A kidney transplant is a delicate, highly sophisticated procedure.
Success depends not only on an excellent operation, but upon intensive
medical management. Main
Line Health’s Kidney Transplant Program, located at Lankenau
Medical Center, has an excellent record of success in kidney
transplantation, and an equally outstanding reputation for care that is
both highly professional and very personal.
A kidney transplant is procured in a three-step process, focusing on:
identifying the kidney donor
preparing for the surgical process
recovering after the transplant
The Kidney Donor
A kidney transplant can only happen when a kidney becomes available from
a donor. Kidneys can come from two sources: living and cadaver donors.
Living Donors: Studies have shown that the
longevity of kidneys taken from living donors is better than
kidneys from cadaver donors. There are two designations for
living donors: Living-Related and Living-Unrelated.
Cadaver Donors: If a living donation is not
available to you, your name can be put on a waiting list for a
kidney from someone who has recently passed away. These are
healthy kidneys that are recovered from brain dead donors. The
family of the person who has died donates the kidneys for
transplant to give someone else the “gift of life.”
Living Organ Donors
Patients who receive a kidney from a living donor may have better
outcomes, keep their transplants longer and be able to receive a
transplant sooner than patients who wait for a deceased donor. This
means less time on dialysis
for the transplant recipient and a quicker return to an active life. A
living donor does not have to be a relative and can be anyone who wishes
Potential living donors will be evaluated by the transplant team to
determine whether they are a suitable match for you. Your living donor
will receive the same level of personalized attention and education
about the transplantation process. Our team will carefully evaluate the
donor’s health and compatibility to minimize any risks. Our surgeons are
skilled in removing donor kidneys using the most advanced minimally
invasive laparoscopic techniques. This will minimize the donor’s
recovery time, scarring and discomfort.
Lankenau participates in national donor exchange programs which give
people who are unable to receive a kidney from a loved one or friend the
opportunity to still receive a kidney from a living donor. With
paired-organ donation, your donor exchanges his or her kidney with the
living donor from another incompatible donor/recipient pair to create
two compatible pairs.
Cadaver Organ Donations
Waiting for a “Gift of Life”
There is no way to know how long you may be on the waiting list for a
kidney from a donor who has passed away. It could take as little as a
few weeks to several years. While you are waiting, blood work will be
done every month to check your antibody levels. This will help your team
find the kidney that is an acceptable match for you. It will also let
your doctors know if your body may reject a specific kidney due to high
High antibody levels can result from a blood transfusion, pregnancy or
previous transplant. If your antibody levels are high, it will be harder
to find a compatible kidney for you and you may have a longer wait.
Distribution of Kidneys
Kidneys from deceased donors are distributed through the United Network
for Organ Sharing. This organization has a national list that is on
computer. The list is kept up to date with all of the important
information about patients waiting for kidneys. It operates 24 hours a
day, every day of the year.
Whenever a kidney becomes available, a computer list is generated which
allocates or distributes the kidney to an individual based on degree of
match, time waiting and level of antibody in the blood.
Notification of Kidney Availability
No one can predict when a kidney may become available for you. However,
your transplant team will work with you to arrange a contact system so
that you can be notified immediately if a kidney does become available.
You will be contacted by telephone.
The kidney that you will receive will be stored in a cold, slushy
solution and has a limited viability span. So, once you are called, you
must be immediately available to come into the hospital. If we are
unable to contact you when a kidney becomes available, then we must
offer the kidney to the next person on the list.
In some cases you may be called as back-up. This means that there are
other patients in front of you for this particular kidney. If they are
not compatible or not available, you would receive the kidney.
Preparing for Your Visit
You will first have an evaluation by the kidney transplant team to
determine if you are eligible for a transplant. Even if you are not
considered eligible for transplant at another center, you can contact
Lankenau to be evaluated for a second opinion. We understand your
dialysis commitment and can accommodate your schedule. The evaluation
involves not only understanding your physical health but also the
psychological issues that may impact your ability to successfully handle
a transplant. During the evaluation process, the transplant nurse
coordinator will obtain a complete personal history, and you will
undergo a series of tests. You will have a meeting with the transplant
surgeon and nephrologist who will perform an examination, review your
history and answer your questions. Later, you will be notified about
your eligibility. Even if the team decides you are a good candidate for
transplant, the final decision to proceed rests with you.
