By Dr. Vantario Taylor, Transplant & General Surgeon
There are several conditions that can cause kidney failure. Long standing diabetes, as well as poorly controlled high blood pressure are common reasons worldwide and locally. Other reasons include inflammation of the kidneys, blockage of both kidneys and kidney problems present at birth.
When your kidneys fail, treatment is required to take over the work that the failing kidneys no longer can do. There are two types of treatment for kidney failure: dialysis or transplant. Most people feel that a kidney transplant offers more freedom and a better quality of life than dialysis.
What is a kidney transplant?
When a patient gets a kidney transplant, a healthy kidney is placed inside their body to do the work their own kidneys can no longer do. Advantages include fewer restrictions on what the patient can eat and drink, but they should continue to follow a heart-healthy diet. Health and energy stolen by the disease should return. Really, a successful transplant allows patients to live the type of life they had before the diagnosis. Studies have shown that those who receive a transplant live longer as well.
Disadvantages include the risks of surgery and the need to take antirejection medication for as long as the new kidney is working. These medications can have side effects and increase the risk of infections and certain types of cancer. While most transplants are successful and last for many years, the number of years can vary from person to person. Many patients will need more than one kidney transplant in their lifetime.
Who can get a kidney transplant?
Kidney patients of all ages from small children to senior citizens are eligible. They must be healthy enough for the operation and free from cancer and infection. Everyone being considered will receive a thorough medical and psychosocial evaluation to make sure they are a good candidate. The evaluation process helps to find any problems, which can be corrected before transplant.
What happens during the evaluation?
A team of medical professionals will conduct a full physical exam, review health records, and order a series of tests and x rays to learn the patient ’ s general health. Everything that can affect how well they will handle treatment will be checked. It is a very thorough as the transplant team needs to know a lot about the patient to decide if transplant is right for them. If someone you know would like to donate a kidney to you, that person will also need to go through a screening to see if they are a match and fit to donate. If the evaluation process finds that a transplant is right for you, the next step is finding a suitable kidney.
What about the operation itself?
It may be a surprise to some, but the patient’s own kidneys generally aren’t taken out when you they a transplant. The surgeon leaves them where they are unless there is a medical reason to remove them. The donated kidney is placed into the lower abdomen (belly), where it’s easiest to connect it to the important blood vessels and bladder. Putting the new kidney in the abdomen also makes it easier to take care of any problems that might come up. The operation takes about four hours. The patient will be sore at first, but they should be out of bed in a day or so, and home within a week. If the kidney came from a living donor, it should start to work very quickly. A kidney from a deceased donor can take longer to start working—two to four weeks or more. If that happens, dialysis may be needed until the kidney begins to work. After surgery, the patient is taught about the medicines they’ll have to take and their side effects. They’ll also learn about diet. In those coming from dialysis, they’ll find that there are fewer restrictions on what they can eat and drink, which is one of the benefits of a transplant.
Where do the donated kidneys come from?
A donated kidney may come from someone who died and donated a healthy kidney. A person who has died and donated a kidney is called a deceased donor.
Donated kidneys also can come from a living donor. This person may be a blood relative (like a brother or sister) or non-blood relative (like a husband or wife). They can also come from a friend or even a stranger.
When a kidney is donated by a living person, the operations are done on the same day and can be scheduled at a convenient time for both the patient and the donor. A healthy person who donates a kidney can live a normal life with the one kidney that is left. But the operation is major surgery for the donor, as well as the recipient. As in any operation, there are some risks that you will need to consider. To get a deceased donor kidney, you will be placed on a waiting list once you have been cleared for a transplant. It can take many years for a good donor kidney to be offered to you. From the time you go on the list until a kidney is found, you may have to be on some form of dialysis. While you’re waiting, you’ll need regular blood tests to make sure you are ready when a kidney is found. If you’re on dialysis, your center will make the arrangements for these tests. Your transplant center should know how to reach you at all times. Once a kidney become available, the surgery must be done as soon as possible. In the Bahamas, we do not have a deceased donor program just yet so upcoming transplants performed here will be living donor transplants.