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Organ Transplant Programs
In this section, you can read more about the different types of kidney transplants and what you can expect in terms of pre-transplantation tests.
The kidneys are a pair of bean-shaped organs that lie on either side of the spinal cord near the bottom of the rib cage. These organs filter the blood to remove waste products, maintaining the balance of fluids, electrolytes and minerals—such as sodium, potassium, calcium and phosphorus—in the blood. The kidney also makes substances called hormones that help regulate blood pressure and influence the production of hemoglobin (the substance that carries oxygen in the blood) and vitamin D.
A number of conditions can affect the ability of the kidney to perform its functions. Diabetes and hypertension (high blood pressure), glomerulonephritis (an inflammation of the filtering units in the kidney) and certain inherited conditions such as polycystic kidney disease can cause damage. Long-term use of certain over-the-counter medicines can impair the kidneys. The kidneys may also be harmed by toxins, pesticides and street drugs such as heroin and crack cocaine.
Damage to the kidney may lead to permanent kidney failure, also known as end-stage renal disease (ESRD). At this point, treatment is necessary to replace the function of the kidneys. The two therapies that may be used are dialysis and transplantation. A kidney transplant is the single best therapy to treat most individuals with ESRD. The expected survival of transplant recipients exceeds that of those individuals who either choose not to receive a transplant or who are unable to receive a transplant because of other complicating medical conditions or the lack of a compatible donor.
Cadaveric Kidney Donors
There are two different kinds of kidney donors: cadaveric (deceased) and living. Most kidneys transplanted in the United States are recovered from individuals who have just died. The vast majority of these individuals have suffered a head injury or stroke that has led to brain death. Brain death means that there is no blood flow or oxygen to the brain and the brain is completely unable to function, with no chance of recovery. A person who is declared brain dead is legally dead in all 50 states. Other organs, including the kidneys, pancreas and heart, may continue to function for a few days beyond brain death. These organs may be transplanted into other individuals.
Federal law requires that all families of brain-dead patients be offered the option of organ and tissue donation. If the family agrees to donate their loved one's organs, the donation process begins. The United Network for Organ Sharing (UNOS) maintains a computerized registry of all eligible patients waiting for an organ transplant. When a medically and physically suitable recipient is identified, a specifically trained organ-recovery surgeon is contacted; this surgeon will decide whether the organ is suitable for transplant. If the organ is accepted, the intended recipient is contacted and told to come to the transplant center. At this time, the organs are recovered from the donor in a surgical procedure and transported to the recipient's transplant center (if necessary), then transplanted into the recipient.
Allocation of Organs from Cadaveric Donors
UNOS maintains a computerized registry of all eligible patients waiting for an organ transplant. When an organ becomes available, this database is searched for the patient who is most qualified to receive the organ, based on waiting time, blood type, tissue match, and other medical factors. The UNOS registry ensures the equitable sharing of donated organs, without regard to sex, race, social statutes or any other non-medical factors. Patients CANNOT buy a higher priority on the waiting list or otherwise influence the chances of receiving a donated organ.
Living donor transplant is a rapidly growing treatment for kidney failure. Indeed, in some institutions, living donors provide the majority of kidneys. Living donor transplants are accomplished when a healthy individual agrees to have one of his or her two healthy kidneys removed and provided to an individual whose kidneys have failed.
Living donors may be blood relatives, such as a parent, a brother, a sister, or an adult child, or non-blood relatives, such as a spouse or close friend. In general, fewer people need temporary dialysis after a living related or living unrelated transplant than after a cadaveric transplant. There is generally a lower rate of rejection with living donation than with cadaveric kidneys, although the risk of rejection cannot be completely eliminated. In most cases, living donors should be between 18 and 60 years of age.
Potential living donors will need to undergo a number of tests to ensure that the donor is healthy to minimize complications for both the donor and recipient. Blood and tissue typing, as well as a "cross-match" test, will be done to ensure that the donor and recipient are compatible. The recipient's insurance pays for the testing of the donor; the donor will not have to pay for any of the testing.
Once a compatible donor is identified, the transplant surgery may be scheduled. Depending on the profession, the donor will need to have up to two months off from work to recover from the surgery. After this recovery time, the donor should be able to lead a normal, active life and work, drive, exercise and participate in sports as usual.
Before the Transplant
Once you have been referred a to the ECMC Transplant Program, we will begin your pre-transplant evaluation. This will include a review of your medical records and a prescribed series of tests. Pre-transplant testing will help us determine your overall health and identify any conditions that may need special attention in order to minimize the risk of complications. These tests will also indicate whether transplantation is in fact the best option for you.
These tests may include:
- Physical exam with complete medical and surgical history
- Family history
- Blood tests
- Blood typing—There are four blood types: A, B, AB and O. Every person is one of these types. Your donor's blood type does not have to be exactly the same as yours, but it must be compatible.
- HLA—Certain proteins ("markers") are found on the surface of all body cells. These are inherited from your mother and father. These markers are used to match your donor's kidney to you.
- PRA—A measure of sensitization (indicates your chances of rejecting a transplanted organ). A higher PRA makes it more difficult to find a suitable organ.
- Viral testing—Determines if you have been exposed to certain viruses, including hepatitis, Epstein-Barr (EBV), Cytomegalovirus (CMV) or HIV.
- PPD—tests for exposure to tuberculosis
- Chest X-ray—determines the health of your lungs and lower respiratory tract
- Kidney/Ureter/Bladder X-ray and Ultrasound—helps determine the health and specific location of these organs
- Urologic Tests
- Urinalysis—helps determine your current kidney function and certain abnormalities, including infection and the amount of protein or sugar in the urine
- VCUG—shows how well the bladder and ureters and urethra (the connecting tubes) are working (required in selected patients)
- Bladder scan—helps to evaluate the filling and emptying of the bladder
- Cardiac (Heart) Tests
- Electrocardiogram (EKG)—helps determine how well your heart's electrical system is functioning
- Echocardiogram—an ultrasound examination of the heart that helps determine the function of the heart valves and how well the heart muscle is contracting
- Stress tests (most patients) and PET scans (selected patients)—helps measure how well blood is flowing to the heart when you exercise
- Cardiac Catheterization—determines how well the blood vessels that feed the heart are working
- Specific Tests for Women
- Mammogram—a specialized X-ray of the breast that can detect signs of breast cancer
- Gynecological evaluation—includes a Pap smear, which can detect signs of cervical cancer
- Specific Tests for Men
- PSA—a blood test that can detect early signs of prostate cancer
- Prostate exam—an enlarged prostate can cause difficulty in urinating or may be a sign of prostate cancer
- Colonoscopy—an exam that can help to detect early signs of colon and rectal cancer (required for patients over 50 and selected other patients based on medical and family history)
- Other tests as determined by our nephrologists and surgeons