Q: Why should I consider a kidney transplant instead of dialysis?
A: While dialysis is a life-saving treatment, it does only about 10 percent of the work that a functioning kidney does. Because of its impact on the body, dialysis can also cause other health problems. Patients typically live 10 to 15 years longer with a kidney transplant than if they stayed on dialysis. And most people report that in comparison, transplantation offers them a much better quality of life.
Q: Am I a good candidate for a kidney transplant?
A: You will need a thorough evaluation by the kidney transplant staff, in consultation with referring physicians, to determine if transplantation is the best treatment option. Being a good candidate for transplant depends upon your physical health, emotional well-being and ability to manage medication and care plans.
Q: When is the best time for me to get a transplant?
A: If at all possible, it is best to have a transplant before you have dialysis or spend a long time on dialysis. Patients who have a living kidney donor have the best chance of avoiding dialysis, or being on dialysis for less time than if they had to wait for a deceased donor kidney. If you have a living donor, it may be possible for you to undergo a transplant before you ever need dialysis. Studies show that patients who receive a kidney from a living donor before being on dialysis, have better results than patients who have had dialysis prior to transplant.
No matter how long someone has been on dialysis, a transplant from a live donor should still be considered. Living donation can also be scheduled at the convenience of both donor and recipient at a pre-determined time, rather than as an urgent operation when a deceased donor kidney becomes available.
Q: How do I get a kidney?
A: Sometimes, a relative, spouse or friend is able to donate a kidney to a loved one, provided the removal of the kidney will not harm the living donor's health. The donor must undergo a thorough medical evaluation that includes, among other things, blood work to assess tissue compatibility and the likelihood of organ rejection.
Living donation is preferred because it offers patients the best chance for a good quality kidney with the shortest possible waiting time. Once a living kidney donor has been medically cleared to donate, both surgeries (transplant and donation) can be scheduled at the convenience of the donor and recipient.
If a living donor is not an immediate option for you, then you will be listed with the United Network for Organ Sharing (UNOS). UNOS administers and maintains the national organ transplant waiting list.
LifeShare of Oklahoma is the regional transplant procurement organization for St. John Medical Center, and shares organs through UNOS. LifeShare will enter your medical information into a database and notify our transplant team when an organ becomes available based on your blood type, your place on the waiting list and other factors.
All organ procurement organizations and transplant centers belong to UNOS. LifeShare operates according to policies set by UNOS, which is supervised by the federal government. LifeShare helps ensure equal access to all patients who need a kidney for transplant by balancing the needs of long-term patients on the waiting list with the goal of transplanting well-matched kidneys. Please talk to the St. John kidney transplant team if you have questions.
Q: How long will I wait on the national waiting list?
A: Typically the wait for a deceased donor kidney is long. And there is no guarantee when a deceased donor kidney will become available. Patients could wait several years for a deceased donor kidney, during which time their health may decline. For this reason, we strongly advise patients to consider talking to family members, friends and others about living kidney donation.
The average wait time at St. John is 23 months, compared to the U.S. average of 53 months. Patients who have a living kidney donor may be able to avoid dialysis, or may spend less time on dialysis than if they had to wait for a deceased donor kidney.
Q: What medication must I take?
A: You will take anti-rejection (immunosuppressant) medications for as long as you have a functioning transplant. You will also need medications to prevent infection for a short time after your transplant. Additionally, you may need medications to control blood pressure and prevent fluid retention.
You are responsible for managing your own medication schedule, as determined by the St. John Kidney Transplant Team and your nephrologist. You should never stop taking your medication or change the dose without approval from the transplant team, even if you experience unpleasant side effects. Tolerating some side effects may be necessary to prevent organ rejection. Tell your transplant team about any bothersome side effects. Your doctor may be able to adjust your medication.
Q: What if my body rejects the new kidney?
A: Rejection is a signal that your immune system has identified the new kidney as foreign tissue and is trying to get rid of it. Preventing rejection with anti-rejection (immunosuppressant) medication is the first priority. The most common sign of rejection is change in kidney function (an increase in creatinine, a waste product), as measured by a blood test. This is why you need frequent blood testing in the first three months after transplantation, and regular testing after that.
If a kidney biopsy and ultrasound confirms rejection, then the transplant team will increase the amount of anti-rejection medication or prescribe a different combination of anti-rejection drug therapy. Using medicine, most rejection episodes can be successfully reversed, if detected early enough. However, if the episode is severe, it may shorten the overall lifespan of the new kidney.
Q: How often will I have to go to the transplant program after my transplant?
A: You will have frequent follow-up visits with the transplant team or your nephrologist and frequent laboratory tests for the first year after your transplant. Gradually, you will see the transplant team less often, and can look forward to having more time for yourself and your activities.
As you see the transplant team less often, many of your healthcare visits will be to your primary care physician, nephrologist and other specialists. Always tell your healthcare providers that you have had a transplant, so if you become ill, they can determine whether your symptoms are related to your transplant. We recommend you keep a list of your current medications, as well as any drug allergies, with you at all times.
Q: May I exercise?
A: Yes. It will take time to regain strength and endurance after a transplant, but eventually you may resume normal activity. Walking and stair climbing are excellent exercises for maintaining muscle tone and strength. You should consider walking five to ten minutes a day when you first arrive home following surgery, and then slowly increase the time you walk each week. Do not begin strenuous exercises, such as jogging, tennis and weightlifting for at least two months after the operation, and be sure to rest when tired.
Q: Are there any restrictions I must follow?
A: You should not smoke after your transplant; quitting prior to the transplant is crucial to extend your life and the life of your new kidney. The transplant team will let you know when you can begin to drive again, return to work or school, and travel. You can decide when to resume sexual activity, depending upon how you feel. Postoperative discomfort usually does not interrupt sexual activity for more than a few weeks.
Q: How do I pay for a transplant?
A: A financial coordinator and social worker will help you map out a financial plan to cover the costs associated with transplant care, surgery and medication. Patients typically finance costs associated with their transplant by combining more than one resource. For the uninsured or underinsured, private, public, and social programs will be explored, depending upon individual circumstances. Our financial coordinator and social worker will help you explore every available option and keep current on legislation and policies that impact transplant funding.
Q: What are my out-of-pocket costs after the transplant?
A: Out-of-pocket costs following a transplant are highly variable, based on whether you have insurance, Medicare or Medicaid coverage. We understand that finances are a major concern for patients, and good planning will help reduce this stress. Your financial coordinator will review your situation and help as needed to address your financial concerns and investigate available resources. As a courtesy, transplant candidates will receive information from the financial coordinator detailing current insurance policy guidelines, inpatient hospitalization and medication coverage.