Who Performs the Kidney Transplants? Where Is It Performed?

A kidney transplant is performed by a transplant surgeon in one of more than 200 UNOS-approved hospitals nationwide. If the patient has no living donor, he or she must go through an evaluation procedure to get on the UNOS national waiting list and the UNOS Organ Center's UNet database.

Questions to Ask the Doctor

How many kidney transplants have both you and the hospital performed?
What are your transplant success rates? How about those of the hospital?
Who will be on my transplant team?
Can I get on the waiting list at more than one hospital?
Will my transplant be performed with a laparoscopic or an open nephrectomy?
What type of immunosuppressive drugs will I be on post-transplant?

Organ transplantation is subject to the law of supply and demand, and demand for organs far outweighs supply from both living and deceased donors. But results from a new, nationwide Scientific Registry of Transplant Recipients (SRTR) study led by University of Michigan (U-M) Health System researchers may offer new hope to some patients with end-stage renal disease waiting for a kidney transplant.

The study found that the growing use of organs from expanded criteria donors (ECD) - older donors and those with certain pre-existing kidney or other medical problems is not only adding to the pool of kidneys available for transplantation, but also increasing the chances for survival for certain patients with end-stage renal disease, depending on their age, how long they would need to wait for a donor organ, and the severity of their kidney disease.

Results from this study are published in the Dec. 7, 2005, Journal of the American Medical Association (JAMA). Currently, more than 64,000 Americans await a kidney transplant. With the need for kidneys increasing and the number of available kidneys from deceased donors failing to keep pace, patients may wait years for a healthy, or non-ECD, kidney to become available.

But many can't afford to wait. So more patients are turning to ECD kidneys - despite a higher risk for organ failure - in lieu of staying on dialysis while waiting for a healthier kidney to become available, says lead author Robert M. Merion, M.D., a professor in the surgery department at U-M Medical School. "The real challenge has been determining which patients would benefit most by taking the ECD kidney now and which ones would be better served by waiting for a healthier kidney for transplantation," says Merion, the clinical transplant director for the SRTR, which is administered by the University Renal Research and Education Association (URREA), an independent, nonprofit research organization, and supports the ongoing evaluation of the scientific and clinical status of solid organ transplantation in the United States.

"We calculated the average lifetime for patients who accept an ECD organ compared to those who remained on dialysis with the option of accepting a non-ECD transplant at a later time, in order to help patients choose between these options," says co-author Robert A. Wolfe, Ph.D., professor emeritus of biostatistics at the U-M School of Public Health. "The answer depends upon the patient's situation, so different patients might make different choices based on their particular situation and their willingness to trade off an earlier transplant with an ECD kidney vs. a higher chance of failure of the transplant."

To gauge which patients are better off opting for an ECD kidney transplant now rather than waiting for a non-ECD kidney, Merion and his colleagues measured the outcomes of patients on dialysis from the day they were placed on the organ wait list. The study looked at all U.S. patients a total of 109,127 people who were on dialysis for kidney failure and had been added to an organ wait list between 1995 and 2002. Researchers followed their progress through July 2004.

Factors such as age, gender, ethnicity, the cause of the patient's kidney disease, and the local wait time for a non-ECD kidney were all taken into account. Outcomes for patients who did not receive a transplant or got a non-ECD kidney were then combined and compared against patients who had an ECD kidney transplant. By the end of the study, 7,790 candidates received an ECD kidney transplant, 41,052 received a non-ECD deceased donor transplant, 15,203 received a living donor transplant, and 45,082 either died before receiving a transplant or were still waiting for a donor kidney.

Overall, recipients of ECD kidney transplants had a 17 percent long-term lower risk of dying when compared with those who remained on dialysis or eventually received a non-ECD transplant. However, not all patients were found to enjoy this benefit. Researchers found ECD kidneys to have the greatest benefits, in terms of survival, for patients over the age of 40 and those who would need to wait more than 44 months for a non-ECD kidney to become available. Only diabetic patients were found to benefit from ECD kidneys in areas where wait times were shorter. For patients younger than 40, there was no significant advantage to accepting an ECD kidney.

