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While dialysis is a life-saving treatment, it does only about 10 percent of the work that a functioning kidney does. Because of its impact on the body, dialysis can also cause other health problems. Patients typically live 10 to 15 years longer with a kidney transplant than if they stayed on dialysis. And most people report that in comparison, transplantation offers them a much better quality of life.
You will need a thorough evaluation by the Transplant Institute staff, in consultation with referring physicians, to determine if transplantation is the best treatment option. Being a good candidate for transplant depends upon your physical health, emotional well-being, and ability to manage medication and care plans.
If at all possible, it is best to have a transplant before you have dialysis or spend a long time on dialysis. Patients who have a living kidney donor have the best chance of avoiding dialysis, or being on dialysis for less time than if they had to wait for a deceased donor kidney. If you have a living donor, it may be possible for you to undergo a "preemptive transplant"; that is, before you ever need dialysis. Studies show that a transplanted kidney from a living donor functions longer, and the recipient lives longer, compared to those patients who have had dialysis prior to transplant.
With preemptive transplants, patients receive their kidney when their health is generally quite stable, which can improve new kidney function, and enhance overall health and life expectancy. Preemptive transplant is especially beneficial for patients with diabetes who need a kidney transplant, and who may also benefit from a subsequent deceased donor pancreas transplant.
However, no matter how long someone has been on dialysis, a transplant from a live donor should still be considered. Living donation can also be scheduled at the convenience of both donor and recipient, and is performed at a pre-determined time, rather than as an urgent operation when a deceased donor kidney becomes available.
Sometimes a relative, spouse or friend is able to donate a kidney to a loved one, provided the removal of the kidney will not harm the living donor's health. Or a Good Samaritan (a compassionate stranger) steps forward to donate. The donor must undergo a thorough medical evaluation that includes, among other things, blood work to assess tissue compatibility and the likelihood of organ rejection.
Living donation is preferred because it offers patients the best chance for a good quality kidney in the shortest possible waiting time. Once a living kidney donor has been medically cleared to donate, both surgeries (transplant and donation) can be scheduled at the convenience of the donor and recipient.
If a living donor is not an immediate option for you, then you will be listed with the United Network for Organ Sharing (UNOS). UNOS administers and maintains the national organ transplant waiting list.
The New England Organ Bank (NEOB) is the local (regional) procurement organization for Beth Israel Deaconess Medical Center, and shares organs through UNOS. Staff at NEOB will enter your medical information into a computer and will notify our transplant team when an organ becomes available based on your waiting time on the list, blood type and other factors. All organ procurement organizations and Transplant Institutes belong to UNOS. The NEOB operates according to policies set by UNOS, which is supervised by the federal government. Donor kidneys from deceased individuals are a precious national resource. The NEOB helps ensure equal access to all patients who need a kidney for transplant by balancing the needs of patients who have waited a long time with the goal of transplanting well-matched kidneys. It is a complex process. Please talk to the Transplant Institute team if you have questions.
Typically the wait for a deceased donor kidney is long, often several years. And there is no guarantee when a deceased donor kidney will become available. Patients could wait several years for a deceased donor kidney, during which time their health may decline. For this reason, we strongly advise patients to consider talking to family members, friends and others about living kidney donation.
Patients who have a living kidney donor may be able to avoid dialysis, or may spend less time on dialysis than if they had to wait for a deceased donor kidney. This has a number of health benefits for the transplant patient.
A pancreas transplant may be considered as a treatment option for some people who have Type 1 diabetes (when the body does not produce insulin). Those who have kidney failure or are about to require dialysis may be considered for a simultaneous deceased-kidney/pancreas transplant, or for a living or deceased donor kidney transplant followed by a deceased donor pancreas transplant. With the benefit of a living donor, some patients may undergo kidney transplant without ever experiencing dialysis or dialysis access surgery. Called preemptive transplants, these patients receive their kidney transplant when their health is generally quite stable, which can improve their immediate outcome and long-term prognosis.
Occasionally people with diabetes with early signs of kidney disease may be candidates for a pancreas transplant alone. With the addition of specialized transplant surgeons, and through closer collaboration with the world-renowned Joslin Diabetes Center, the Transplant Institute at Beth Israel Deaconess has established one of the more active pancreas transplant programs in New England.
You must always take anti-rejection medications for as long as you have a functioning transplant. You will also need medications to prevent infection for a short time after your transplant. Additionally, you may need at some point in time medications to control blood pressure and prevent fluid retention.
You are responsible for managing your own medication schedule, as determined by the Transplant Institute team. You should never stop taking your medication or change the dose without approval from the transplant team, even if you experience unpleasant side effects. Tolerating some side effects temporarily may be necessary in order to prevent organ rejection. Tell your transplant team about any side effects that bother you. Your doctor may be able to adjust your medication.
