CHAPTER 1: Overview

INTRODUCTION

The main benefits of transplantation are:

• Improved survival

• Improved quality of life

• From a public health perspective, a successful kidney transplant is more effective medically and financially than chronic dialysis therapy

• Preemptive (prior to starting dialysis) transplantation provides the best outcomes

• Risk of death is directly proportional to time on dialysis

• As in all medical and surgical procedures, no guarantees can be provided with respect to outcomes and/or results

• “Transplant candidate”: Before transplantation

• “Transplant recipient”: After transplantation

Transplantation entails a multidisciplinary team approach that includes but is not limited to:

• Transplant center director

• Transplant administrator

• Transplant coordinator

• Transplant financial coordinator

• Transplant independent living donor advocate/team (at institutions performing live donor transplants)

• Transplant nephrologist

• Transplant nurse practitioners

• Transplant pharmacist

• Transplant physician assistants

• Transplant social worker

• Transplant surgeon

• Transplant unit staff nurses

• Consulting specialists (cardiology, infectious diseases, psychiatry, endocrinology, others)

• Referring physicians

Evaluation:

• Medical, surgical, pharmacy, nutritional, social, and financial conditions are considered when determining candidacy

Waiting list:

• Once approved for transplantation, candidates are placed on a waiting list

  • Regular re-evaluations are required, especially when approaching the top

• Being in the waiting list for a deceased donor does not guarantee transplantation

  • Events such as strokes and myocardial infarctions may disqualify candidates

Donors:

• Kidneys can be obtained from live or deceased donors

• Live donor kidneys are associated with better outcomes than those of deceased donors

Facts about live donation:

• Donor safety and well-being constitute the main priority when considering live donor transplantation

• Communications between potential donors and the transplant center should always be kept confidential (unless otherwise authorized by the donor)

Positive aspects of living donation:

• Short waiting time

• Elective procedure

• Improved graft and recipient outcomes.

• Potentially improved genetic compatibility

• Psychological benefit for donors (and recipients)

Risks involved in living donation:

• Donor surgical, medical, psychiatric, social, and financial risks

• Complications may be short and/or long lasting

Blood typing:

• Donor and recipient must be ABO identical or compatible (unless otherwise addressed prior to transplantation) (Table 1-1)

• Organs from donors with blood subtype A2 (technically known as “A1-negative” or “A, non-A1”) can also be potentially transplanted onto O and B recipients (in addition to A and AB recipients)

• Organs from donors with blood subtype A2B (“AB, non-A1B”) can potentially be transplanted onto B recipients

• Transplantation across incompatible blood types is possible, but requires intensive preparation both before and after transplantation.