Kidney transplantation has been an evolving process for over 50 years now and over that time it has become recognized as the most effective treatment for End-Stage Renal (Kidney) Disease (ESRD), the final stage of kidney failure. This transplant process, whether involving an organ originating from a deceased or living donor, can be broken down into four basic areas: evaluation, preparation, surgery and postoperative care.
All patients seeking a kidney transplant must first go through an extensive evaluation by the Upstate Kidney Transplant Team to see if a transplant is the best option for them. Prior to their evaluation patients will receive a packet of information in the mail that will help them prepare for the required evaluation appointment that must be scheduled. During the evaluation visit patients will meet with several members of the transplant team to discuss the details of kidney transplantation; this will include a transplant nurse coordinator, a transplant nephrologist who specializes in kidney diseases and a transplant surgeon. Patients may also meet with a social worker, a nutritionist as well as a financial coordinator to ensure they have adequate insurance coverage for all aspects of the transplantation process.
If after being evaluated, patients are given medical and financial clearance to proceed with a kidney transplant then they are put on a waiting list which involves having their names and pertinent medical information entered into a national database managed by the United Network for Organ Sharing (UNOS). Although New York only allows a patient to be listed at one transplant program in the state it is possible for the same patient to be listed at other transplant programs outside of New York at the same time. For more information on how to be listed multiple times in more than one transplant program please refer to the UNOS Multiple Listing Brochure .
The length of time patients wait before receiving an organ will vary greatly and is dependent on several factors to include tissue and blood types, as well as organ availability which can be a result of either a deceased or living donation. The average waiting time for a kidney transplant in this region is two to six years.
Regardless of how long patients wait each must go through the same preparation both medically and personally. Patients must have a series of medical tests performed prior to their initial evaluation appointment or shortly after to ensure they can be added to the waiting list as soon as possible.
On a personal level, patients can help prepare by creating a strong community of support among family and friends. This close network of support may also prove very important if patients are considering living donation as a potential donor may more readily come forward from that close group.
Patients should also try to maintain as healthy of a lifestyle as possible to include eating properly and exercising regularly. This will promote strength and endurance which will help speed up recovery following your transplant.
When a suitable donor becomes available, patients are immediately notified and scheduled for their transplant surgery.
On the day of the transplant surgery patients should follow the instructions provided to them by the transplant team and report directly to the hospital admissions office at Upstate University Hospital. After being admitted, the transplant team will perform a final preparation for surgery both administratively to make sure all necessary paperwork has been completed and medically to make sure that no changes have occurred that would prevent surgery.
Until patients are taken to the operating room for their surgery, family members may remain with them and are encouraged to do so. During the surgery family members may wait in the surgical intensive care waiting room where they will be provided with updates during the course of the surgery.
The transplant surgery will take approximately two to four hours. The patient is put under anesthesia and then an incision is made in the lower abdomen to accommodate the placement of the transplant kidney. If the transplant is a result of a living donation then the operating room where the donor kidney is being removed will be situated directly adjacent to the recipient's operating room to facilitate the quickest and easiest transferal possible. After the transplant surgery has been completed patients are moved to the surgical recovery room where family members may see them.
Following surgery transplant patients are moved to a surgical recovery room where it is important to ensure that the transplanted kidney is functioning properly as primarily detected by the creation of urine. Kidneys transplanted from a living donor usually start making a large amount of urine almost immediately so a catheter will be inserted right away in order to drain urine from the bladder. Kidneys from deceased donors however may take days or even weeks to start producing urine so in the event that this happens patients may need to go on dialysis for a short period of time. Typically, transplant patients can leave the hospital and return home within three to seven days following their surgery.
As with any surgery follow-up care is essential to ensure quick recovery and the best possible outcome. It is important for kidney transplant patients to take all medications as prescribed and to be aware of the possible side effects of these medications. Patients must also pay close attention to their diet as some foods may interact with their medications. They must also be aware of how some over-the-counter medications, particularly many cough and cold medications, can have harmful effects on a transplanted kidney.