Kidney transplant options and how kidney donation and donor exchange work
A kidney transplant is a delicate, highly sophisticated procedure involving three steps:
- Identifying the kidney donor
- Preparing for the surgical process
- Recovering after the transplant
A kidney transplant can only happen when a kidney becomes available from a donor. Kidneys can come from two sources: living and cadaver (deceased person) donors.
This is a kidney transplant option that involves a living person who donates one of their kidneys for transplant. A living donor can be "living-related" (a blood relative of the person receiving the donation) or living-unrelated (a person with no blood relationship to the recipient).
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 the transplant recipient can avoid dialysis or spend less time on dialysis and experience a quicker return to an active life.
Potential living donors are 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 donation process. Our team will carefully evaluate the living donor's health and compatibility to minimize any risks. Our surgeons are skilled in removing a living donor's kidney using the most advanced minimally invasive laparoscopic techniques. This will minimize the living donor's recovery time as well as any scarring and discomfort.
Deceased donor kidney transplant
If living donation is not available to you, the other kidney transplant option is to be added to the waiting list for a kidney. This is a waiting list of people who are waiting for a deceased kidney donor—someone who is an organ donor who has recently passed away or someone who has been determined to be "brain dead." The family of the person who has died or determined to be brain dead donates the kidneys for transplant to give someone else the "gift of life."
There is no way to know how long you may be on the waiting list for a kidney from a deceased donor. It could take as little as a few weeks to several years. The average waiting time in the Philadelphia area is six to eight years.
While you are waiting, blood work will be done every month to check your antibody levels. This will help your team find a 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 antibody levels.
High antibody levels can result from a blood transfusion, pregnancy or previous transplants. If your antibody levels are high, it may be harder to find a compatible kidney for you and you may have a longer wait.
Matching of kidney transplant donors and recipients
There are several tests that you and a potential donor must undergo before being "matched" for a kidney transplant. These tests include:
Blood type testing
A test to determine what type blood—O, A, B, or AB—you have, and whether your blood is compatible with the potential donor's blood. Type O is the most common blood type and is considered a universal donor, meaning someone who has this type of blood can donate to any other blood type.
Type AB is considered a universal recipient and can receive blood from people of any blood type. Between the different types of blood, there are some that can and cannot give and receive to one another. This test will determine blood type compatibility with your donor.
Serum crossmatching
A test involving mixing of your blood with that of the kidney donor to determine whether your body's cells will attack the donor's cells. If this happens, it means you have antibodies against this donor's cells and the crossmatch is considered "positive," an indication that your body would reject a kidney from this donor.
If your body does not produce antibodies against the donor's cells, the crossmatch is "negative," meaning your body will likely accept the donor organ and cells. For kidney transplant, you will need a negative crossmatch in order to proceed.
HLA (human leukocyte antigen) testing
A blood test that determines which antigens you (and the potential donor) have inherited. Antigens are proteins found on the cells and they are what trigger the body to produce antibodies, which fight off bacteria, viruses, and anything perceived as foreign to the body. While there are many different types of antigens, there are six that have been identified as particularly important for successful kidney transplant. This test will help determine whether your HLA is likely to fight against (reject) your donor's HLA.
Donor exchange programs and how kidney distribution works
In cases where there is a living donor who is medically able to donate a kidney, but the donor is not a match for the recipient, paired-organ donation may be a kidney transplant option for you. In this scenario, there are two (or more) sets of donors and recipients. A donor from one set matches the recipient from another set, and vice versa. Switching donors and recipients with one another creates a win-win situation allowing multiple recipients to receive transplants.
Lankenau Medical Center participates in two national donor exchange programs; the National Kidney Registry and the OPTN Kidney Paired Donation Pilot Program.
Deceased donor kidney allocation
Kidneys from deceased donors are distributed through the United Network for Organ Sharing (UNOS). This organization has a national database, a computerized list that is kept up to date with important information about patients waiting for kidneys. UNOS operates 24 hours a day, every day of the year.
Whenever a kidney becomes available, a computerized list is generated, which allocates or distributes the kidney to an individual based on:
- Degree of (how well the donor and recipient) match
- The amount of time the recipient has been waiting
- The level of antibody in the recipient's blood
- Distance in nautical miles between the recipient's transplant hospital and the deceased donor's hospital
Notification of kidney availability
As previously mentioned, 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 when a kidney does become available. You will be contacted by telephone.
The kidney that you receive will be stored in a cold, slushy solution and has a limited viability span, meaning it can only last for so long outside of the body. 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, the kidney will be offered to the next person on the list.
In some cases, you may be called as back-up. This means there are other patients in front of you for a particular kidney. If they are not compatible or not available, you may be next in line to receive the kidney.
Some people are eligible for "pre-emptive" kidney transplantation. This means that you are able to have a transplant before going on dialysis.
Organ rejection and other potential complications
In order to ensure the best possible outcome for kidney transplant, you will take special medications called immunosuppressants, which "suppress" (hold down) your body's immune system to keep it from fighting against the "foreign" kidney being transplanted in your body.
In some cases, regardless of how well the antigens of the kidney donor are matched with your own, the immunosuppressant fails to prevent your immune system from attacking the donor organ. This is called rejection, and there are three different types:
- Hyperacute rejection – happens within minutes of transplant, an emergency requiring immediate removal of the donor kidney
- Acute rejection – within one week to three months of transplant
- Chronic rejection – occurs over many years as your immune response causes slow and steady damage
Aside from organ rejection, you may experience side effects from the immunosuppressants, such as bone thinning and bone damage, high cholesterol and blood pressure, edema (swelling), and increased risk of cancer.
Additional complications may also arise, including blood clots, infection, bleeding, development of diabetes mellitus, and failure of the donor kidney.
Having a kidney transplant is a life-altering experience. Be sure to discuss your thoughts and concerns with your doctor as well as trusted family, friends and advisors to determine whether this type of surgery is right for you.
Visit our frequently asked questions page to find additional answers to questions you might have about kidney transplant options.