In general, two main groups of patients emerged as the best recipients of ECD kidneys: patients with long projected wait times and/or limited access to donor kidneys, and those with kidney failure due to diabetes, which can lead to death from other medical complications, such as heart attack or stroke. "ECD kidneys are clearly a good solution in certain situations," says Merion. "This study's results allow us, with greater clarity than before, to maximize the benefits of ECD kidneys for patients, and match patients with a transplant option that will offer them the best chance for survival."

Merion notes that the study provides useful new information that transplant physicians can use to counsel patients entering the wait list for organs. While this study focuses on survival rates of kidney transplant patients, Merion says future research needs to be done to address quality of life issues for patients who remain on dialysis and those who opt for an ECD kidney transplant

Kidney Transplant

When an individual's kidneys fail, three treatment options are available: hemodialysis, peritoneal dialysis and kidney transplantation. Many patients feel that a successful kidney transplant provides a better quality of life because it allows greater freedom and often is associated with increased energy levels and a less restricted diet. In making a decision about whether this is the best treatment for you, you may find it helpful to talk to people who already have had a kidney transplant. You also need to speak to your doctor, nurse and family members.

What is a kidney transplant?

A kidney transplant is an operation in which a person whose own kidneys have failed receives a new kidney to take over the work of cleaning the blood.

Are there different kinds of kidney transplants?

Yes. There are two types of kidney transplants: those that come from living donors and those that come from unrelated donors who have died (non-living donors). A living donor may be someone in your immediate or extended family or your spouse or close friend, and in some cases a stranger who wished to donate a kidney to anyone in need of a transplant. There are advantages and disadvantages to both types of kidney transplants. These are covered in the NKF's free brochure "Kidney Transplant." You can obtain a copy by calling 800 622-9010.

How do I start the process of getting a kidney transplant?

Your doctor can discuss the transplant process with you or refer you to a transplant center for further evaluation.

How can I pay for my transplant?

Most private health insurance policies cover many expenses associated with kidney transplants, including medications. In addition, most kidney transplant candidates are eligible for Medicare, which will cover 80 percent of the cost of the transplant surgery. After transplantation, you will need to take medications to prevent rejection of your new kidney. Medicare Part B will cover 80 percent of the cost of these anti-rejection medications, but not the cost of other medications you may need. For most patients, this Medicare coverage will stop after 36 months. However, if you are eligible for Medicare coverage based on age or disability, the cost of your anti-rejection medications may be covered for as long as you are on medicare. The social worker or financial counselor at your transplant center should be available to answer questions about your coverage options.

What is rejection?

The most important complication that may occur after transplant is rejection of the kidney. The body's immune system guards against attack by all foreign matter, such as bacteria. This defense system may recognize tissue transplanted from someone else as "foreign" and act to combat this "foreign invader."

You will need to take medications every day to prevent rejection of your new kidney. Most patients need to take three types. The major one is usually cyclosporine or tacrolimus or sirolimus. In addition, you will most likely be taking some type of steroid and a third medication, such as mycophenolate mofetil, azathioprine or rapamycin. Additional treatment may be needed if a rejection episode occurs. Regular checkups at your transplant center will ensure early detection and treatment of rejection.

What are the side effects of the anti-rejection medications?

Anti-rejection medications have a large number of possible side effects because the body's immune defenses are suppressed. Fortunately, these side effects usually are manageable for most patients. If side effects do occur, changing the dose or type of the medications will usually take care of them. Some of the most common side effects include high blood pressure, weight gain and a susceptibility to infections and tumors. You may also require additional medications to maintain blood pressure and prevent ulcers and infections.

What are the chances that a transplanted kidney will continue to function normally?

Results of transplantation are improving steadily with research advances. In the event that a transplanted kidney fails, a second transplant may be a good option for many patients.

Will I need to follow a special diet?

Kidney transplants, like other treatments for kidney failure, often require following special diet guidelines. If you were on dialysis before, you may find this new diet less restricted. The length of time you must follow the special diet varies. Your progress will be followed closely, and your doctor and dietitian will change your diet as needed.

What else can I do?

Call (800) 771-3325 today for more information or to get a free quote.