Organ Transplants | Kidney Transplant

Most people are born with two kidneys, located behind the abdominal organs and below the rib cage. They perform several important functions including:

The kidneys are two bean-shaped organs that produce urine. Urine is carried to the bladder and when the bladder is full, urine is excreted from the bladder through the urethra.

When the kidneys stop working, the condition is referred to as "end-stage renal disease." Toxic waste products accumulate in the body and either dialysis or a kidney transplant is required to sustain life.

The most common causes of kidney failure include:

During a kidney transplant evaluation, a transplant coordinator will arrange a series of tests to assess your treatment options. You'll be evaluated for potential medical problems such as heart disease, infections, bladder dysfunction, ulcer disease and obesity. A social worker will discuss transportation, housing, financial and family support needs in regard to a transplant and a financial counselor will address the benefits of your insurance policy.

We want you to learn as much as possible about the transplant process before making a decision.

Regardless of the type of kidney transplant you may undergo — living or cadaveric — special blood tests are needed to determine your blood and tissue type. These test results help match a donor kidney.

The first test establishes blood type. There are four blood types — A, B, AB and 0. Everyone fits into one of these inherited groups. The recipient and donor must have either the same blood type or compatible ones. The list below shows compatible types.

The AB blood type, called the universal recipient, is the easiest to match because the individual accepts all blood types. Blood type 0, called the universal donor, is the hardest to match. Although people with blood type O can donate to all types, they can only receive kidneys from blood type 0 donors. For example, if a patient with blood type O were transplanted with a kidney from an A donor, the body would recognize the donor kidney as foreign and destroy it. The Rh type (+, -) is not a factor in donor matching.

The second test, a blood test for human leukocyte antigens (HLA), is called tissue typing. These antigens are substances found on many cells of the body, but are mostly seen on white blood cells. Tissue type likeness between family members may be 100, 50 or 0 percent. The tissue type of all potential donors is considered in donor selection.

The prospective recipient and all interested family members and non-relatives can arrange with the transplant team to have the tissue typing test. No special preparation is required and results are available within two weeks. Pre-packaged kits with instructions to collect and return blood samples are available for mailing to out-of-town relatives. Blood can be drawn at a local doctor's office or hospital laboratory and sent to the UCSF Transplant Service via ovennight mail.

Your body makes substances called antibodies, which are produced by the immune system to attack foreign substances, such as bacteria and viruses. You make antibodies when you have an infection, are pregnant, have a blood transfusion or undergo a kidney transplant. If you have antibodies to the donor kidney, your body will destroy the kidney. To ensure that you don't already have antibodies to the donor, we conduct a test called a crossmatch.

The crossmatch is done by mixing your blood with cells from your donor. If the crossmatch is positive, you have antibodies against the donor and should not receive this kidney. If the crossmatch is negative, you don't have antibodies to the donor and you're eligible to receive this kidney.

Crossmatches are obtained several times during preparation for a living-related donor transplant, particularly if donor-specific blood transfusions are used. A final crossmatch is performed within 48 hours before the transplant.

Testing is conducted for potentially transmissible diseases, such as HIV (human immunodeficiency virus), hepatitis and CMV (cytomegalovirus).

When the transplant evaluation is complete, the transplant team will meet and discuss your results. Your medical and social history is evaluated and a decision is made whether to place you on the transplant waiting list. This decision is made only after discussing your situation with a nephrologist or kidney specialist, surgeon, transplant coordinator, social worker and financial counselor. If you're a transplant candidate, you will be placed on the waiting list of the United Network for Organ Sharing (UNOS).

If a transplant is not in your best interest, a transplant team member will discuss other options with you.

You may qualify for a kidney transplant if:

People who are 60 years of age and older are considered for transplant on an individual basis after medical and cardiovascular evaluation. People with anatomically abnormal urinary tracts may not qualify until appropriate reconstructive surgery is completed.

