The Kidney Transplant Process

Kidney transplants are performed using a kidney from one of two sources a deceased donor or a living donor.

Deceased donors are people who have recently died but who provided prior permission for their healthy organs to be used for life-sustaining transplants.

Living donors are people who are willing to donate one of their kidneys to someone with chronic kidney disease. The living donor option offers several advantages, including shorter waiting times and better long-term kidney survival rates. For a healthy individual, living kidney donation is a rewarding experience. The overall risks are considered to be low.

Regardless of the source, donated kidneys must come from individuals whose blood type and characteristics match those of the recipient. New immunosuppressant medications that counteract the body's tendency to reject foreign tissues have increased the one-year success rate for deceased kidney transplants to 92 percent and for living kidney transplants to 96 percent.

Your transplant coordinator will talk with you about the process for receiving a donated kidney.

If you are interested in receiving a deceased donor kidney, information including your name and blood and tissue type will be placed on the national United Network for Organ Sharing (UNOS) patient waiting list. When an organ becomes available, the UNOS computer will generate a list of patients ranked by criteria including blood and tissue type, immune status and length of waiting time. This ranking system alone is used to choose the recipient, who is then contacted and scheduled for final testing and surgery.

If you have a willing living donor who is compatible with you, donor evaluation leading to a transplant may begin immediately. If your living donor is not compatible, there are other options for continuing the transplant process. Through a program called a proxy donation, your living donor may donate to someone who is on the waiting list for a deceased donor organ. This allows you to move to the top of the deceased donor waiting list in your blood group.

Another option is to register to become part of a paired kidney exchange program. Through paired donation, friends or family members may donate to a suitable recipient through a paired kidney exchange program such as the National Kidney Registry, of which the Virginia Transplant Center is a member. Your loved one will receive a kidney from a compatible living donor in the network. This program has greatly expanded the opportunities for living donor transplants.

• If you receive a deceased donor kidney, you will be called to come to the hospital as soon as the kidney becomes available. Because there is no way to predict when that may happen, it's important that you are prepared to come to the hospital at any time.
• If you receive a kidney from a living donor, your transplant surgery will be scheduled at a time that is convenient for you and your donor. You will be admitted to the hospital the day before your surgery is scheduled.
• Once admitted, you will have your blood drawn, a chest X-ray and an EKG. The doctor will examine you to make sure there are no reasons to prevent the transplant at this time. You may receive dialysis prior to surgery.
• The surgery will take from two to four hours, during which time the donated kidney will be placed in your lower abdominal area and connected to the appropriate organs and veins.
• After your surgery, you'll be moved to the recovery room and then to an intensive care unit. You will have an intravenous fluid line, a catheter and other devices to allow your transplant team to monitor your progress.
• You can expect to remain in the hospital for approximately seven days.

The main medications prescribed after transplant surgeries are drugs known as immunosuppressants. These overpower your body's natural impulse to reject any foreign tissue. You will take these medications as prescribed for as long as you have a transplanted kidney. Failure to take these medications as directed may cause your donated kidney to fail.

For six weeks after your transplant, you will have follow-up appointments twice weekly for lab and other tests as required. Once you pass that benchmark, you will continue to come for lab tests and follow-up less often, but typically at least monthly. Appointments may be scheduled at the Virginia Transplant Center or your doctor's office.