If you are on a waiting list for a deceased donor kidney, you must go to the hospital as soon as you receive notification that a kidney is available. If a family member or friend is donating the kidney you will receive, you will schedule the operation in advance. Your transplant team will operate on you and your donor at the same time, usually in side-by-side rooms. One surgeon will perform the nephrectomy-the removal of the kidney from the donor-while another prepares you for placement of the donated kidney. In some centers, the same surgeon performs both operations. You will receive general anesthesia to make you sleep during the operation. The surgery usually takes 3 or 4 hours.

Every day, your kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. Chronic kidney disease (CKD) means your kidneys are not filtering as well as they should. CKD usually does not get better and may lead to kidney failure over time. When your kidneys fail, harmful wastes and extra salt and fluid buildup in your body. You then need treatment to replace the work your damaged kidneys have stopped doing. Treatment options include

• hemodialysis
• peritoneal dialysis
• a kidney transplant

These treatments can help you stay well. Some people live with kidney disease for years without needing to go on dialysis or get a transplant. Others progress quickly to kidney failure. Left untreated, kidney failure will lead to coma, seizures, and death.

The transplant process has many steps.

Talking with Your Health Care Provider

The first step is to talk with your health care provider about whether you are a candidate for a transplant. Transplantation is not for everyone. Your health care provider may tell you that you are not healthy enough for surgery or that you have a condition that would make transplantation unlikely to succeed. If you are a good candidate for a transplant, your health care provider will refer you to a transplant center.

Medical, Psychological, and Social Evaluation at a Transplant Center

The next step is a thorough physical, psychological, and social evaluation at the transplant center, where you will meet members of your transplant team. Your pretransplant evaluation may require several visits to the transplant center over the course of weeks or even months.

You will need to have blood tests as well as other tests to check your heart and other organs. Your blood type and other matching factors help determine whether your body will accept an available donor kidney.

Your transplant team will make sure you are healthy enough for surgery. Some medical conditions or illnesses could make transplantation less likely to succeed.

In addition, your team will make sure you can understand and follow the schedule for taking the medicines needed after surgery. Team members need to be sure that you are mentally prepared for the responsibilities of caring for a transplanted kidney.

If a family member or friend wants to donate a kidney, that person will need a health exam to test whether the kidney is a good match.

Your transplant team has many members, including your

• surgeon-the doctor who places the kidney in your body.
• nephrologist-a doctor who specializes in kidney health. The nephrologist may work in partnership with a nurse practitioner or a physician’s assistant.
• transplant coordinator-a specially trained nurse who will be your point of contact, arrange your appointments, and educate you before and after the transplant.
• social worker-a person who is trained to help people solve problems in their daily lives, such as finding employment, affordable housing, or daycare.
• dietitian-a person who is an expert in food and nutrition. Dietitians teach people about the foods they should eat and how to plan healthy meals.

If your medical evaluation shows you are a good candidate for a transplant, your transplant center will submit your name to be placed on the national waiting list for a kidney from a deceased donor. The Organ Procurement and Transplantation Network has a computer network that links all regional organ-gathering organizations-known as organ procurement organizations-and transplant centers. The United Network for Organ Sharing (UNOS), a private, nonprofit organization, runs the Organ Procurement and Transplantation Network under a contract with the Federal Government. When UNOS officially adds you to the waiting list, UNOS will notify you and your transplant team.

UNOS allows you to register with multiple transplant centers to increase your chances of receiving a kidney. Each transplant center usually requires a separate medical evaluation.

UNOS gives preference to people who have been on the waiting list the longest. However, other factors-such as your age, where you live, and your blood type-may make your wait longer or shorter. Wait times can range from a few months to several years.

If you have a living donor, you do not need to be placed on the waiting list and can schedule the surgery when it is convenient for you and your donor.

While you are on the waiting list, notify the transplant center of changes in your health. Also, let the transplant center know if you move or change phone numbers. The center will need to find you immediately when a kidney becomes available.

While you wait for a kidney, you will have blood drawn once a month. The sample will be sent to the transplant center. The center must have a recent sample of your blood for comparison with any kidney that becomes available.

Organ procurement organizations identify potential organs for transplant and coordinate with the national network. When a deceased donor kidney becomes available, the organ procurement organization notifies UNOS and creates a computer-generated list of suitable recipients.

Whether you are receiving your kidney from a deceased donor or a living donor, the transplant team considers three factors in matching kidneys with potential recipients. These matching factors help predict whether your body’s immune system-which protects your body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances-will accept or reject the new kidney.