You may not qualify for a kidney transplant if you:

As kidneys become diseased, they lose their ability to function, a condition called end-stage renal disease (ESRD) or kidney failure. Treatments for kidney failure are hemodialysis, a mechanical process to clean the blood of waste products; peritoneal dialysis, in which toxins are removed by passing chemical solutions through the abdomen; and kidney transplant.

None of these options is a cure for kidney failure. But a transplant offers the best prospects, given that the transplanted kidney functions successfully.

Kidneys for transplant come from a living donor or a deceased (cadaver) donor. When a kidney is transplanted from a living donor, the donor's remaining kidney enlarges to take over the work of two. As with any major operation, there is a chance of complication. But kidney donors have the same life expectancy, general health and kidney function as others. (See Living Donor FAQs.)

Any healthy person can safely donate a kidney. The donor must be in excellent health, well informed about transplantation and able to give informed consent.

Costs for living donor surgery, hospitalization, diagnostic tests and evaluation usually are paid by the recipient's insurance. Travel and living expenses are not covered. Insurance coverage will be discussed during the transplant evaluation.

If you have a potential living donor, he or she will undergo an evaluation and discuss the possibility of organ donation. Tests will be performed to ensure that the donor and recipient are compatible. In some families, several people are compatible donors. In other families, none are suitable.

Since 1999, UCSF has been using a procedure, called laparoscopic donor nephrectomy, to remove living-donor kidneys. More than 850 of these procedures have been performed, making our program one of the most experienced in the country. The procedure has a shorter recovery period. It involves tiny incisions and a scope or camera, similar to one used to remove a gall bladder. The complication rate of this procedure is very low and the quality and function of transplanted kidneys are excellent.

The procedure will be described in detail by the surgeon prior to surgery. The operation usually takes three hours. Most patients undergoing laparoscopic surgery for kidney donation require a hospital stay of only two to three days. After discharge from the hospital, the donor is seen for follow-up care in the transplant clinic. If the donor resides outside the San Francisco region, he or she should stay in the area for at least a week after discharge. Donors, who undergo laparoscopic surgery, often return to work within three to four weeks after the procedure.

Watch our video, "The Gift of Life", which tells the stories of three patients and their living kidney donors.

A cadaveric kidney comes from a deceased donor. The Uniform Anatomical Gift Act allows us to donate organs for transplant when we die and allows our families to provide permission as well. All donors are carefully screened to prevent disease transmission.

If you decide to undergo a cadaveric kidney transplant and you're medically eligible, your name will be placed on a cadaver waiting list. A blood sample for antibody level will be sent monthly to the medical center. The waiting period for a cadaver kidney depends upon the availability of a cadaver donor compatible with your blood type and your antibody level.

When a kidney becomes available, your referring kidney specialist is contacted for approval. The transplant service will verify that you have no recent infections or medical problems that would interfere with a safe transplant. We will assist you in making arrangements for your transplant.

Your surgery may last from two to four hours. During the operation, the kidney is placed in your pelvis rather than the usual kidney location in the back. (Your own kidney will not be removed.) The artery that carries blood to the kidney and the vein that removes blood from it are surgically connected to two blood vessels in the pelvis. The ureter, or tube that carries urine from the kidney to the bladder, is transplanted through an incision in the bladder.

After the operation, you will remain in the recovery room for a few hours and then return to the Kidney Transplant Unit. The surgeon will inform your family when the procedure is over.

You will be encouraged to get out of bed 12 to 24 hours after surgery and walk as much as you can. Nurses will instruct you in taking your medications, explain the side effects and discuss making lifestyle changes.

A cadaver kidney transplant sometimes will be temporarily slow in functioning, a condition called a "sleepy" kidney or acute tubular necrosis (ATN). You may need to undergo dialysis a few times. A "sleepy" kidney usually starts working in two to four weeks.

Most transplant recipients must take medication called immunosuppressants to prevent rejection of the transplanted organ. One of the side effects of these anti-rejection drugs is an increased risk for cancer, particularly skin cancer and lymphoma. You should be closely monitored for these conditions.