Kidney Transplantation Donor procedure - information of surgery
A surgical OPERATION to place a healthy, functioning kidney into a person whose own kidneys have permanently failed. The first successful kidney transplantation took place between identical twin brothers in 1954. However, until the discovery of the immunosuppressive DRUG cyclosporine in 1983, the risk of organ rejection was very high, and kidney transplantation was a treatment of last resort. With current IMMUNOSUPPRESSIVE THERAPY the recipient of a transplanted kidney can expect to live 5 to 20 years or longer with relatively normal kidney function.
Since the mid-1980s kidney transplantation has become the standard of treatment for END-STAGE RENAL DISEASE (ESRD), also called permanent kidney failure (RENAL FAILURE). Transplant surgeons in the United States perform about 15,000 kidney transplant operations each year. However, a severe shortage of donor kidneys limits the availability of kidney transplantation. Another 30,000 to 45,000 people are eligible for kidney transplantations and await donor organs. A donor kidney may be a cadaver organ donation (donated after a person’s death) or come from a person who has two healthy kidneys and offers to donate one to the recipient.
In the United States, the federal health-care program Medicare pays for 80 percent of most expenses related to kidney transplantation for those who meet the qualification criteria. The U.S. Centers for Medicare and Medicaid Services Web site (www.cms.hhs.gov) provides comprehensive information about eligibility and covered services. Private health insurance and other public programs also provide coverage for kidney transplantation costs, though coverage varies among carriers and programs.
Donor Kidneys
The primary source of donor kidneys is cadaver donation—people who authorize the donation of their organs when they die. In the United States the United Network for Organ Sharing (UNOS) administers the nationwide cadaver donor organ collection and distribution program, the Organ Procurement and Transplantation Network (OPTN). People eligible for kidney transplantation register with OPTN through regional organ transplantation centers. OPTN follows strict guidelines intended to ensure equitable access to donor organs. People may wait several months to several years for a matched cadaver donor kidney, as the OPTN system distributes organs to matched recipients who are the sickest.
The wait time for a living donor kidney transplant is typically significantly shorter, often only several months, because as soon as the transplant team confirms the intended donor is a match the surgeries (donation and transplantation) can take place. Living organ donation does not fall within OPTN. Only the intended recipient may receive the kidney from the living donor. The living donor is often a family member though may be a stranger who is a strong match with the recipient.
Donor-Recipient Match
The donor kidney must match the recipient as closely as possible in three ways. First, the donor and the recipient must have the same BLOOD TYPE. Second, the donor and the recipient must match HUMAN LEUKOCYTE ANTIGENS (HLAS), which are proteins on the surfaces of leukocytes (white BLOOD cells), as closely as possible. Every person has six HLAs. The more HLAs that match between donor and recipient, the higher the likelihood that the recipient’s body will accept the donor kidney (though all organ transplant recipients take lifelong immunosuppressive therapy). Transplant surgeons like to see a match of three or more HLAs. Third, the donor’s blood must not initiate an ANTIBODY response with the recipient’s blood (called a negative crossmatch), which the transplant team tests by mixing samples of blood from each in a test tube.
Surgical Procedure
The transplant surgery generally takes three to five hours. With the person under general ANESTHESIA, the transplant surgeon makes an incision in the lower abdomen, placing the donor kidney in the abdominal cavity below the native kidneys. The surgeon attaches the donor kidney’s arteries and veins to the recipient’s iliac ARTERY and iliac VEIN, respectively, and the donor kidney’s URETER to the BLADDER. Depending on the reason for the ESRD, the surgeon may either leave or remove the recipient’s nonfunctioning kidneys. After returning to full consciousness in the recovery room, the recipient typically remains in the hospital for three to five days. The transplanted kidney may begin functioning immediately or take several weeks. The recipient undergoes RENAL DIALYSIS until kidney function becomes adequate.
Risks and Complications
The risks of transplantation surgery include bleeding during or after the operation and postoperative INFECTION. Because the transplanted kidney is lower in the abdomen than the native kidneys it lacks the protection of the rib cage and is more vulnerable to traumatic injury. Rarely the recipient’s body may immediately reject the donor organ, in which case the transplant team must operate again to remove it. Most people recover fully from the surgery without complications, though there is always the risk of organ rejection. Many kidney transplant recipients experience episodes of organ rejection that the transplant doctor can treat with various medications. The IMMUNOSUPPRESSIVE THERAPY that is necessary for organ transplant recipients to take lowers the body’s overall immune response, lowering resistance to infection. IMMUNOSUPPRESSIVE MEDICATIONS have numerous other side effects as well. People who take long-term immunosuppressive therapy do have an increased risk for LYMPHOMA, a type of cancer that affects the lymph nodes.
Outlook and Lifestyle Modifications
Most people who receive transplanted kidneys feel better immediately after surgery and enjoy relatively normal lifestyles after recovering from surgery; however, they must continue taking immunosuppressive medications and receive regular medical checkups to monitor the health of their transplanted kidneys. Doctors generally recommend that people who have transplanted kidneys avoid activities with increased risk for blunt trauma to the abdomen, such as contact sports. The doctor may further recommend specific dietary and lifestyle modifications to maintain optimal kidney function.
See also ORGAN TRANSPLANTATION; SURGERY BENEFIT AND RISK ASSESSMENT.