• Blood type. Your blood type-A, B, AB, or O-must be compatible with the donor’s. Blood type is the most important matching factor. Some transplant centers have developed techniques for transplanting kidneys that are not matched by blood type.
• Human leukocyte antigens. These six antigens are proteins that help your immune system tell the difference between your own body’s tissues and foreign substances. You may still receive a kidney if the antigens do not completely match, as long as your blood type is compatible with the organ donor’s blood type and other tests show no problems with matching.
• Cross-matching antigens. The cross-match is the last test performed before a kidney transplant can take place. A lab technician mixes a small sample of your blood with a sample of the organ donor’s blood in a tube to see if the mixture causes a reaction. If no reaction occurs-called a negative cross-match-the transplant can proceed.

If you are on a waiting list for a deceased donor kidney, you must go to the hospital as soon as you receive notification that a kidney is available. If a family member or friend is donating the kidney you will receive, you will schedule the operation in advance. Your transplant team will operate on you and your donor at the same time, usually in side-by-side rooms. One surgeon will perform the nephrectomy-the removal of the kidney from the donor-while another prepares you for placement of the donated kidney. In some centers, the same surgeon performs both operations. You will receive general anesthesia to make you sleep during the operation. The surgery usually takes 3 or 4 hours.

After surgery, you will probably feel sore and groggy when you wake up. However, many people who have a transplant report feeling much better immediately after surgery. Even if you wake up feeling great, you will typically need to stay in the hospital for several days to recover from surgery, and longer if you have any complications. You will have regular follow-up visits after leaving the hospital.

If you have a living donor, the donor will probably also stay in the hospital for several days. However, a new technique for removing a kidney for donation uses a smaller incision and may make it possible for the donor to leave the hospital in 2 to 3 days.

You need to know how to keep your body from rejecting your new kidney. Your immune system will sense that your new kidney is foreign. To keep your body from rejecting it, you will have to take medicines, called immunosuppressants, that turn off, or suppress, your immune system response. You may have to take two or more immunosuppressants, as well as medicines such as antibiotics to protect against infections. Your transplant team will teach you what each medicine is for and when to take each one. Be sure you understand the instructions for taking your medicines before you leave the hospital.

Often, rejection begins before any signs appear. The signs of rejection include indications that your kidney is not working as well as it should-for example, high blood pressure or swelling because your kidney is not getting rid of extra salt and fluid in your body. Advances in immunosuppressants have made other signs of rejection-such as fever, soreness in the lower abdomen where the new kidney is, and a decrease in the amount of urine you make-rare. If you have any of these symptoms, tell your transplant team. You will receive stronger doses of your immunosuppressants and additional medicines to help keep your body from rejecting your new kidney.

Even if you do everything you should, your body may still reject the new kidney, and you may need to go on dialysis. Unless your transplant team determines that you are no longer a good candidate for transplantation, you can go back on the waiting list for another kidney.

Blood tests help you know your new kidney is working. Before you leave the hospital, you will schedule an appointment with your transplant team at the transplant center. At that appointment, a health care provider will draw blood to be tested. The tests show how well your kidneys are removing wastes from your blood. At first, you may return to the transplant center every 2 weeks, then every month. Eventually, you will need to return to the transplant center only once every 6 months or once every year, after your transplant team has determined that your kidney is doing its job.

Your blood tests may show that your kidney is not removing wastes from your blood as well as it should. You may have other signs that your body is rejecting your new kidney. If these problems occur, your transplant surgeon or nephrologist may order a kidney biopsy. Biopsy is a procedure that involves taking a small piece of tissue for examination under a microscope. Your transplant surgeon or nephrologist performs the biopsy in the transplant center or a hospital. The health care provider will give you light sedation and local anesthetic; however, in some cases, a patient may require general anesthesia. A pathologist-a doctor who specializes in diagnosing diseases-examines the tissue in a lab. The test can show whether your body is rejecting your new kidney.

Some immunosuppressants may change your appearance. Your face may get fuller; you may gain weight or develop acne or facial hair. Not all people have these problems, and those who do can use diet, makeup, and hair removal to minimize changes in appearance.

Immunosuppressants weaken your immune system, which can lead to infections. In some people over long periods of time, a weakened immune system can increase their risk of developing cancer. Some immunosuppressants cause cataracts, diabetes, extra stomach acid, high blood pressure, and bone disease. When used over time, these medicines may also cause liver or kidney damage in some people. Your transplant team will order regular tests to monitor the levels of immunosuppressants in your blood and to measure your liver and kidney function.