The Waiting Period for Kidney Transplant
If you are recommended as a candidate for transplant, it is important
that you quickly finish all the requirements necessary to be registered
on the national organ transplant waiting list. You will then begin a
period of waiting to be matched with a donor. The waiting period can
range from several months to several years; there is no way to predict
how long your wait will be. Each time an organ becomes available, a
process of matching begins in which a centralized system identifies and
ranks the most ideal candidates for that kidney. While you are waiting,
stay healthy and active. It is important to stay in close contact with
the transplant team during this time.
Once you have had your transplant, you will immediately begin a recovery
period that includes rehabilitation, medication and a follow-up care
plan that will last for the rest of your life. You will likely be
discharged from the hospital less than one week after your surgery. To
minimize side effects from transplant medications, we avoid using
long-term steroid medications after transplant in most patients. Many
patients choose Lankenau because of their desire to avoid steroids. You
will return to the transplant clinic for regular assessments for up to
six months. During these visits, the physician will address your
medication management, routine medical care and recovery. After this
time, you will return to your referring nephrologist for ongoing care.
Recovering After the Kidney Transplant
When your surgery has been completed, you will be taken to the Recovery
Room or Intensive Care Unit, where you will be closely monitored for
several hours. When your team feels you are ready, you will be moved to
the transplant unit.
The First Few Days After Kidney Transplant
While you are recovering, you will be closely monitored to be sure that
you and your new kidney are doing well.
You will be connected to a cardiac monitor for approximately 48
hours or until you are in stable condition.
A catheter placed in your bladder during surgery will provide
continuous drainage of urine from the bladder. The urine will
travel through a tube to the outside, and then be collected in a
bag. This enables accurate measurement of urine output. This
continuous drainage of urine will help the bladder to heal. The
urine may appear bloody for a few days. This is not uncommon.
The catheter will remain in place usually for four days after
Your heart and fluids will be monitored through an intravenous
catheter placed near your collar bone.
You will be asked to cough and take deep breaths every hour
after the operation. This helps to mobilize the mucus which may
have accumulated in your lungs during the operation. If this
mucus is not cleared from your lungs, it can be an excellent
place for bacteria to grow. This could result in infection.
In a couple of days you will be walking around the Transplant Unit as
much as you can tolerate. This will help your lungs and body get back
Monitoring Your New Kidney
Your new kidney may be sluggish, and may not work well right away. If
this is the case, you may need dialysis temporarily to help you feel
well. In most cases the kidney will begin to work within two weeks.
Your doctors may evaluate the function of the transplant kidney with a
nuclear scan or a renal ultrasound. These tests may be done frequently
during your hospital stay to help your doctor identify any collection or
blockage so it can be treated immediately.
Going Home After Kidney Transplant Surgery
If all is going well, you may be discharged from the hospital in about
4-7 days. (Your discharge may occur sooner or later, depending on your
condition). Your transplant coordinator will help you prepare for your
return home and provide you with information to help you through your
recovery at home.
Because rejection and other problems usually occur in the first few
months, your team will want to continue monitoring your progress and
condition very closely. So, you can expect to return frequently to the
Transplant Clinic. As your condition stabilizes, visits to the clinic
will become less frequent.
Medical problems of any nature must be called into the Transplant
Office. A transplant nurse and physician are “on-call” 24 hours a day.
When you start feeling more like yourself, you can begin enjoying the
social and professional activities that were not possible while you’re
were on dialysis.
The human body protects itself against germs through the immune system.
This system also fights against cells or tissues that your body does not
recognize as yours. This includes the tissue of your “new” kidney.
To keep your body from rejecting (attacking) your new kidney, you will
need to take drugs called immunosuppressants. You must take these drugs
every day, as long as your new kidney is working. If you do not take
these drugs you will lose the kidney. Immunosuppressants increase your
risk of contracting infections or getting some forms of cancer.
Many immunosuppressants have side effects. However, every patient is
different. Many experience no side effects at all, others experience a
few or several. Immunosuppressants you may be taking, and their possible
side effects can be found in the Kidney Transplant Medication Chart.
For more information, call 1.866.CALL.MLH.