Organ Donation and Transplantation
Welcome to the transplantation area of the NKF web site. This page contains some basic answers to frequently asked questions on transplantation: for more detailed answers, click on the button at the end of each answer.
A successful transplant:-
- Can come from a person who has died, or from a living relative or friend
- Makes life with kidney failure much better
- Can fail, but half of transplants last over 10 years
Don’t expect a transplant:-
- Automatically when you’re on dialysis, you may not be fit enough
- To solve all your problems – there are complications
- To arrive right away – there is a long waiting time for some people
A kidney transplant is someone else’s kidney put inside the body by a surgeon. A successful kidney transplant means that dialysis is no longer needed. However, it is not a complete cure for all the problems of kidney failure. This is because it is necessary to take drugs to keep the transplant working, and these have side effects.
The normal position for a transplant is low down in the abdomen, well away from the position of normal kidneys. The transplant sits under the skin, and can be felt if you press hard, just above the pelvic brim – the pelvic brim is the bone you can feel just above the front pocket on a pair of trousers.
Only about one half (50%) of people starting dialysis are suitable for a kidney transplant. Reasons for being unfit are most commonly heart disease, risk of serious infection after a transplant or previous cancer. These problems all lead to a high risk of death after transplantation. Few people over the age of 70 years are fit for a transplant.
It is possible to use a kidney from a relative or partner or occasionally a friend. It is most important that the potential donor is extremely physically fit and has no reservations about going through with kidney donation. Also, of course, the recipient must be happy with the idea of putting someone else through the stress of kidney donation.
Taking a kidney from someone who has died is handled with respect by experienced teams of transplant specialists. It is important to realise that when someone has died, donation of their organs for transplantation is generally an enormous consolation to the family of the deceased.
Most people who die are not suitable to be kidney donors because of infection, cancer or old age. Transplantable kidneys come from people who have had strokes (bleed into the brain) or a car crash and are transferred to a hospital intensive care unit and die whilst attached to a ventilator (breathing) machine.
Click here to read a paper on ‘Death whilst on life support’ by Dr Peter Doyle, Department of Health (UK)
When the kidneys from a dead person become available for transplantation, they are allocated so that they have the best chance of long term success. Research has shown that the best results are achieved by allocating kidneys to dialysis patients with the same blood group and with a good ‘tissue type’ match. There is a national system for kidney allocation and kidneys are sent all over the country so that they can be given to the most suitable recipients.
There is a shortage of kidneys for transplantation. At present, in the first 2 years after going on the waiting list, there is, on average, a 50% (one in two) chance of being offered a kidney. The ‘waiting list’ is not like a queue so, if someone has a rare tissue type or blood group, the chances of getting a transplant are reduced.
When a kidney comes from someone who has died, it is most important to prevent any extra suffering to the donor’s family. Therefore the transplant patient will usually be told very few details about the kidney donor. Of course transplant patients feel grateful for the gift they have received and often a letter of thanks or a Christmas card is sent from the recipient to the donor family.
A kidney transplant operation takes about 2 hours. After the operation, there are a number of tubes in the neck, arm, side and bladder to help give fluids and drugs and to monitor the urine output. It is usually possible to sit out of bed the day after a transplant, to walk two or three days after. Most people go home about 10 days after their transplant.
It can be stressful waiting for a transplant. When a kidney does come up it is common to be very excited and quite frightened. The first three months after the transplant can also be hard going. Frequent clinic visits are needed and many patients have to be readmitted into hospital for tests or extra treatment. In the longer term, though, someone with a successful transplant only has to visit hospital once every couple of months.
The other main complications of transplantation are:
- problems with the transplant kidney itself, such as rejection (discussed below), or problems with the blood supply or urine drainage,
- infections, such as urine infection or pneumonia,
- high blood pressure and high cholesterol levels,
- cancer, which is most commonly a small skin cancer.
The body thinks someone else’s kidney is an invader, like a germ, and fights it off in the same way it would fight off an infection. This is called rejection. About a half of patients get some rejection in the first few weeks after a transplant. Fortunately this usually shows up as only a slight change in the blood results, and can be treated effectively with extra drugs. The chances of losing a kidney from rejection in the first few weeks after a transplant are about 5% (one in twenty).
Transplant patients usually take a lot of drugs, and unfortunately it is necessary to take them all the time – the transplant will reject and fail if the drugs are all stopped. There are three groups of drugs:
- anti-rejection drugs – many hospitals use three different drugs together to prevent rejection,
- drugs to prevent complications of the anti-rejection drugs,
- drugs for high blood pressure or high cholesterol.
Diabetes can become harder to control in people who had the disease before their transplant. It can also occur as a side effect of the drugs taken to prevent rejection of the transplant.
A successful transplant usually means that sexual function improves, and it is easier to have children. This is particularly important for women as it is very unusual to have a baby while on dialysis. It is not recommended that a woman gets pregnant in the first year after a transplant.
Most people can resume a nearly normal life after a transplant, although some conditions that caused kidney failure in the first place (such as diabetes) will of course not be cured. It is usually recommended that people plan for 3 months off work after a transplant, though some can go back sooner.
After one year, 90% (nine out of ten) transplants are functioning, after five years, about 70% (seven out of ten); and after 10 years only 50% (five out of ten). Kidneys fail most commonly because of rejection that develops slowly over several years. Some transplants fail because of failure to take the anti-rejection drugs regularly, or to attend clinic appointments.
Most people can go back on the transplant list for a second transplant, or have a kidney from a family member. It is necessary to check again that it is safe to have a transplant , especially from the point of view of the heart. It may be more difficult to find a second kidney, because a better tissue type match may be needed.
Written by Rob Higgins, Renal Consultant, Walsgrave Hospital, Coventry, 1999
The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.