Paths to Transplantation

Benefits Of A Kidney Transplant
Living Donor Transplants
Deceased Donor Transplants
Expanded Criteria Donor Kidneys
Pancreas Transplants
Complications

Benefits of a Kidney Transplant
There are important advantages of kidney transplantation over dialysis. The lifestyle of a transplant recipient is improved because time is not spent in a dialysis unit. This allows freedom to travel, work and enjoy the life you remember prior to suffering kidney failure. A transplanted kidney corrects mineral levels more naturally, resulting in fewer dietary restrictions, no fluid restrictions and more energy, activity and independence. Perhaps the most important long-term benefit is a longer life.

There are responsibilities, however. In addition to always taking the prescribed medicines, you need to be careful about side effects these medicines may have. Transplantation will not cure all the medical problems you have, but it can significantly benefit lifestyle.

Living Donor Transplants
Some chronic kidney disease (CKD) patients know someone who will donate a kidney to them. If initial screening tests are clear and a potential living donor happens to be a successful match, a full, careful evaluation can be done. If the timing is right, this pair may complete a kidney transplant before the recipient ever starts dialysis. Alternatively, patients who have already started dialysis may receive a kidney from someone they know and are able to stop dialysis. Living donation is an important part of transplantation at Virginia Mason. Kidneys from living donors function sooner after transplant, provide better kidney function and last longer than those from deceased donors. Surgeons can now remove a kidney from a donor via laparoscopy, which speeds the recovery time of the person donating the kidney.

Living kidney donation and transplants are scheduled to occur at convenient times for the donor and the recipient. The results are slightly better than kidney transplantations from deceased donors. Donors do very well with their single remaining healthy kidney while their other kidney now helps keep someone else from requiring dialysis. All donors are carefully screened to be sure they are safe to donate and only donate out of the goodness of their hearts.

It is against the law to ever pay anyone in the United States to donate an organ. Regardless of sensational news stories and urban myths that circulate, the sale of organs is against the law and never done in this country. We feel that our living organ donors are very special, generous people and we want them all to receive individual attention while making this gift.

Deceased Donor Transplants
Dialysis patients, or those who will need dialysis soon, who do not have a donor may be placed on a national list for people waiting for a kidney transplant from a deceased donor.

Just under half of our transplanted kidneys come from a deceased donor, a hospitalized person whose brain is no longer functioning. These patients are usually victims of accidents who were otherwise completely healthy before the accident. Most of these donors give organs to seven or more recipients, sometimes in different parts of the country, who have organ failure (heart, lungs, liver, kidneys, pancreas).

There is a carefully organized and regulated system for sharing these valuable and life-saving organs across the country and there are many resources for learning about how it is done. Special care is taken to keep the donor's name private and to allow the family to let their loved one make this special gift. Once a kidney from a deceased donor is available, it must be transplanted as soon as possible, usually within 36 hours. A person waiting for a deceased donor transplant must be prepared to travel to the Transplant Center at any time, and the Center must be able to contact the patient quickly. Patients on the list can be issued special pagers and their contact numbers must be kept on file.

Expanded Criteria Donor Kidneys
There is an increasing shortage of deceased donor kidneys (kidneys recovered from someone who died) while, at the same time, an increasing number of
patients with kidney failure being listed for transplantation. The waiting list increases by several thousand each year. One effort to increase the number of
deceased donor kidneys is to use expanded criteria donor kidneys. These are kidneys from donors whose characteristics may include general or organ-specific factors such as advanced donor age, prior infection with hepatitis B or hepatitis C, history of high blood pressure, diabetes mellitus, abnormal donor organ function or non-heartbeating status of a deceased donor. Kidneys from expanded criteria donors will be offered only to patients who we feel are appropriate and have agreed in advance to be considered for an expanded criteria kidney. During the evaluation appointment, your Transplant Nurse Coordinator will discuss this option and answer any questions. We expect this kidney to work, and work well, though likely the function will not last as long.

Pancreas Transplants
The pancreas is an organ that performs many functions. Patients with diabetes often have developed this from destruction of the insulin producing cells (islets) in their pancreas. In patients that have diabetes due to the lack of insulin production (type 1), a pancreas transplant allows them to stop insulin shots and avoid many of the dangerous health problems of lifelong diabetes.

A pancreas transplant is a far more complex operation than a kidney transplant. The ability of the pancreas to make digestive enzymes makes it difficult to handle. Both the operation and recovery periods are longer. Pancreas transplants are only an option for about one in ten diabetic patients with kidney failure. Such a transplant may be an important option to consider for someone with insulin-requiring diabetes since childhood.

A pancreas can be placed at the same time as a kidney transplant (simultaneous pancreas-kidney or SPK), or a patient may receive a pancreas after the kidney transplant (pancreas after kidney or PAK) or before a patient needs a kidney transplant. At Virginia Mason, we do about ten kidney transplants for every pancreas transplant we perform. Pancreas transplants can only come from deceased donors.

Complications
We do many kidney transplants each year at Virginia Mason and most patients do very well. A kidney transplant involves an incision and isolation of the important vessels that supply the legs. There are three connections: the artery, the vein and the urine tube (ureter) that connects the kidney internally to the bladder so the patient can urinate normally. After surgery, we are concerned about these three important connections and we often do scans to make sure nothing leaks.

At first, there are a variety of six to 12 new medications transplant patients need to take. Some are to protect against infections, others to block a rejection of the new kidney and others for protection against new problems (described in detail in the section). All these medications can have side effects or can interact with each other. Good communication between you and your caregivers is crucial in determining how a particular individual tolerates these medicines. After the first few months, the number of medications is quickly reduced and the regimen becomes much easier to follow, but at first it requires a lot of work and attention.

Rejection is the process of your body's immune system attacking the transplanted organ. We take multiple steps to avoid this predictable response.

Transplant patients take anti-rejection medications that keep your body from recognizing some invading micro-organisms as foreign and suppressing the body's natural immune response that could leaving the patient more susceptible to infection. We use medications to keep this to a minimum and we are extra careful with our patients to listen to new symptoms and treat infections quickly.

In addition to surgical problems, medication problems, rejection and infections, underlying illnesses can get worse with the stress of surgery. Often, the patients who come to us for transplantation may have once had a severe medical problem like a heart attack or stroke but still wish to go ahead with a kidney transplant. These patients are at increased risk from surgery and are screened and tested carefully.

Patients who have been on dialysis for many years are also at higher risk during the time of surgery. Death is very rare, but it can happen. Every transplant program is closely supervised and the federal government publishes results on every transplant center in the United States on the Internet. We are proud of our superb results at Virginia Mason.