Kidney

Transplant Options

Nebraska Medicine's Kidney Transplant Program offers several types of transplant options and therapies for adults, adolescents and pediatric patients with kidney failure. Those options include:



Living-Donor Kidney Transplants

Living-donor kidney transplants are accomplished when a healthy individual with two functioning kidneys agrees to donate one of their healthy kidneys to someone who is on dialysis or will need dialysis in the very near future. Individuals who need dialysis have been determined by their physician/nephrologists to have end-stage renal disease (ESRD), making them potential candidates for a transplant.

Each year, the number of patients needing kidney transplantation increases while the number of deceased donors has remained about the same. Living donation has been successful because the risk of death or disease to the donor is very low. Donor selection is very important to ensure minimal risk. It is important for the transplant team to evaluate a donor's overall health to provide a safe surgical procedure.

Types of Living-Donor Transplants

Living Related Donors - Individuals who are blood relation to the transplant recipient such as parent, aunt, uncle, brother, sister, nephew, niece, etc.

Living Unrelated Donors - Individuals who are not blood relation to the transplant recipient and may include spouse, friend, neighbor, co-worker, brother-in-law, sister-in-law, etc.

Anonymous Donors - Individuals who offer to donate a kidney to a transplant recipient who is included on the waiting list. Donors and recipients do not know each other. The donation is made "out of the goodness of their heart" and with no financial gain. An Anonymous Donor can further be defined as follows:

  • Altruistic/Good Samaritan - an individual who wishes to donate to the general pool with no specific recipient in mind.
  • Paired Exchange - an individual wishes to donate to a relative or friend but cannot because of incompatible blood types or cross match. If another pair is found in the same circumstance, an exchange may be possible between the two pairs.

Surgical Approaches

Traditional-Kidney Transplant

A kidney transplant is performed by placing the kidney on the right or left side of the lower abdomen. An incision is made to implant the new kidney, attach it to the necessary blood supply and to the bladder for urine drainage. Generally, the native kidneys are left in place; however, exceptions may be made in the event of infection, the potential for infection, the presence of cancer and, in some cases, if a patient has very large kidneys as seen with patients who have polycystic kidney disease.

Open-Donor Nephrectomy

An open-donor nephrectomy is done through a flank incision either on the left or the right side of the abdomen, just above or below the twelfth rib. This type of donor nephrectomy is considered the standard or traditional method of removing a kidney and can be fairly painful. Average length of stay in the hospital is four to five days. Return to work after discharge can be four to six weeks.

Laparoscopic-Donor Nephrectomy

Laparoscopic-donor nephrectomy is a procedure in which the kidney is removed from the donor through several small (approximately one-inch) incisions. The operation is performed with the aid of a camera, which is inserted through one of the small incisions. Pencil-thin instruments are inserted through the other incisions. At the end of the procedure, the kidney is removed through a five- to seven-inch incision that extends slightly above and slightly below the belly button.

Deceased-Donor Kidney Transplants

Kidneys are distributed to patients on the waiting list through the United Network of Organ Sharing (UNOS). Recipients are determined by a point system that is calculated by the length of time they have been on the waiting list, how well the donors match the recipients and emergent status of the recipients, as well as whether the patients are pediatric patients.

Kidney/Pancreas Transplant (Simultaneous Kidney/Pancreas)

This dual transplant is considered when individuals with Type I or Type II diabetes mellitus have developed kidney failure as a result of diabetes and have completed a transplant evaluation. It also has been determined that the individuals are acceptable candidates for the combined transplant. The patients are placed on the deceased donor list and receive a kidney and pancreas from the same donor. If patients have acceptable kidney donors, we can proceed with the living-donor kidney transplant. When patients recover from this surgery, they are placed on the waiting list for a pancreas (after kidney) transplant.

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