A Deceased Donor Kidney Transplant (DDKT) is a surgical procedure where a failing kidney is replaced with a healthy one from an individual who has recently passed away. It offers a treatment option for individuals with end-stage kidney disease, aiming to restore kidney function and improve overall well-being.
Why a Kidney Transplant is Needed
A kidney transplant becomes necessary when an individual develops end-stage renal disease (ESRD), a condition where the kidneys can no longer effectively filter waste products and excess fluids from the blood. ESRD occurs when approximately 90% of normal kidney function has been lost, and the glomerular filtration rate (GFR) falls below 15 mL/min.
Common causes of ESRD include uncontrolled diabetes, the leading cause globally, and chronic, uncontrolled high blood pressure. Other conditions like chronic glomerulonephritis, an inflammation and scarring of the kidney’s filters, and polycystic kidney disease, a genetic disorder, also contribute to kidney failure. While dialysis can remove waste and fluids, it cannot replicate the kidneys’ hormonal functions, making transplantation a more comprehensive and long-term solution.
The Deceased Donor Process
The process of obtaining and allocating kidneys from deceased donors is managed by national organizations like the Organ Procurement and Transplantation Network (OPTN) and the United Network for Organ Sharing (UNOS). When a patient is deemed a suitable candidate for transplant, their information is added to a national waiting list. Organ procurement organizations identify potential deceased donors, individuals who have experienced brain death or cardiac death, and secure consent for donation.
Once donor information is entered into the system, a matching process begins. Factors considered for a match include blood type, tissue type (HLA matching), organ size, the patient’s medical urgency, and the length of time on the waiting list. Geographic proximity between the donor and transplant hospital is also a factor. The system generates a ranked list of potential recipients, and the organ is offered to the top-ranked patient, with the process continuing down the list if the offer is declined.
The Transplant Procedure and Recovery
During a deceased donor kidney transplant, the new kidney is placed in the lower right or left side of the abdomen. The recipient’s native kidneys are generally not removed. The surgeon connects the new kidney’s artery and vein to the recipient’s blood vessels, and the new kidney’s ureter is connected to the recipient’s bladder.
Following surgery, patients remain in the hospital for about 3 to 5 days. The transplant team monitors for signs of complications like infection or initial organ rejection. The new kidney may start functioning immediately, or it might take a few days or even weeks to work fully, sometimes requiring temporary dialysis. Patients are encouraged to begin light activity, like walking, soon after surgery to aid recovery.
Living with a Transplanted Kidney
Life with a transplanted kidney involves ongoing management. Patients must take immunosuppressive medications daily for the rest of their lives to prevent their immune system from rejecting the new kidney. These medications, such as tacrolimus, cyclosporine, mycophenolate, and prednisone, work by suppressing the body’s immune response.
These medications can have side effects, including an increased risk of infections, certain cancers, high blood pressure, and diabetes. Regular follow-up appointments with the transplant team and other specialists are important to monitor kidney function, adjust medication dosages, and screen for potential complications. Lifestyle adjustments, such as maintaining a healthy diet, engaging in regular exercise, and avoiding exposure to infections, are also recommended to support the transplanted kidney and overall health.