Kidney transplants - when are they considered?

A kidney transplant is another treatment option for kidney failure, but, like dialysis, it is not a cure. It is a surgical procedure which can give you a new, healthy functioning kidney. The new kidney will perform the functions that the failed kidneys cannot.

Transplantation offers people with kidney failure increased independence and freedom from the constraints of dialysis. Following a transplant, more normal, active life can be resumed. However, the new kidney requires lifetime management and care.

Transplants are available to medically suitable patients, usually after they have been stabilised on dialysis. Not everyone is suitable for a transplant; your doctor will discuss this with you. Factors that influence your eligibility for a transplant include your general physical health (excluding kidney failure), your willingness to undergo the procedures involved and your acceptance of the idea of transplantation.

How successful is a transplant?

Transplant surgery is very successful; over 90% of transplants are working one year later. The procedure takes two to three hours, placing the kidney in the pelvis, near the bladder, through an incision in the lower part of the abdomen. Usually the old kidneys are not removed.

As long as the transplanted kidney remains healthy, a kidney transplant means that you will not have to continue regular long-term dialysis or have the dietary and lifestyle restrictions imposed by dialysis.

After a transplant, immunosuppressive drugs are necessary for the rest of the person's life to prevent the transplant from being rejected by the body. If a transplant is rejected, dialysis treatment will again be necessary.

Kidney donors

Kidneys for transplantation come from two sources; living donors and cadaveric (recently deceased) donors. Living donors are often close family members, although other living donors are increasingly donating kidneys, such as the patient's partner, friend or more distant family.

In some countries wealthy kidney failure patients offer to pay strangers for their kidneys. Trade in human organs is illegal in New Zealand and doctors who participated in such an arrangement would lose their medical registration and possibly face prosecution.

Kidney allocation

If no living donor is available, kidney failure patients are usually placed on the waiting list for a cadaveric kidney transplant. Unfortunately there are many more people waiting than there are donors. The average wait for a cadaveric kidney in New Zealand is two to three years. The length of time you spend on the waiting list can vary. Kidney allocation depends on matching of blood and tissue type as well as on length of time on the list.

Advantages of transplantation:

• most similar to original kidneys
• no dialysis needed
• no internal or external access required
• normal diet and fluid intake
• normal lifestyle
• fewer hospital visits after the first few months.

Disadvantages of transplantation:

• stress of waiting for a transplant
• long waiting times
• risk of transplant rejection 
• requires regular life-long medication
• lowered resistance to illness and infection
• side effects of medication
• risks associated with major surgery.

Original material provided by the New Zealand Kidney Foundation. Edited by everybody, August 2005.