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A kidney transplant is a surgical procedure performed to replace a diseased kidney with a healthy kidney from another person. The kidney may come from a deceased organ donor or from a living donor. Family members or individuals who are unrelated but make a good match may be able to donate one of their kidneys. This type of transplant is called a living transplant. Individuals who donate a kidney can live healthy lives with the remaining kidney.
A person receiving a transplant usually receives only one kidney, but, in rare situations, he/she may receive two kidneys from a deceased donor. In most cases, the diseased kidneys are left in place during the transplant procedure. The transplanted kidney is implanted in the lower abdomen on the front side of the body.
A kidney transplant is recommended for children who have serious kidney dysfunction and will not be able to live without dialysis or a transplant. Some of the kidney diseases in children for which transplants are done include the following. However, not all cases of the following diseases require kidney transplantation. Always consult your child's physician for a diagnosis.
Visit the United Network for Organ Sharing (UNOS) Web site for statistics of patients awaiting a kidney transplant, and the number of patients who underwent a transplant this year.
The majority of kidneys that are transplanted come from deceased organ donors. Organ donors are adults or children who have become critically ill and will not live as a result of their illness. If the donor is an adult, he/she may have agreed to be an organ donor before becoming ill. Parents or spouses can also agree to donate a relative's organs. Donors can come from any part of the United States. This type of transplant is called a cadaveric transplant.
A child receiving a transplant usually receives only one kidney, but, in rare situations, he/she may receive two kidneys from a cadaveric donor. Some experimentation with splitting one kidney for two recipients is underway. Family members or individuals who are unrelated but make a good match may also be able to donate one of their kidneys. This type of transplant is called a living transplant. Individuals who donate a kidney can live healthy lives with the kidney that remains. While most children requiring kidney transplants weigh more than 15 kilograms, or 33 pounds, some transplant centers are able to transplant adult kidneys into children and infants weighing only 5 kilograms, or 11 pounds.
The United Network for Organ Sharing (UNOS) is responsible for transplant organ distribution in the United States. UNOS oversees the allocation of many different types of transplants, including liver, kidney, pancreas, heart, lung, and cornea.
UNOS receives data from hospitals and medical centers throughout the country regarding adults and children who need organ transplants. The medical transplant team that currently follows your child is responsible for sending the data to UNOS, and updating them as your child's condition changes.
Criteria have been developed to ensure that all people on the waiting list are judged fairly as to the severity of their illness and the urgency of receiving a transplant. Once UNOS receives the data from local hospitals, people waiting for a transplant are placed on a waiting list and given a "status" code. The people in most urgent need of a transplant are placed highest on the status list, and are given first priority when a donor kidney becomes available.
When a donor organ becomes available, a computer searches all the people on the waiting list for a kidney and sets aside those who are not good matches for the available kidney. A new list is made from the remaining candidates. The person at the top of the specialized list is considered for the transplant. If he/she is not a good candidate, for whatever reason, the next person is considered, and so forth. Some reasons that people lower on the list might be considered before a person at the top include the size of the donor organ and the geographic distance between the donor and the recipient.
An extensive evaluation must be completed before your child can be placed on the transplant list. Testing includes:
Tests are done to gather information that will help determine how urgent it is that your child is placed on the transplant list, as well as ensure the child receives a donor organ that is a good match. These tests include those to analyze the general health of the body, including the child's heart, lung, and kidney function, the child's nutritional status, and the presence of infection. Blood tests will help improve the chances that the donor organ will not be rejected. These tests may include:
Other blood tests will help improve the chances that the donor organ will not be rejected. They may include:
The diagnostic tests that are performed are extensive, but necessary to understand the complete medical status of your child. The following are some of the other tests that may be performed, although many of the tests are decided on an individual basis:
The transplant team will consider all information from interviews, your child's medical history, physical examination, and diagnostic tests in determining whether your child can be a candidate for kidney transplantation. After the evaluation and your child has been accepted to have a kidney transplant, your child will be placed on the United Network for Organ Sharing (UNOS) list.
The group of specialists involved in the care of children who are undergoing a transplant procedure is often referred to as the "transplant team." Each individual works together to provide the best chance for a successful transplant. The kidney transplant team consists of:
There is no definite answer to this question. Sometimes, children wait only a few days or weeks before receiving a donor organ. If no living-related donor is available, it may take months or years on the waiting list before a suitable donor organ is available. During this time, your child will receive close follow-up with his/her physicians and the transplant team. Various support groups are also available to assist you during this waiting time.
Each transplant team has their own specific guidelines regarding waiting on the transplant list and being notified when a donor organ is available. In most instances, you will be notified by phone or pager that an organ is available. You will be told to come to the hospital immediately so your child can be prepared for the transplant.
Once an organ becomes available to your child, you and your child will be immediately called to the hospital. This call can occur at any time, so you should always be prepared to go to the hospital, if needed. Once at the hospital, the child will have some more final blood work and tests to confirm the match of the organ.
The child will then go to the operating room. The transplant surgery may require several hours, but will vary greatly depending on each individual case. During the surgery, a member of the transplant team will keep you informed on the progress of the transplant.
After the surgery, your child will go to the intensive care unit (ICU) to be monitored closely. The length of time your child will spend in the ICU will vary based on your child's unique condition. After your child is stable, he/she will be sent to the special unit in the hospital that cares for kidney transplant patients. Your child will continue to be monitored closely. You will be educated on all aspects of caring for your child during this time. This will include information about medications, activity, follow-up, diet, and any other specific instructions from your child's transplant team.
Rejection is a normal reaction of the body to a foreign object. When a new kidney is placed in a person's body, the body sees the transplanted organ as a threat and tries to attack it. The immune system makes antibodies to try to kill the new organ, not realizing that the transplanted kidney is beneficial. To allow the organ to successfully live in a new body, medications must be given to trick the immune system into accepting the transplant and not thinking it is a foreign object.
The following are the most common signs and symptoms of rejection. However, each child may experience symptoms differently. Symptoms may include:
Your transplant team will instruct you on who to call immediately if any of these symptoms occur.
Medications must be given for the rest of the child's life to fight rejection. Each child is unique, and the transplant team has preferences for different medications. Some of the anti-rejection medications most commonly used include the following:
New anti-rejection medications are continually being approved. Physicians tailor drug regimes to meet the needs of each individual child. The doses of these medications may change frequently as your child's response to them changes. Because anti-rejection medications affect the immune system, children who receive a transplant will be at higher risk for infections. A balance must be maintained between preventing rejection and making your child very susceptible to infection. Blood tests to measure the amount of medication in the body are done periodically to make sure your child does not get too much or too little of the medications. White blood cells are also an important indicator of how much medication your child needs.
This risk of infection is especially great in the first few months because higher doses of anti-rejection medications are given during this time. Your child will most likely need to take medications to prevent other infections from occurring. Some of the infections your child will be especially susceptible to include oral yeast infection (thrush), herpes, and respiratory viruses.
Living with a transplant is a life-long process. Medications must be given that trick the immune system so it will not attack the transplanted organ. Other medications must be given to prevent side effects of the anti-rejection medications, such as infection. Frequent visits to and contact with the transplant team are essential. Knowing the signs of organ rejection (and watching for them on a daily basis) is critical. When the child becomes old enough, he/she will need to learn about anti-rejection medications (what they do and the signs of rejection), so he/she can eventually care for himself/herself independently.
Every child is unique and every transplant is different. Results continually improve as physicians and scientists learn more about how the body deals with transplanted organs and search for ways to improve transplantation.
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Online Resources of Transplantation
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