Transplant

When the kidneys stop working, toxic waste products build up in the body, eventually resulting in end-stage kidney disease.  A child who reaches end-stage kidney disease will need either dialysis — a mechanical process for filtering waste products out of blood — or a transplant. Neither of these options cures kidney failure. However, a successful transplant offers the closest thing to a normal state.

During the evaluation for a kidney transplant, a transplant assistant will arrange for a series of tests to assess your child's treatment options. The transplant staff will discuss any medical problems that need to be evaluated before the transplant. A social worker will meet with you to assess transportation, housing, financial and family support needs, and a financial counselor will meet with you to ensure you understand the covered benefits of your insurance policy.

We encourage you to ask questions and learn as much as possible about the transplant process before making a decision. You do not need to reach a decision by the end of the session.

Screening Tests

Regardless of the type of kidney your child may receive — from a living donor or a deceased donor — special blood tests are needed to determine your child's kind of blood and tissue. These test results help to match a donor kidney to your child.

Once the evaluation is complete, the transplant team will meet and a decision is made whether or not to place your child on the transplant waiting list. This decision is made only after discussing each case with the nephrologist, surgeon, transplant coordinator, social worker and financial counselor. You will be notified when your child's name is placed on the national transplant waiting list. If a transplant isn't in your child's best interest, a transplant team member will call and discuss other options with you.

Kidneys for transplantation come from either a living donor or a deceased donor. When a living person donates a kidney, his or her remaining kidney will enlarge as it takes over the work of two kidneys. As with any major operation, there's a chance of complications, but kidney donors have the same life expectancy, general health, kidney function and activities as most other people. Any healthy person can donate a kidney. Sometimes a family member or close friend may wish to donate a kidney. A donor must be in excellent health, well informed about transplantation and able to give informed consent.

If you have a potential living donor, he or she will meet with a transplant surgeon and a transplant coordinator during the evaluation process to discuss the possibility of organ donation. We will perform tissue typing and other tests to determine if the potential donor is suitable. In some families, several people may be compatible donors. In other families, none of the relatives or non-relatives may be suitable.

Living Donors

Our living donor surgeries are done through a procedure called laparoscopic donor nephrectomy. This procedure uses tiny incisions and miniature instruments to remove the kidney. Our team has performed more than 60 of these procedures since 1999.

Most laparoscopic nephrectomy patients stay at the hospital only two or three days after the surgery, compared to four or five days for a conventional nephrectomy. The laparascopic procedure is just as safe for both donor and recipient, and recovery is easier for the donor. Laparoscopic nephrectomy is now offered to any patient who meets the physical requirements.

Deceased Donors

A deceased kidney comes from a person who has died. The Uniform Anatomical Gift Act allows all of us to consent to donate organs when we die and allows our families to provide such permission as well. After permission for donation is granted, the kidneys are removed and stored until a recipient has been selected. All donors are carefully screened to prevent any disease transmission.

If you want your child to undergo a deceased kidney transplant and this is a medically acceptable option, your child's name will be placed on a deceased waiting list. A sample of blood for antibody level is sent monthly to the medical center. The waiting period for a deceased kidney depends upon the availability of a deceased donor compatible with your child's blood type and antibody level.

When a kidney becomes available, you will be contacted. The transplant team will verify that your child has no recent infections or medical problems that would interfere with safe transplantation. The transplant team will tell you when a deceased kidney is available and will assist in planning for your transplantation.

Transplant Surgery

Your child's surgery may last from two to over four hours. In children weighing over about 45 pounds, the kidney is placed in the pelvis rather than the usual kidney location in the back. Your child's own kidney will usually remain undisturbed. The artery that carries blood to the kidney and the vein that removes blood from it are surgically connected to two blood vessels already existing in the pelvis. The ureter, or tube that carries urine from the kidney to the bladder, is also transplanted through an incision in the bladder. If your child is smaller, there is not enough room in the pelvis for the new kidney. In that case, the kidney is placed within the abdomen, requiring the intestines to be manipulated. The blood vessels of the kidney are connected to the main artery (aorta) and vein (vena cava) in the abdomen, and the ureter is connected to the bladder. Other procedures may be carried out during the transplant operation (such as removal of appendix, gall bladder, possibly your child’s own kidney or kidneys). This is a bigger specialized operation which will require a longer time for recovery.

After the operation, your child will be taken to the recovery room for a few hours and then will return to the surgical ICU. The surgeon will inform you when the procedure is over. Your child will be encouraged to get out of bed 12 to 24 hours following surgery to walk around the unit as much as he or she can. Nurses will help teach your child how to take medications, about side effects and about nutrition guidelines after a transplant.

A deceased kidney will occasionally perform as a "sleepy" kidney, a condition called acute tubular necrosis, or ATN. This means that the kidney is temporarily slow in functioning. Your child may need dialysis a few times, which will not harm the kidney. The "sleepy" kidney usually starts working in two to four weeks.