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Medical Author:

Michael B McDonnell, MD, Staff Physician, Department of Emergency Medicine, University of Southern California

Medical Editor:

John P. Cunha, DO, FACOEP

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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When the doctor diagnoses end-stage renal disease, he or she will discuss the treatment options. Whether kidney transplantation is an option for a patient depends on their specific situation. If the doctor thinks the patient may be eligible for a transplant, he or she will learn about the pros and cons of this treatment. If a patient is a potential candidate, he or she will undergo a thorough medical evaluation. In the meantime, the patient will be treated with dialysis.

Kidney transplantation is replacement of nonworking kidneys with a healthy kidney from another person (the donor). The healthy kidney (the "graft") takes over the functions of the nonworking kidneys. A person can live normally with only one kidney as long as it functions properly.

The transplantation itself is a surgical operation. The surgeon places the new kidney in the lower abdomen and attaches it to an artery and vein in that area (usually the external iliac artery and vein). The kidney is also attached to the ureter, which carries urine from the kidney to the bladder. The patient's own kidneys are usually left in place unless they are causing problems, such as infection.

Every operation has risks, but kidney transplantation is not a particularly difficult or complicated operation. It is the period after the surgery that is most critical. The medical team will watch very carefully to make sure that the new kidney is functioning properly and that the body is not rejecting the kidney.

Is the patient eligible for a transplant?

Before a patient can receive a kidney transplant, he or she must undergo a very detailed medical evaluation.

• This evaluation may take weeks or months and require several visits to the transplant center for tests and examinations.
• The purpose of this thorough evaluation is to test whether the patient would benefit from a transplant and can withstand the rigors of the surgery and antirejection medications and the adjustment to a new organ.

The medical team, which includes a nephrologist, a transplant surgeon, a transplant coordinator, a social worker, and others, will conduct a series of interviews with the patient and his or her family members.

• The patient will be asked many questions about his or her medical and surgical history, the medications he or she takes and have taken in the past, and their habits and lifestyle.
• It will seem like they ask every imaginable question at least twice! It is important that they know every detail about the patient that could bear on a future transplant.
• They also want to make sure the patient is mentally prepared for following the necessary medication regimen.

The patient will also have a complete physical examination. Lab tests and imaging studies complete the evaluation.

• The patient's blood and tissue will be typed so that he or she can be matched to a donor kidney. This significantly lessens the chance of rejection.
• The patient will have blood and urine tests to monitor their creatinine level, other organ functions, and electrolyte levels.
• The patient will have X-rays, ultrasounds, CT/MRI scans, and other imaging tests as needed to make sure the other organs are healthy and functioning.

Any of the following conditions significantly increase the patient's chance of rejecting the new kidney and may make him or her ineligible for transplant:

• Active cancer
• HIV infection
• Serious heart or lung disease
• Positive results for hepatitis C
• Severe infection
• Smoking
• Alcohol or drug abuse

Potential kidney donors also must be in good health and undergo a thorough medical evaluation.

If a patient is considered eligible for a transplant, every effort will be made to find a donor among his or her family members (who are most likely to match) and friends. If no suitable donor can be found, the patient's name will be added to the waiting list for a donor kidney.

• This list is administered by the Organ Procurement and Transplantation Network, which maintains a centralized database of everyone waiting for a transplant and of living donors.
• OPTC is run by the United Network for Organ Sharing, a private nonprofit organization.
• Every new kidney that becomes available is tested and checked against this list to find the most perfect match.

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