Compared to dialysis, a kidney transplant is typically the better treatment option for kidney failure. A kidney transplant offers you better health, a longer life expectancy, as well as a better quality of life.
After your kidney transplant, you will be on anti-rejection medications for the rest of your life. However, you can live a more normal life as compared to dialysis, where you are committed to many hours a week for treatments.
At LVHN, we will partner with you to make this important decision. You will undergo a thorough evaluation to see if you are a potential kidney transplant candidate. You will meet with our transplant team, which includes a nephrologist, surgeon, nurse coordinator, social worker, dietician, pharmacist and financial coordinator. We are committed to offering the best care and treatment decision for you.
Everyone must be evaluated for appropriateness for transplant candidacy, and not everyone will be placed on the transplant waiting list. You may not be healthy enough for a transplant or have other problems which limit your candidacy. Determining if you are a candidate for any organ transplant requires a comprehensive evaluation, beginning with a medical record review, and the process often includes additional medical testing. Beyond the initial indicators, all patients must be fully evaluated by the transplant team to determine if transplantation is the best treatment option.
Potential transplant candidates include:
- Patients with end-stage kidney disease on dialysis.
- Patients with advanced chronic kidney disease (stage 4 or 5 with calculated or estimated GFR <20ml/min).
- Patients with chronic kidney disease (stage 4 with GFR <30ml/min) who also need another organ transplant.
- Patients with chronic kidney disease who have type 1 diabetes that has not responded to medical treatment may also be considered for a combined kidney-pancreas transplant.
We strongly recommend that you stop using nicotine products. You may be required to quit based on your medical history and other factors. Active consumption of nicotine products could prolong the start of the evaluation process in determining eligibility.
We are here to support you with your effort to quit. LVHN offers a smoking cessation group and we would be happy to refer you to this resource. If you feel that you may require additional supports, we encourage you to contact your family doctor to discuss medications and other options to aid in the goal of discontinuing nicotine dependence. Smoking cessation aids such as nicotine gum, lozenges or patches are great ways to manage withdrawal symptoms. However, keep in mind that you will be tested on all nicotine in your system, so you will also need to stop these aids before beginning your evaluation. It is our goal for your transplant to be successful. In order to do so, it is crucial to reduce as many risk factors as possible to ensure safety.
If you are approved for a kidney transplant, you will be placed on the waiting list. In this region, our wait-list time is 3-4 years, so it’s important to be evaluated early – as soon as kidney function is less than 20 percent of normal. During your time on a wait list, you can begin searching for a suitable living donor.
You must be on the transplant list to receive a kidney transplant, regardless of the type of donor. You have the right and the ability to be on wait lists at multiple transplant centers in the U.S.
What if I don't have a living donor? Will I still be on the list?
Yes, the waiting list is for candidates waiting for a kidney from a deceased donor. A deceased donor is someone who has died, usually from a severe brain injury.
Are all deceased donors the same?
No, every donor is different: Different ages, genders, ethnicities, some with prior diabetes or high blood pressure, each with different levels of kidney function. Much of this information is summarized in the Kidney Donor Prognostic Index (KDPI). The KDPI scale is in a percent from one, the best donor, to 100, not a good donor. We only offer kidneys from donors with KDPI greater than 85 percent to those who have agreed to receive offers from these donors.
Will you tell me anything about the donor?
We are obligated to keep the donor anonymous, so there is very little information we can share with you. However, when you get called with an organ offer, if you have consented to receive offers of KDPI greater than 85 percent donors, we will tell you which category the donor falls into, KDPI less than 85 percent or greater than 85 percent. Most high KDPI donor kidneys will have a biopsy performed to look for how well we hope the kidney will function, and we will share this biopsy result with you.
I have heard about people accepting organs from donors who have done IV drugs or who overdosed. Is this true?
Yes, this is true. In general, illicit drugs, while they have lots of bad effects, do not damage the kidneys or impair kidney function. Medically, our concern for donors who use illicit drugs is the risk of the donor kidney transmitting a viral infection like hepatitis to a transplant recipient.
For any organ offer, we will tell you if the donor meets so-called risk criteria, meaning that the donor has engaged in some type of behavior that increases the donor's chance of acquiring a viral infection. All donors are tested by a very sensitive test for many infections including hepatitis B, hepatitis C, HIV and COVID. You'll be told of any test that is not completely negative, and what the test result means.
The risk of acquiring a viral infection from a transplant is very, very low, but can never be zero. For the riskiest type of donor, which is a donor who died after injecting drugs intravenously, the risk of acquiring a viral infection is less than 1 in 1000. However, all donors carry a risk of disease transmission. Viruses, bacterial infections and cancers have been transmitted to recipients. These are rare events, and more importantly, the risk of dying on the wait list is much higher than contracting a disease from the donor.
