Transplant Process

Transplant Process

What is kidney failure and chronic kidney disease (CKD)?

You may be a candidate for a kidney transplant if your doctor has diagnosed you with kidney failure, or chronic kidney disease (CKD).

CKD means your kidneys can no longer filter waste from your blood properly. Normally, kidneys help your body:

• Maintain a balance of water and chemicals, called electrolytes
• Filter the body’s waste products out of the blood, which then leave the body in the urine
• Keep a steady blood pressure
• Secrete erythropoietin, a hormone needed to make red blood cells
• Maintain strong bones

Without treatment, kidney failure or ESRD can cause a number of complications, including:

• Hypertension (high blood pressure)
• Fatigue
• Edema (swelling from fluid overload)
• Anemia (decreased number of red blood cells)
• Osteoporosis (weakened bones)
• Sexual dysfunction

If you have been diagnosed with kidney failure or ESRD, you will need treatment. Many people choose dialysis, a procedure in which a machine does the job of your kidneys, filtering your blood. Dialysis requires a time commitment that can be disruptive to daily activities. A kidney transplant offers the opportunity to greatly improve both your health and quality of life.

How will I know if a kidney transplant is right for me?

You may be considered for a kidney transplant if:

• Other treatments for kidney disease did not work
• Other treatments are not expected to work
• A transplant could improve your quality of life

What is kidney transplantation?

Kidney transplantation surgery involves the replacement of a diseased kidney with a healthy kidney from an organ donor. During the surgery, your surgeon may or may not remove your kidneys, depending on whether or not they retain some function. Although everyone is born with two kidneys, most people can live normally with one healthy kidney.

How do I start the process of kidney transplantation?

To be considered for a kidney transplant, you must first complete a thorough medical evaluation. This includes a series of blood tests and exams, and may take several months to complete. The tests and evaluations will help the kidney transplant team weight the risks and benefits of a kidney transplant. All results will be reviewed with you.

How do I find a kidney donor?

Once you have been determined a good candidate for kidney transplantation, you will be registered with the United Network for Organ Sharing (UNOS) to find a donor kidney.

Kidneys for transplantation can come from two sources:

• Living donors
• Deceased (non‐living donors)

Living donor kidney transplantation

Living donor kidney transplantation is an option if a family member or friend is willing to donate a kidney to you. Once the transplant team determines that transplantation is an option for you, you may want to contact potential donors.

Since the wait time for a deceased kidney donor is usually four years or more, we suggest that all patients think about living donor transplantation. In order for a living donor to be a match for you, the living donor must undergo blood tests to see if their blood type and immune system are compatible with yours. Once it is determined that a living donor is healthy enough to donate and compatible with you, the surgeries may be scheduled.

What if my living donor is not a match? Blood type and immune incompatibility –

Approximately one‐third of living donors who come forward are not matches for their intended recipient because their blood type and immune system are incompatible.

Most blood types form antibodies against the other blood types, meaning most parents cannot get blood transfusions or organ transplants from donors with blood types different from their own. In the past, a blood type or immune system difference would have ruled out a donor and recipient pair. Now, there are two options: desensitization treatment and kidney paired donation.

• Desensitization treatment: Organ Transplant Center is one of only a handful of centers in the country offering desensitization treatment. This treatment allows the donor’s kidney to be placed in the intended recipient. A week or two before surgery and a week or two after the transplant, these patients undergo a variety of treatments that help make antibodies compatible. Typically, three to five treatments are required before transplant. Long‐term outcomes of kidney transplants following desensitization have been excellent and comparable to compatible donor transplants.
• Kidney paired donation: Another option for donor and recipient pairs who aren’t compatible is kidney paired donation (KPD). KPD transplants are made possible when a kidney donor who is incompatible with the intended recipient is paired with another donor and recipient in the same situation.

Northwestern Medicine Organ Transplant Center has performed more than 200 KPD surgeries to date, the largest of them being an eight‐way paired exchange that involved eight donors and eight recipients. KPD exchanges are becoming more common and signal a trend in the field of organ transplantation. They have the potential to dramatically increase the number of patients who receive transplants, and reduce or eliminate me spent on the waiting list.

Deceased donor kidney transplantation

As a kidney candidate, you will get an individual estimated post‐transplant survival (EPTS) score. This is a percentage score that ranges from 0 to 100 percent. The score is associated with how long you will likely need a transplanted kidney compared with other candidates. If you have an EPTS score of 20 percent, you are likely to need a kidney longer than 80 percent of other candidates. Someone with an EPTS score of 60 percent will likely need a kidney longer than 40 percent of other people. Your transplant team can calculate your EPTS score for you.

Your EPTS is calculated based on factors that affect how long you are likely to need a kidney, including:

• Your age
• Length of me spent on dialysis
• Whether you have received a previous transplant (of any organ)
• If you currently have diabetes The donated kidneys also receive a score, called the kidney donor profile index (KDPI), based on the age and health of the donor. The 20 percent of kidneys that are expected to last the longest—those with a KDPI score of 20 percent or less—will first be offered to patients likely to need a transplant the longest—those with an EPTS of 20 percent or less.

For more information and resources about transplant visit: https://optn.transplant.hrsa.gov/

What happens while I wait for a kidney?

It is impossible to know how long you will be on the list before you are called for your transplant. In the mean me, you will need to make sure that you have your blood samples sent every month to the Gift of Hope (GOH), which is an organization that allows you to receive organ offers. You must send monthly samples even if you are waiting for a living donor transplant. Other things you will do while waiting for a kidney:

• Prevent infection by avoiding people with a cold or flu, and practicing good hygiene
• Keep all of your dialysis appointments
• Rest and exercise
• Take only your prescribed medications