Rejection is a signal that your immune system has identified the new kidney as foreign tissue and is trying to get rid of it. Preventing rejection with immune-suppressing medication is the first priority. The most common sign of rejection is change in kidney function (an increase in creatinine, a waste product), as measured by a blood test. This is why you need frequent blood testing in the first three months after transplantation, and regular testing after that. If a kidney biopsy and kidney ultrasound confirm the rejection episode, then the transplant team will increase the amount of anti-rejection medication or prescribe a different combination of anti-rejection drug therapy. Using medicine, we can successfully reverse most rejection episodes, if we detect it early enough. However, if the episode is severe, it may shorten the overall life span of the new kidney.
For the first three to six months after your transplant, you will have frequent follow-up visits with the transplant team and frequent laboratory tests. Gradually, however, you will see the transplant team less often. At this stage, you can look forward to having more time for yourself and your activities. You will become even more responsible for maintaining your own health.
As you begin to see the transplant team less often, many of your healthcare visits will be to your primary care physician and/or nephrologist and other specialists as needed. Always tell your healthcare providers that you have had a transplant, so if you do become ill, they can determine whether your symptoms are, or are not, related to your transplant. We recommend you keep a list of your current medications, as well as any drug allergies, with you at all times.
Because of the medication you must take, transplant patients are more likely to be affected by germs that may be on or in foods. You should wash all fruits and vegetables thoroughly before eating and avoid raw or undercooked meat, poultry, fish, sushi, raw shellfish and raw eggs in any form (including cookie dough and eggnog). Also, you cannot have grapefruit or any juices or beverages containing grapefruit because they will interfere with your medications.
Because you feel better with your new organ, your diet will be less restricted. Also, some medicines may increase appetite. Therefore, it is very important for you to follow a healthy diet to avoid gaining too much weight. The transplant team works with each patient to develop an individualized diet plan, taking into consideration special needs and restrictions.
Yes! It will take time to regain strength and endurance after a transplant, but eventually you can resume normal activity. Walking and stair climbing are excellent exercises for maintaining muscle tone and strength. You should consider walking 5 to 10 minutes a day when you first arrive home following surgery and then slowly increase the time you walk each week. Do not begin strenuous exercises, such as contact sports, jogging, tennis and weightlifting, for at least two months after the operation. It is normal to tire easily so you should rest when tired.
You should not smoke after transplant and every attempt to quit prior to the transplant is crucial to extend your life and the life of the new kidney. The transplant team will let you know when you can begin to drive again, return to work or school, and travel. You can decide when to resume sexual activity depending upon how you feel. Postoperative discomfort usually does not interrupt sexual activity for more than a few weeks.
Any healthy person over age 18 who has a compatible blood type and compatible HLA tissue typing may be considered as a possible donor. However, individuals with certain medical conditions may not be able to donate. The transplant team closely evaluates these conditions.
The decision to donate a kidney requires careful thought and consideration. The transplant team is available for confidential discussions and questions. Potential donors undergo a thorough evaluation to determine their general health and condition of kidneys. A transplant nephrologist, a physician specializing in kidney care, supervises this medical evaluation and ensures privacy and an objective opinion about the donor's medical suitability to donate a kidney.
The operation to remove a kidney for donation is called a donor nephrectomy. With the patient under general anesthesia, surgeons perform either an open or laparoscopic procedure. This is major surgery.
Most patients who donate a kidney qualify for laparoscopic donor nephrectomy, which uses minimally invasive procedures to remove the kidney. Surgeons insert a small scope connected to a video camera into the donor's abdomen. The kidney is detached using additional instruments inserted through very small holes. The kidney is removed through a 2 to 3-inch incision in the middle of the abdomen. Patients typically experience less postoperative pain, and quicker recovery, without harming the function of the donor kidney. Beth Israel Deaconess transplant surgeons are particularly skilled in this laparoscopic procedure, which they perform in one of the medical center's advanced endosuites for minimally invasive surgery.
BIDMC offers dialysis services as needed for hospitalized patients through the acute dialysis services of DaVita. BIDMC nephrologists staff the acute dialysis unit. If you begin hemodialysis in the hospital, you will transition to an outpatient unit of your choice. Outpatient dialysis units are located in numerous communities throughout greater Boston.
The financial coordinator on the transplant team, along with the social worker, will help you map out a financial plan to cover costs associated with transplant care, surgery and medication. Patients typically finance costs associated with their transplant by combining more than one financial resource. There are several options for those who do not have any type of health coverage, and there are policies and laws designed to help transplant patients with special financial needs. The Transplant Institute's social worker and financial counselor help develop a workable plan for each patient.
Out-of-pocket costs following a transplant are highly variable, based on whether you have insurance or whether you are eligible for Medicare or Medicaid coverage. We understand that finances are a major concern for patients, and good planning will help to reduce this stress. Your financial counselor will review your own unique situation, and help you on an individual basis address your financial concerns and available resources. Together we can help you manage the financial impact of your illness, transplant surgery and long-term recovery.