A kidney transplant is a surgery done to replace a diseased kidney with a healthy kidney from a donor. The kidney may come from a deceased organ donor or from a living donor. Family members or others who are a good match may be able to donate one of their kidneys. This type of transplant is called a living transplant. People who donate a kidney can live healthy lives with one healthy kidney.
A person getting a transplant most often gets just 1 kidney. In rare situations, he or she may get 2 kidneys from a deceased donor. The diseased kidneys are usually left in place. The transplanted kidney is placed in the lower abdomen on the front side of the body.
You may need a kidney transplant if you have end stage renal disease (ESRD). This is a permanent condition of kidney failure. It often requires dialysis. This is a process used to remove wastes and other substances from the blood.The kidneys:
Sometimes family members, including brothers, sisters, parents, children (18 years or older), uncles, aunts, cousins, or a spouse or close friend may wish to donate a kidney. That person is called a "living donor." The donor must be in excellent health, well informed about transplantation, and able to give informed consent. Any healthy person can donate a kidney safely.
A deceased donor kidney comes from a person who has suffered brain death. The Uniform Anatomical Gift Act allows everyone to consent to organ donation for transplantation at the time of death and allows 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.
Regardless of the type of kidney transplant-living donor or deceased donor-special blood tests are needed to find out what type of blood and tissue is present. These test results help to match a donor kidney to the recipient.
The first test establishes the blood type. There are four blood types: A, B, AB, and O. Everyone fits into one of these inherited groups. The recipient and donor should have either the same blood type or compatible ones, unless they are participating in a special program that allow donation across blood types. The list below shows compatible types:
The AB blood type is the easiest to match because that individual accepts all other blood types.
Blood type O is the hardest to match. Although people with blood type O can donate to all types, they can only receive kidneys from blood type O donors. For example, if a patient with blood type O received a kidney from a donor with blood type A, the body would recognize the donor kidney as foreign and destroy it.
The second test, which is a blood test for human leukocyte antigens (HLA), is called tissue typing. Antigens are markers found on many cells of the body that distinguish each individual as unique. These markers are inherited from the parents. Both recipients and any potential donors have tissue typing performed during the evaluation process.
To receive a kidney where recipient's markers and the donor's markers all are the same is a "perfect match" kidney. Perfect match transplants have the best chance of working for many years. Most perfect match kidney transplants come from siblings.
Although tissue typing is done despite partial or absent HLA match with some degree of "mismatch" between the recipient and donor.
Throughout life, the body makes substances called antibodies that act to destroy foreign materials. Individuals may make antibodies each time there is an infection, with pregnancy, have a blood transfusion, or undergo a kidney transplant. If there are antibodies to the donor kidney, the body may destroy the kidney. For this reason, when a donor kidney is available, a test called a crossmatch is done to ensure the recipient does not have pre-formed antibodies to the donor .
The crossmatch is done by mixing the recipient's blood with cells from the donor. If the crossmatch is positive, it means that there are antibodies against the donor. The recipient should not receive this particular kidney unless a special treatment is done before transplantation to reduce the antibody levels. If the crossmatch is negative, it means the recipient does not have antibodies to the donor and that they are eligible to receive this kidney.
Crossmatches are performed several times during preparation for a living donor transplant, and a final crossmatch is performed within 48 hours before this type of transplant.
Testing is also done for viruses, such as HIV (human immunodeficiency virus), hepatitis, and CMV (cytomegalovirus) to select the proper preventive medications after transplant. These viruses are checked in any potential donor to help prevent spreading disease to the recipient.
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