Explore Kidney Transplantation

Many patients in kidney failure are curious whether they should get a living or deceased donor kidney transplant. There are very good reasons for getting a transplant; in general, patients who receive kidney transplants live longer lives and experience a better quality-of-life than patients that stay on dialysis. Here are some common questions about kidney transplants – Do you know the answers?

What is the difference between a deceased and a living kidney donor?
A deceased donor is a generous person who agrees to donate his kidneys and other organs and tissues upon their death. A living donor is a friend, family member or other person who wants to donate a kidney while they are alive.

How does medical evaluation of kidney recipients and living donors work? 
To qualify to receive a kidney from a living or deceased donor, a patient must complete the transplant medical evaluation process. The first step to transplant evaluation is to contact a transplant center. There, patients complete a series of medical tests that ensure that they are healthy enough to receive a kidney transplant. Potential kidney recipients review their Medicare and insurance status with a transplant financial coordinator and talk to a psychologist or other mental health professional. These tests are usually done on an outpatient basis. At the end of this process, a kidney patient will know if he or she is medically eligible for a transplant, will understand what expenses will be covered by insurance and/or Medicare, and have the opportunity to talk to transplant experts.

Potential donors must also go through similar medical and psychological tests to make sure that they are healthy enough to donate; they will be ruled out if they have diabetes, high blood pressure, or any other risks for having kidney problems in the future themselves.

What are the advantages of getting a living donor kidney instead of a deceased donor kidney? 
Because there are more people in need of kidneys than there are kidneys from deceased donors, patients may wait 3-5 years on the waiting list for a deceased donor kidney. Sometimes a matching deceased donor kidney never becomes available, no matter how long a patient waits. On the other hand, a patient receiving a living donor kidney may have a new functioning kidney in as little as a few months.

Deceased donor kidneys and living donor kidneys also vary in the amount of time they last. On average, a kidney from a deceased donor will last around 10-15 years, while a kidney from a live donor can last 15-20 years. If a kidney transplant stops working, a patient can either return to dialysis or pursue getting another transplant.

Living donor transplant surgeries have fewer complications than deceased donation kidney surgeries, and kidneys from living donors often start to function and produce urine quicker after the surgery than deceased donor kidneys. Another important difference for a patient receiving a deceased or living donor kidney is the convenience of the surgery time. A kidney patient waiting on a deceased donor kidney could be called or paged at any time and need to be able to get to the transplant hospital right away. After receiving the call, the patient would need to arrange childcare, pet care, time off from work and transportation to the hospital.

For patients receiving a living donor kidney, they can schedule the transplant surgery at a time that is convenient for both the recipient and living donor, allowing them to make arrangements ahead of time.

But, what health risks does a living donor face?
Kidney transplants have been happening for over 50 years. There is a small risk that the donor would die during surgery due to anesthesia risk – 3 in 10,000, or less than 1 percent. Due to innovations in the transplant surgery (nephrectomy), donors now have a shorter hospital stay, less pain following the surgery and smaller surgery incisions. Because only healthy people are allowed to donate a kidney, studies have found that living donors are less likely to have high blood pressure than people in the general population who are the same age.

Most patients are most concerned about what would happen if the living donor’s remaining kidney failed. This happens very rarely. If a living donor’s remaining kidney failed 15 years after they donated, because of their generous gift, he would receive priority for the next matching deceased donor kidney from the waiting list.

Is transplant the right option for me? 
Only you know the answer to this question. Sometimes, kidney patients may feel comfortable with dialysis and not want to change treatment options. Their health may not be good enough to undergo transplant surgery, making it better to remain on dialysis. If you are deciding, sometimes it is helpful to call a transplant center to talk to an expert. You may want to undergo transplant evaluation to learn whether you are eligible for transplant medically, and financially, how much your Medicare or insurance covers. If you learn that transplant is not the right treatment option for you, you can always stop pursuing it.

To learn more, feel free to check out the websites: www.exploretransplant.org or www.aakp.org.

References: 
1. Wolfe RA, Ashby VB et al. “Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant.” N Engl J Med.1999;1725-30.
2. “Types of Kidney Donation.” http://www.barnesjewish.org/kidney-transplant-types-of-kidney-donation.Barnes Jewish Hospital, n.d. Web. 22 Jun. 2011.
3. “Deceased or Living Donation?”. Explore Transplant Education Program. 2010.
4. “Partnering With Your Transplant Team The Patient’s Guide to Transplantation”
5. http://optn.transplant.hrsa.gov/ContentDocuments/PartneringWithTransplantTeam_508v.pdf U.S. Department of Health and Human Services. n.d. Web. 22 Jun. 2011.
6. “Risks of Kidney Transplant”
7. http://www.barnesjewish.org/kidney-transplant-risks Barnes Jewish Hospital, n.d. Web. 22 Jun. 2011.
8. Wright AD, Will TA, “Laparoscopic Living Donor Nephrectomy: A Look at Current Trends and Practice Patterns at Major Transplant Centers Across the United States.” J Urology. 2008; 179(4):1488-92.
9. Goldfarb DA, Matin SF, Braun WE etal. “Renal outcome 25 years after donor nephrectomy.” J Urol.2001;166(6): 2043 

Amy D. Waterman, PhD, is a Health Psychologist and Assistant Professor of Medicine at Washington University School of Medicine and Barnes-Jewish Transplant Center in St. Louis, Mo. She conducts research about kidney patients’ transplant decision-making and designs health education to help patients make informed transplant choices. She currently serves as Vice Chair for the National OPTN/UNOS Living Donor Committee and on the board of the American Society of Transplantation Organ Donation Advisory Council.

This article originally appeared in the November 2011 issue of aakpRENALIFE magazine.

The majority of ReMend mentors have underwent kidney transplantation.  They are available to assist those interested in pursuing kidney transplantation. 

Via their experience, they can  share with you how they found their donor whether it was living-related or living non-related donor.  This article talks about several ways that one can use to find a kidney donor, the ReMend mentor you contact can provide additional insight into other approaches that they may have taken in finding a donor.

In addition, they can share the process steps they went through to get approved with their Transplantation Medical Units where they would have their kidney transplant surgery.   They can tell you about their post-transplant surgery experience and what to expect in the hospital, what to expect after you are discharged and other valuable information in how they successfully handled their overall transplant experience.

Contact A ReMend Transplantation Mentor