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Before Transplantation | Kidney

Someone who has kidney failure — often called End Stage Kidney Disease (ESKD) — has three treatment options: a transplant from a deceased person, or a transplant from a living person, or dialysis.

DIALYSIS

In hemodialysis, your blood passes through a machine with a special filter to remove wastes and excess fluid. The procedure is done at home or at a dialysis center and takes about three or four hours per session and typically occurs three times per week.

Another way to remove wastes from the blood is a process called peritoneal dialysis. During peritoneal dialysis, a solution is placed in your abdomen and waste products from the blood move into the dialysis solution, which is then drained from the body.

KIDNEY TRANSPLANTATION

Kidney transplantation is the preferred treatment for kidney failure because it can restore kidney function to normal or near-normal. It is also associated with better survival and quality-of-life than dialysis.

MATCHING KIDNEY FROM A DECEASED DONOR

To match organs between deceased donors and potential recipients there is a centralized computer network — called UNetSM — available 24 hours a day, seven days a week. The network – run by the United Network for Organ Sharing (UNOS) — links all transplant hospitals and organ procurement organizations using a secure passwords.

Medical information about the deceased donor is matched against transplant candidates. In general, this "match run" automatically creates a ranked list of suitable candidates for each organ based on several factors.

Kidney Allocation from Deceased Donors

The allocation of kidneys from deceased is based on the characteristics of both the donor and the transplant candidate. A combination of factors, working together, determines who receives which organ. These factors include:

• Tissue match between donor and candidate
• Blood type
• Blood antibody levels (see above)
• Time spent on the waiting list
• Whether the potential organ candidate is a child
• Geographic factors (distance between the potential recipient and the donor)

Expanding the Pool of Donated Kidneys

There several ways to increase the pool of kidneys from deceased donors including transplanting a single donor kidney into one recipient and accepting organs from "extended criteria donors" (ECD). Although there is no universally accepted definition of ECD, some of the criteria are advanced donor age; longer time that the donated kidney is without blood supply; need for medications to increase blood pressure in the donor; and donation after the donor's heart stops beating.

Transplant doctors continue to evaluate the risks to the recipient associated with ECD organ transplantation.

FINDING A LIVING DONOR

Living donor kidney transplantation involves taking one of the donor's kidneys and transplanting it into the recipient. The surgical removal of a kidney can be done either through an in incision on the side of the kidney to be removed (open nephrectomy) or by "keyhole" surgery (laparoscopic nephrectomy)

Some living donors are related to the organ recipient — genetically and/or emotionally — whereas others are not. Some individuals donate a kidney explicitly for a single recipient, but "exchanging" kidneys among multiple donors and recipients is also an option.

The types of living kidney donations are described below:

Related

Blood relatives of transplant candidates are considered related living donors. These include:

• Siblings
• Parents
• Other blood relatives

Non-Related

Individuals not related by blood but with an emotional bond to the transplant candidates are considered unrelated living donors are. These include:

• Wife or husband
• In-law relatives
• Friends, neighbors, co-workers

Non-Directed

Non-directed donation refers to donation by altruistic or "good Samaritan" donors who are anonymous to the recipient.

Paired Donation

Kidney Donor Waiting List Exchange

In some regions of the United States, a living kidney donor list exchange has been set up. This allows a living kidney donor who is not compatible with the intended recipient to donate a kidney to someone on a deceased donor waiting list. In exchange, a kidney from the pool of deceased donors goes to the incompatible recipient of the live donor.

Non-Directed Living Donors and Donor Chains

Donor chains have been proposed as a means to increase the number of kidney transplants facilitated by non-directed donation. A donor chain occurs when a non-directed donor gives a kidney to a recipient whose living donor in turn gives a kidney to another recipient. The chain continues.

This proposal allows two types of donor chains: open and closed.

The United Network for Organ Sharing/Organ Procurement and Transplantation Network (UNOS/OPTN) Living Donor Committee is evaluating a proposal to include donor chains in their kidney paired donation pilot program.

Internet Solicitation

There are internet web sites to help candidates for kidney transplantation identify potential organ donors. However, internet solicitation is controversial and associated with a number of potential problems. A recent UNOS-sponsored conference discussed guidelines for the psychological and social evaluation of living donors who come forward through internet solicitation and other public appeals. In such cases, assessment of donor motives is very important to evaluate donor suitability.

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