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Kidney Transplant

Alternate Names

  • renal transplant
  • transplantation of the kidney
  • Kidneys and ureters

Definition

Kidney transplantation involves placing a healthy donated kidney into a person whose own kidneys have stopped working.

Who is a candidate for the procedure?

Only people who have complete and irreversible kidney failure are candidates for this procedure. Before the transplant, their kidney function is usually being handled artificially by a dialysis machine (either hemodialysis or peritoneal) or else a prior kidney transplant has failed.
The most common causes of kidney failure are:
  • diabetes
  • glomerulonephritis, which is an inflammation of the filtering cells of the kidney
  • polycystic kidney disease, which is a condition that causes cysts throughout the kidney as well as other abnormalities
  • high blood pressure
  • congenital problems in children
There are a few conditions that would rule out a transplant entirely. These include:
  • cancer that has progressed to a stage where it cannot be cured or arrested
  • untreated infections
  • severe heart, lung, or liver problems that make transplant surgery or the medication used afterward too risky
  • another terminal condition.
Once a person is deemed suitable as a transplant candidate, a donor must be found.
The best situation is for the donor kidney to come from a living donor. A member of one's immediate family is most likely to be willing to donate, and is also most likely to be a good genetic match.
However, many kidneys are now being donated across unrelated lines in a broader sharing effort (called designated donation). The only type of kidney donor that cannot be used is one from a person of a different blood type than the recipient.
If no suitable living donor can be found, the person can be placed on a national waiting list for a kidney from someone who has died. Presently there are 2 commonly used definitions for death in these donors: brain or heart criteria. This waiting list for kidneys is very long. Patients often wait for a kidney for many years, continuing on dialysis all the while, and unfortunately, some die waiting.

How is the procedure performed?

A single kidney is removed from the living, healthy donor in an operating room after the person is put to sleep with anesthesia.
If the donor is dead, both kidneys (for 2 different recipients) are removed at the same time that many other organs (liver, heart, etc.) are being taken for transplantation into others.
The recipient of the kidney transplant is also put to sleep with anesthesia. An incision is made in the lower part of one side of the abdomen. The kidney is transplanted close to the bladder, a location much easier to reach surgically than the usual kidney location, resulting in a quicker and less painful recovery for the recipient.
The blood vessels of the donor kidney must be connected to the corresponding vessels in the recipient's pelvis. The ureter, which is the tubular part of the kidney that carries urine, is connected to the recipient's bladder. There is usually room for the donor kidney to be implanted without having to remove the patient's original kidneys. When all the connections have been made, the incision is closed just like after any other surgery.

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