By Jaclyn Cosgrove Published: September 8, 2013
When does someone need a kidney transplant?
The kidney has two main functions — to filter out waste products and to regulate blood pressure by balancing fluids, making sure a person makes urine and reabsorbs water.
When your kidneys begin to fail, harmful wastes build up in your body, your blood pressure might rise, and your body might hold onto too much fluid and not make enough red blood cells. When this happens, you need treatment to replace the work of your failed kidneys.
A kidney transplant is performed when a person’s kidneys no longer function properly.
Many people who develop kidney failure are diabetic, suffer from chronic uncontrolled blood pressure or suffer from chronic inflammation that scars the tiny filters within their kidneys.
Sometimes, people suffer from congenital abnormalities, such as polycystic kidney disease, an inherited disease that’s the fourth leading cause of kidney failure.
The majority of donated kidneys come from a person who has died. In some cases, a friend or family member might donate one of their kidneys to a loved one. And sometimes, an “altruistic” donor comes along, someone who donates their kidney to a stranger. You need only one donated kidney to replace the work previously done by your kidneys.
Some people fundraise before the transplant to pay for the procedure. A kidney transplant is generally an expensive procedure and can be a financial strain. One of the biggest costs is the time people spend in the intensive care unit. Also, anti-rejection drugs and other medications can cost about $3,000 a month immediately after the transplant.
Most private health insurance policies cover many expenses associated with kidney transplants, including medications. In addition, most kidney transplant candidates are eligible for Medicare, which will cover 80 percent of the cost of the transplant surgery.
Currently, about 600 people in Oklahoma are on a kidney transplant waiting list. The wait time in Oklahoma is about three years.
Before your kidney transplant, you will undergo several tests and likely have frequent doctor appointments. Each transplant center will differ on requirements for the types of testing you will undergo.
For example, you might undergo a test to ensure your heart is healthy enough for you to have the transplant. You might also be required to have a colonoscopy if you’re older than 50 and haven’t recently had one. In general, you have to be physically able to undergo the operation and have a social support system for after the surgery.
To begin the surgery, you will be placed under general anesthesia. A catheter will be placed in your bladder, and you might have a large IV, known as a central line, placed in your neck or collarbone.
The kidney will be taken out of the ice and cleaned, flushed out with a special solution to clear it of any preservatives that were placed in the kidney during the procurement process.
Generally, the kidney you receive is from a donor with your same blood group. You will receive the kidney soon after the organ is removed from your donor’s body. Kidneys generally can stay on ice for 24 hours, although facilities will have different rules on how long they will wait to perform a transplant.
A team of surgeons and nurses will work together during your transplant. Your surgeon will make an incision near your abdomen and use tools to open the incision wide enough to place the kidney inside.
Your surgeon connects the artery and vein of the new kidney to your artery and vein. Your blood flows through the new kidney, which makes urine, just like your own kidneys did when they were healthy.
Generally, your kidneys are left inside of you, unless they’re causing infection or high blood pressure. The new kidney sits near the pelvis, in a somewhat empty space next to your bladder. Meanwhile, your native kidneys sit in your back.
Does it hurt?
During the surgery, you should be asleep and not feel anything. Generally, your surgeons will make a cut about seven inches long to place the kidney inside of you.
Most patients are off intravenous pain medication within about 24 hours. You will be prescribed oral pain medication for about two weeks. The amount of pain you feel will range, depending on your pain tolerance and the details of your surgery.
The year after your surgery, you likely will have a lot of feelings and emotions. There are different types of support groups for kidney patients. These can be helpful for you to learn from others who have been where you are.
What are the risk factors?
Your body could reject the kidney. A rejection occurs when your body’s immune system begins to attack the kidney, viewing it as a foreign object. Because the body never accepts the kidney as part of itself, rejection can occur even years later, particularly if you stop your medicines.
With any surgery, there’s risk of bleeding and infection. Also, you will take medicines to prevent rejection that also weaken your immune system. These drugs can increase your chances of developing a hernia.
Most rejections occur within the first six months, often with no symptoms. However, most rejections can be treated and reversed, although the threat of rejection never goes away. You will take medicine for the rest of your life to better ensure that your body doesn’t reject the kidney.
You also have a higher chance of developing some cancers because of the immune suppression drugs. Your body should become more tolerant of the kidney after between a year and 18 months. At this point, you should be able to reduce the number of drugs you take.
What’s the recovery time?
A kidney transplant is a major surgery. Patients generally spend between three to seven days in the hospital.
Within the first 24 to 48 hours, if the kidney works right away, you should begin to feel better. Some kidneys take longer to wake up after ice, though, and you might have to undergo dialysis within the first few days after transplant. However, you should start to feel better once the new kidney starts functioning.
The recovery period after a kidney transplant is about six months.
What’s the follow-up?
You will likely see your doctor often, but it will depend somewhat on what you and your doctor decide is best. For example, you might see your doctor weekly at first and then monthly. After a year, you might only see your doctor for an annual checkup.
A successful kidney transplant requires close follow-up with your doctor and always listening to your doctor’s instructions. It’s also important to take your medicine as directed.
Sources: Dr. Shea Samara, associate kidney transplant surgeon for the Nazih Zuhdi Transplant Institute; U.S. National Library of Medicine; the Mayo Clinic; National Kidney and Urologic Diseases Information Clearinghouse; National Kidney Foundation; Massachusetts Institute of Technology.