kidney transplant recipients although is seen in only 1 person in 10 within the first year and in another 1 person in 10 within the following decade. Most rejection episodes cause no symptoms and are detected by changes in blood tests. Most importantly, most rejection episodes that occur early after transplantation are treatable. Failure of a transplant due to rejection is rare unless the individual has stopped taking their immunosuppressive medications.
You must understand that despite efforts to prevent rejection, it may still occur. Generally, rejection is treatable with medication and usually does not lead to immediate loss of the kidney. However, for some patients, one or more rejection episodes or complete failure of a transplanted kidney can occur. It helps to understand just why your body might want to reject a transplanted kidney.