United States citizens who have kidney failure are eligible to receive Medicare, the Federal Government insurance program. Treatment for kidney failure costs a lot; however, Medicare pays much of the cost, usually up to 80 percent. Often, private insurance pays the rest. For people who are not eligible for Medicare or who still need help with the portion Medicare does not cover, states have Medicaid programs that provide funds for health care based on financial need. Your social worker can help you locate resources for financial help.

Through patient-assistance programs, prescription drug companies give discounts to people who can show they cannot afford the cost of their prescribed medicines. Social workers can help patients complete applications to these programs.

The Partnership for Prescription Assistance has a website that directs patients, caregivers, and doctors to more than 275 public and private patient-assistance programs, including more than 150 programs offered by pharmaceutical companies. The website www.pparx.org features tools to help a person determine which programs might be available.

Medicare has also compiled information to help beneficiaries pay pharmaceutical expenses. Read Closing the Coverage Gap-Medicare Prescription Drugs Are Becoming More Affordable at www.medicare.gov/publications.

NeedyMeds is a nonprofit organization that helps people find appropriate patient-assistance programs. The NeedyMeds website-www.needymeds.org -provides a directory of patient-assistance programs that can be searched by a medicine’s brand or generic name or by a program or company name. Applications for these programs are usually available online.

The diet for transplant patients has more choices than the diet for dialysis patients, although you may still have to cut back on some foods. Your diet will probably change as your medicines, test results, weight, and blood pressure change.

• You may need to count calories. Your medicines may give you a bigger appetite and cause you to gain weight.
• You may have to eat less sodium. Your medicines may cause your body to retain sodium, leading to high blood pressure.

Your transplant center’s dietitian can help you understand the reasons for dietary limits, recognize foods you should avoid, and plan healthy and tasty meals.

• A kidney transplant is surgery to place a healthy kidney from a donor into your body. A donor is a person who has just died or a living person, most often a family member.
• Transplantation is not for everyone. Your health care provider may tell you that you are not healthy enough for surgery or that you have a condition that would make transplantation unlikely to succeed.
• You will have a thorough physical, psychological, and social evaluation at the transplant center, where you will meet members of your transplant team. Your pretransplant evaluation may require several visits to the transplant center over the course of weeks or even months.
• Your transplant team has many members, including your

1. surgeon
2. nephrologist
3. transplant coordinator
4. social worker
5. dietitian

• If your medical evaluation shows you are a good candidate for a transplant, your transplant center will submit your name to be placed on the national waiting list for a kidney from a deceased donor.
• If you have a living donor, you do not need to be placed on the waiting list and can schedule the surgery when it is convenient for you and your donor.
• While you are on the waiting list, notify the transplant center of changes in your health. Also, let the transplant center know if you move or change phone numbers. The center will need to find you immediately when a kidney becomes available.
• If you are on a waiting list for a deceased donor kidney, you must go to the hospital as soon as you receive notification that a kidney is available.
• You will receive general anesthesia to make you sleep during the operation. The surgery usually takes 3 or 4 hours.
• You will typically need to stay in the hospital for several days to recover from surgery, and longer if you have any complications. You will have regular follow-up visits after leaving the hospital.
• Your immune system will sense that your new kidney is foreign. To keep your body from rejecting it, you will have to take medicines, called immunosuppressants, that turn off, or suppress, your immune system response. Be sure you understand the instructions for taking your medicines before you leave the hospital.
• Often, rejection begins before any signs appear. The signs of rejection include high blood pressure or swelling because your kidney is not getting rid of extra salt and fluid in your body.
• Even if you do everything you should, your body may still reject the new kidney, and you may need to go on dialysis.
• Blood tests help you know that your new kidney is working. Your blood tests may show that your kidney is not removing wastes from your blood as well as it should. You may have other signs that your body is rejecting your new kidney. If these problems occur, your transplant surgeon or nephrologist may order a kidney biopsy.
• Immunosuppressants weaken your immune system, which can lead to infections. In some people, over long periods of time, a weakened immune system can increase their risk of developing cancer. Some immunosuppressants cause cataracts, diabetes, extra stomach acid, high blood pressure, and bone disease. When used over time, these medicines may also cause liver or kidney damage in some people. Your transplant team will order regular tests to monitor the levels of immunosuppressants in your blood and to measure your liver and kidney function.
• Your social worker can help you locate resources for financial help.
• Through patient-assistance programs, prescription drug companies give discounts to people who can show they cannot afford the cost of their prescribed medicines. Social workers can help patients complete applications to these programs.
• Your transplant center’s dietitian can help you understand the reasons for dietary limits, recognize foods you should avoid, and plan healthy and tasty meals.

Source: NIH