Kidney transplants are performed as treatment for end-stage renal disease (ESRD), or kidney failure. Diabetes is the leading cause of kidney failure. Diabetes can damage blood vessels and nerves, thereby affecting kidney function. Uncontrolled high blood pressure can also lead to kidney failure. Other diseases for which transplantation may be indicated include glomerulonephritis, an inflammatory kidney condition, and polycystic kidney disease, a genetic disorder producing numerous cysts as well as other diseases negatively affecting kidney function.
Types of Transplants
A living donor can be "related" (parent, son, daughter, brother, sister, aunt, uncle, niece, nephew, cousin) or "non-related" (husband, wife, in-laws, friends). A living donor is the ideal choice for several reasons:
- There is a higher transplant success rate achieved due to better donor-recipient tissue matching.
- The time spent waiting for a suitable kidney is significantly decreased.
- The surgery can be scheduled at a convenient time for both the donor and the recipient.
- Recipient receiving a live donor kidney may require fewer immunosuppressive medications.
If a living donor is not available, a kidney from a deceased donor is considered for transplantation. In this case, the potential recipient is placed on the UNOS national donor waiting list. Because the donated kidney must match the recipient's blood type, the waiting period can be several years. While waiting, the recipient must follow the physician's orders and be evaluated periodically.
The first step in the transplantation process begins with a referral to the TriStar Centennial Kidney Transplant Program by the prospective patient's physician. A transplant financial coordinator verifies insurance benefits and begins creating a financial plan regarding all transplant services. The clinic then contacts the patient and the referring physician's office to discuss expectations and schedule an appointment for a half-day pre-transplant evaluation. Recipients are encouraged to bring their potential donors with them to the initial visit.
During the initial clinic visit, the patient meets with the transplant team, including the transplant physician, nurse, die titian, and social worker for a psychosocial evaluation. After the first visit, the transplant team meets to review and discuss the medical, psychosocial, and diagnostic test results from the evaluation at a Patient Care Conference to determine candidacy.
Usually within two weeks of the first visit, the patient, referring physician, and insurance company are given the recommendations made at the Patient Care Conference. For most patients, additional diagnostic tests are required. The clinic??s scheduling staff will work with the patient and dialysis center to have those tests completed as quickly as possible.
Once additional tests are completed and reviewed by the transplant surgeon, the patient is added to the UNOS national donor waiting list and candidacy is determined. If the patient has potential living donors, the donor evaluation begins only after the recipient is cleared. The process for clearing a transplant recipient might take a few weeks or could continue for months. TriStar Centennial Transplant Program is committed to working with the patient at a comfortable pace throughout the evaluation process.
If a compatible living donor cannot be found, the patient must wait for a kidney from a deceased donor which may become available at any time of the day or night. While waiting, the patient follows the physician's orders for dialysis and routine evaluations. Once a kidney becomes available, the patient will be contacted and given specific instructions. The patient will undergo pre-operative testing and receive a physical examination by the transplant physicians to ensure their medical condition is still suitable to receive a new kidney.
Private insurance, as well as Medicare and Medicaid, provides coverage for kidney transplants. Medicare will cover 100% of a living donor?E??Es hospital costs along with any pre-transplant work ups. Our financial coordinators can assist the patient with information and planning.
Our medical, social, and financial specialists are always available to answer questions and provide assistance regarding transplantation.
Patients are notified by the transplant coordinator when a kidney is available for transplant and surgery is scheduled. In the case of a living donation, the coordinator will schedule the two surgeries. After being admitted to the hospital, the patient may undergo some additional pre-operative testing and dialysis.
The transplant operation usually lasts approximately four hours. An incision is made in the lower right or left side of the abdomen above the groin. The new kidney is connected to the bladder and surrounding blood vessels. The diseased kidney is normally not removed unless there are infection risks or increased si" if not removed the diseased kidney will naturally shrink over time. A tube (foley catheter) is placed in the bladder for post-operative urine drainage.
After surgery the patient is usually taken to the Intensive Care Unit (ICU) for 24 hours then transferred to a normal hospital floor. Sitting is restricted for 72 hours to eliminate pressure on the incision. However, the patient can get out of bed and walk with assistance. Coughing and deep breathing exercises are performed to clear the lungs. Dialysis may be necessary temporarily if the new kidney does not immediately function.
The average hospital stay is five days but varies for each individual patient. While hospitalized, the multi-disciplinary team of transplant coordinators, dieticians, social workers and support staff provide post-transplant education and support services. The patient is instructed about diet and exercise. Classes are held to teach medication usage. Discharge arrangements are also planned and may include home care, resumption of daily activities, and scheduling of follow-up clinic visits.
After discharge from the hospital, activity will be limited for six to eight weeks. Mild exercise, such as walking, is encouraged but driving and strenuous exercises are prohibited. The patient must keep a daily record of temperature; intake/output, and doses and times medication is taken. Patients usually return to work within two to three weeks