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Deceased Donation
Deceased donor organs are donated by families that have suddenly lost a close relative. There are two types of deceased organ donors. Donors from brain death (DBD’s), mainly from accidents or a brain haemorrhage. These donors have had a severe and irreversible brain injury that they cannot recover from and are declared ‘brain dead’ (that is their heart and body is kept alive by a breathing machine but their brain has died). The other type of deceased organ donors are donors from cardiac death (DCD’s). All donor families are asked to give consent for their relative’s organs to be used for transplantation after cardiac death.
Unfortunately, the need for organs is higher than the number of organs available for transplant. Currently, there are approximately 650 people waiting for a kidney transplant and between 140 and 170 deceased donor transplants are performed annually.
Deceased donor kidney transplantation has an advantage in that a living donor does not need to undergo a kidney donor operation which has associated discomforts and risks. The disadvantage, however, is that there is a worldwide shortage of kidneys to transplant and people have to wait quite long periods of time for one to hopefully become available. Currently, the Irish average waiting time for a deceased donor kidney transplantation is about 3 years.
DECEASED DONOR KIDNEY TRANSPLANTATION
While a kidney transplant can be a very successful operation, it does require a major operation lasting up to 3-4 hours. Not all patients with kidney disease will be medically fit to cope with this procedure. Patients with severe heart disease, history of stroke or peripheral vascular disease are often better served by continuing on dialysis rather than having a kidney transplant.
Patients that have had a history of cancer (except skin cancer) generally need to wait five years, after definitive treatment for the cancer, before going on the transplant waiting pool.
There is no upper age limit for kidney transplantation but, as a general rule, patients over 70 years of age, who do not have other associated illnesses such as heart disease, history of stroke or peripheral vascular disease, will be accepted on the transplant waiting pool.
In allocating kidneys, there are competing priorities. There is a need to do the best for the individual patient but also the best for society in general, by allocating the scarce supply of kidneys to patients who will get many years of success.
Patients who have certain forms of kidney disease that may recur in the transplanted kidney may be better suited to dialysis rather than having to endure repeat transplantation. Your nephrologist will discuss your individual case with you, and will help you make the right decision regarding transplantation.
RISKS AND OUTCOMES ASSOCIATED WITH KIDNEY TRANSPLANTATION
Kidney transplantation is a major surgical procedure with a success rate of about 95%. That is, 95% of kidneys transplanted will be functioning one year after the surgery.
Viewed another way, about 5 people in a 100 will not have a successful outcome from kidney transplantation. In general, about 3 patients in 100 will die, either during the operation, or shortly afterwards. Pre-operation testing, minimises these risks; nonetheless, you should be aware that there are significant risks associated with transplant surgery.
Other risks associated with transplant surgery will be discussed later in this book, but the transplant medicines necessary for the transplant to function, can cause side effects including diabetes, increased risk of infection, weight gain, increased risk of skin cancer and, rarely, lymphoma, (a form of cancer). There is also approximately a 10% risk of transplant rejection, which can be treated with courses of medicine, but still represents a risk to your new kidney. By following your doctor’s instructions, and having regular medical check-up’s you can help minimise the risk of your new kidney failing.
The outcome of kidney transplantation needs to be compared with the alternative, which is dialysis and the lifestyle restrictions it brings. In general, kidney transplantation results in more than doubling of life expectancy, when compared to remaining on dialysis.
Deceased donor kidney transplants function for an average of 15 or 16 years. A live donor transplant functions for an average of 17 to 20 years and a best matched live donor kidney transplant functions for an average of 32 years.
NEPHRON DOSING
The nephron is the functional unit of the kidney where all filtration takes place. A healthy kidney has approximately one million nephrons. The goal of transplantation is to deliver the “healthiest” kidney to the recipient.
In a small number of cases, usually if the donor is an older individual, both kidneys are transplanted into a single recipient to maximise the number of nephrons delivered. This type of transplant is called “nephron dosing.”
A kidney is placed on either side of the lower abdomen resulting in two scars. This operation takes longer than a single transplant and the recipient has a longer hospital stay. These kidneys can also be ‘slow to start.’ The decision to carry out a nephron dosing transplant is made on a case-by-case basis and is discussed with the potential recipient prior to surgery.
KidNEY PANCREAS TRANSPLANTATION
Patients who have developed kidney disease due to Type 1 diabetes may benefit from having a simultaneous pancreas and kidney transplant (SPK). This option is only suitable for Type 1 diabetes. It is not suitable for Type 2 diabetes.
Type 1 diabetes results from the body’s failure to produce insulin and presently requires the person to inject insulin.
Type 2 diabetes results from insulin resistance, the cells fail to use insulin properly.
During a SPK procedure a whole pancreas is stitched onto the vessel going to one leg and the kidney transplant onto the blood vessel going to the other leg. It is important to realise that a SPK transplant is a much bigger and more difficult operation than a kidney transplant alone.
Currently the results of SPK transplantation are very good with a one year survival of 95% and a 5 year survival rate of 90%. Kidney pancreas transplantation should be considered the treatment of choice for all otherwise, well, young patients with renal failure from Type 1 diabetes. SPK transplantation is conducted in St. Vincent’s University Hospital, Dublin 4.
Advantages of kidney/pancreas transplantation
Disadvantages of kidney/pancreas transplant
