A kidney transplant is a surgical procedure to place a healthy kidney from a living or deceased donor into a person whose kidneys no longer function properly.
The kidneys are two bean-shaped organs located on each side of the spine just below the rib cage. Each is about the size of a fist. Their main function is to filter and remove waste, minerals and fluid from the blood by producing urine.
When your kidneys lose this filtering ability, harmful levels of fluid and waste accumulate in your body, which can raise your blood pressure and result in kidney failure (end-stage kidney disease). End-stage renal disease occurs when the kidneys have lost about 90% of their ability to function normally.
Common causes of end-stage kidney disease include:
People with end-stage renal disease need to have waste removed from their bloodstream via a machine (dialysis) or a kidney transplant to stay alive.
During kidney transplant surgery, the donor kidney is placed in your lower abdomen. Blood vessels of the new kidney are attached to blood vessels in the lower part of your abdomen, just above one of your legs. The new kidney's urine tube (ureter) is connected to your bladder. Unless they are causing complications, your own kidneys are left in place.
A kidney transplant is often the treatment of choice for kidney failure, compared with a lifetime on dialysis. A kidney transplant can treat chronic kidney disease or end-stage renal disease to help you feel better and live longer.
Compared with dialysis, kidney transplant is associated with:
Some people may also benefit from receiving a kidney transplant before needing to go on dialysis, a procedure known as preemptive kidney transplant.
But for certain people with kidney failure, a kidney transplant may be more risky than dialysis. Conditions that may prevent you from being eligible for a kidney transplant include:
Only one donated kidney is needed to replace two failed kidneys, making living-donor kidney transplantation an option.
If a compatible living donor isn't available, your name may be placed on a kidney transplant waiting list to receive a kidney from a deceased donor.
How long you have to wait for a deceased donor organ depends on the degree of matching or compatibility between you and the donor, time on dialysis and on the transplant waitlist, and expected survival post-transplant. Some people get a match within several months, and others may wait several years.
Kidney transplantation can treat advanced kidney disease and kidney failure, but it is not a cure. Some forms of kidney disease may return after transplant.
The health risks associated with kidney transplant include those associated directly with the surgery itself, rejection of the donor organ and side effects of taking medications (anti-rejection or immunosuppressants) needed to prevent your body from rejecting the donated kidney.
Deciding whether kidney transplant is right for you is a personal decision that deserves careful thought and consideration of the serious risks and benefits. Talk through your decision with your friends, family and other trusted advisors.
Kidney transplant surgery carries a risk of significant complications, including:
After a kidney transplant, you'll take medications to help prevent your body from rejecting the donor kidney. These medications can cause a variety of side effects, including:
Other side effects may include:
If your doctor recommends a kidney transplant, you'll be referred to a transplant center. You're also free to select a transplant center on your own or choose a center from your insurance company's list of preferred providers.
When you consider transplant centers, you may want to:
You may also consider:
After you've selected a transplant center, you'll be evaluated to determine whether you meet the center's eligibility requirements for a kidney transplant.
The team at the transplant center will assess whether you:
The evaluation process may take several days and includes:
After your evaluation, your transplant team will discuss the results with you and tell you whether you've been accepted as a kidney transplant candidate. Each transplant center has its own eligibility criteria. If you aren't accepted at one transplant center, you may apply to others.
A kidney donor can be living or deceased, related or unrelated to you. Your transplant team will consider several factors when evaluating whether a donor kidney will be a good match for you.
Tests to determine whether a donated kidney may be suitable for you include:
Additional factors your transplant team may consider in finding the most appropriate donor kidney for you include matching age, kidney size and infection exposure.
Finding a willing living kidney donor is an alternative to waiting for a compatible deceased-donor kidney to become available.
Family members are often the most likely to be compatible living kidney donors. But successful living-donor transplants are also common with kidneys donated from unrelated people, such as friends, co-workers or religious congregation members.
Paired donation is another type of living kidney donation if you have a willing kidney donor whose organ is not compatible with you or does not match well for other reasons. Rather than donating a kidney directly to you, your donor may give a kidney to someone who may be a better match. Then you receive a compatible kidney from that recipient's donor.
In some cases, more than two pairs of donors and recipients may be linked with a nondirected living kidney donor to form a donation chain with several recipients benefitting from the nondirected donor's gift.
If a compatible living donor isn't available, your name will be placed on a waiting list for a deceased-donor kidney. Because there are fewer available kidneys than there are people waiting for a transplant, the waiting list continues to grow. The waiting time for a deceased-donor kidney is usually a few years.
Whether you're waiting for a donated kidney or your transplant surgery is already scheduled, work to stay healthy. Being healthy and as active as you're able can make it more likely you'll be ready for the transplant surgery when the time comes. It may also help speed your recovery from surgery. Work to:
Stay in touch with your transplant team and let them know of any significant changes in your health. If you're waiting for a donated kidney, make sure the transplant team knows how to reach you at all times. Keep your packed hospital bag handy, and make arrangements for transportation to the transplant center in advance.
Kidney transplants are performed with general anesthesia, so you're not awake during the procedure. The surgical team monitors your heart rate, blood pressure and blood oxygen level throughout the procedure.
During the surgery:
After your kidney transplant, you can expect to:
In paired-organ donation, living donors and their recipients aren't compatible for a transplant. However, the donor of each pair is compatible with the recipient of the other pair. If both donors and recipients are willing, doctors may consider a paired donation.
More than one pair of incompatible living donors and recipients may be linked with a nondirected living donor to form a donation chain in order to receive compatible organs.
During kidney transplant surgery, the donor kidney is placed in your lower abdomen. Blood vessels of the new kidney are attached to blood vessels in the lower part of your abdomen, just above one of your legs. The new kidney's ureter is connected to your bladder. Unless they are causing complications, your own kidneys are left in place.
After a successful kidney transplant, your new kidney will filter your blood, and you will no longer need dialysis.
To prevent your body from rejecting your donor kidney, you'll need medications to suppress your immune system. Because these anti-rejection medications make your body more vulnerable to infection, your doctor may also prescribe antibacterial, antiviral and antifungal medications.
It is important to take all your medicines as your doctor prescribes. Your body may reject your new kidney if you skip your medications even for a short period of time. Contact your transplant team immediately if you are having side effects that prevent you from taking your medications.
After your transplant, skin self-checks and checkups with a dermatologist to screen for skin cancer and keeping your other cancer screening up-to-date is strongly advised.
Survival rates among kidney transplant recipients in U.S. transplant centers can be found online at the Scientific Registry of Transplant Recipients website.
If your new kidney fails, you can resume dialysis or consider a second transplant. You may also choose to discontinue treatment. If you decide to discontinue treatment, your doctor can give you medicines to help relieve your symptoms. This decision depends on your current health, your ability to withstand surgery and your expectations for maintaining a certain quality of life.