November 17, 2021

What happens in the kidney transplant process?

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If you have end-stage renal failure, you may qualify for this organ transplant.

A kidney transplant is a surgery done to replace a diseased or injured kidney with a healthy one from a donor. 

The donated kidney may come from a deceased organ donor or from a living donor. Family members or others who are a good match for you may be able to donate one of their kidneys. This type of transplant is called a living donor transplant. People who donate a kidney can live healthy lives with one functioning kidney. 

A person getting a kidney transplant typically receives just one kidney. In rare cases, they may get two kidneys from a deceased donor. The diseased kidneys are usually left in place. The transplanted kidney is placed in the lower belly on the front side of the body. 

After the kidney transplant, a person who receives a kidney will need to take medicines that suppress the immune system to prevent rejection of the transplanted kidney. Although lifesaving, these medicines place transplant recipients at increased of infections and can cause other various side effects. Vanderbilt University Medical Center’s Kidney Transplant Program performed more than 250 kidney transplants in 2020. Beatrice Concepcion, M.D., M.S., medical director of VUMC’s Kidney and Pancreas Transplant Program, talks about what patients can expect if they are facing a kidney transplant. 

When do you need a kidney transplant?

You may need a kidney transplant if you have end-stage kidney disease. This is a permanent condition of kidney failure. It often requires treatment with dialysis, a process used to remove wastes and other substances from the blood when the kidneys cannot do that any longer. 

“Most people will live longer and have a better quality of life with a kidney transplant, compared to being on dialysis,” Concepcion said. 

Healthy kidneys perform many tasks:

  • Removing urea, toxins and waste from the blood in the form of urine. Urea is made when foods containing protein, such as meat, poultry and certain vegetables are broken down in the body. Urea is carried in the blood to the kidneys. 
  • Balancing salts, electrolytes (such as potassium and sodium), and other substances so the blood contains the right proportion of each substance.
  • Making erythropoietin, a hormone that helps red blood cells form. 
  • Regulating blood pressure.
  • Regulating fluid and acid-base balance in the body to keep it neutral. This is needed for normal functioning of many processes in the body. 

Some conditions of the kidneys that may result in end-stage kidney disease include:

  • Repeated urinary infections.
  • Diabetes.
  • High blood pressure (hypertension).
  • Polycystic kidney disease or other inherited disorders.
  • Glomerulonephritis, inflammation of the kidney’s filtering units.
  • Hemolytic uremic syndrome.
  • Lupus and other diseases of the immune system. 
  • Obstructions. 
  • Congenital kidney defects.
  • Genetic (inherited) kidney diseases.

What happens leading up to the kidney transplant procedure?

To get a kidney from an organ donor who has died (a deceased donor), you must be placed on a waiting list of the United Network for Organ Sharing. Extensive testing must be done before you can be placed on the transplant list. 

A transplant team carries out the evaluation process for a kidney. The team includes a transplant surgeon, a transplant nephrologist (a doctor specializing in the treatment of the kidneys), one or more transplant nurses, a social worker, and a psychiatrist or psychologist. Other team members may include a dietitian, a chaplain, your primary care provider, and an anesthesiologist or nurse anesthetist. 

The kidney transplant evaluation includes:

  • Blood tests. Blood tests are done to evaluate your health status. Blood tests also help find a good donor match and to reduce the chances of rejection of the donor organ. 
  • Diagnostic tests. Diagnostic tests may be done to check your overall health status. These tests may include X-rays, cardiac testing, CT scan, ultrasound and dental exams. Women may get a Pap test, gynecology evaluation and a mammogram. 
  • Psychosocial evaluation. Psychological and social issues involved in an organ transplant, such as stress, financial issues, and support by family and significant others are assessed. These issues can greatly affect the outcome of a transplant. The same kind of evaluation is done for a living donor. 

“The transplant team will provide you with the appropriate education and resources to understand the risks and benefits of proceeding with the transplant and the steps you need to take to ensure a good outcome,” Concepcion said. 

The team will weigh all the facts from interviews, your medical history, physical exam and tests to determine your eligibility for a kidney transplant. 

Once you have been accepted as a kidney transplant candidate, you will be placed on the wait list for a kidney from a deceased donor. When a donor organ becomes available, you will be notified and told to come to the hospital right away. 

If you receive a kidney from a living donor, the kidney transplant surgery will be done at a time that’s scheduled in advance. The donor must be compatible and be in good health. A mental health check will be done to be sure the donor is comfortable with the decision.  If your donor is not compatible with you, your donor can be referred for kidney paired donation, which means he or she can donate a kidney on your behalf to another person. This will allow you to receive a kidney from another donor who is compatible with you.

Living Kidney Donor

Vanderbilt Kidney Transplant is one of the largest programs in the country. The program has performed more than 6,000 pediatric and adult kidney transplants since it started, creating deep expertise with even the most complex cases. Vanderbilt Kidney Transplant offers innovative treatment options leading to increased access to kidney transplantation and excellent outcomes.

Learn more