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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


  • 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


  • 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.

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TABLE 1-1 Blood Type Compatibility

Donor ABO

Compatbible Recipient Abo


O, A, B, AB




A, AB, O (potentially), B (potentially)






AB, B (potentially)

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