Kidney transplantation or renal transplantation is the organ transplant of a kidney into a patient with end-stage renal disease. Kidney transplantation is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantation depending on the source of the donor organ. Living-donor renal transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants, depending on whether a biological relationship exists between the donor and recipient.
Types of Donors
The names of the different types of transplants refer to the kidney donor. There are three types of transplant organs
- Living related
- Living unrelated
A cadaveric transplant is a kidney removed from someone who has died. Cadaveric kidneys are only removed after a series of tests have established that the donor is brain dead. This means that the part of the brain called the brainstem, which controls breathing, has permanently stopped working. A brain-dead patient is only being kept alive by a life-support machine.
Depending on your country, your local transplant center or a regional or national agency maintains a waiting list for cadaveric transplants. (The United Network of Organ Sharing (UNOS) maintains a national waiting list for the US.) Each country also has its own system for matching and distributing cadaveric kidneys. An available kidney is not given to the person who has been waiting the longest, but to the patient best suited to receive it. The wait, therefore, could be one day or several years. A patient may be taken off a waiting list if they are ill, have an infection or traveling abroad. Removal from the transplant waiting list can be temporary or permanent. Patients who are on the waiting list may not receive a lot of notice that a kidney is available. It must be possible to contact them at all times, and they must be prepared to go to the hospital at short notice.
Once at the hospital, some final tests will be done to assure the best possible chance of a successful transplant. If the patient has a cold, for instance, he or she may be sent home, since this illness would reduce the chances of the operation being successful. Looking after yourself while on dialysis will increase your chances of being fit for a transplant when the right kidney becomes available.
In living related transplants, a living relative donates a kidney for transplant. A living related transplant is more likely to work than a cadaveric transplant because it is more likely to be a better match than from an unrelated donor.
The relative needs to consider the decision to donate a kidney very thoroughly especially since there is no guarantee the transplant will work. Most donors and recipients receive in-depth counseling before a final decision is reached.
If a kidney patient has a relative who is at least 18 years old, healthy, and willing to donate a kidney, they should speak to the transplant coordinator at their unit. A number of tests will then need to be arranged for both the patient and the donor.
Sometimes an unrelated person will donate a kidney for transplant. It is usually someone close to the patient, such as a husband, wife, partner or close friend. It is illegal in many countries to buy or sell organs. As with a living-related transplant, both the donor and recipient will be given a number of tests and will receive in-depth counselling.