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Transplant Essentials


Kidney Transplantation - types

Where do the kidneys that are used for transplant come from?

  • Kidney donors are divided into 2 main categories;

    • Living donor transplantation and Deceased donor transplantation.

  • Living donors. There are many types of living donors -

    • Living related, in other words, blood relatives

    • Living unrelated (emotionally related), such as friends.

    • ABO incompatible transplants are transplants that are performed regardless of ABO type of the donor and the recipient. For example: (1) A2 blood type donor kidney to O blood type recipient (2) A blood type donor kidney to B blood type recipient (3) B blood type donor to A blood type recipient

    • Positive cross match transplants: Kidney recipient may not be compatible to receive a kidney from a donor because patient has developed antibodies that react against the living-donor's organs. Following points to be considered (1) Such a transplant usually leads to rejection of the transplanted kidney. (2) However, positive cross match transplant can be performed after medical treatment to the recipient before transplantation. (3) Treatment modalities include combination of plasmapheresis, administration of immunoglobulin or other medications which will make the recipient accept the kidney from a donor.

    • Donor exchange transplants are done when patient and his or her donor have incompatibility due to different blood types. Instead of proceeding with such a transplant, Donor A will give kidney to Recipient B and the Donor B will give kidney to Recipient A. Following points to be considered (1) In general, patients and their donors should have the same blood type (2) Patients with AB blood type can receive organs from any blood type (3) Donors with O blood type can give an organ to any blood type (4) Rh positivity and negativity does not matter. That means Rh positive or negative patients can get kidneys from a positive or negative donor (5) Patient may have some antibodies that are not entirely compatible with the donor. Hence, his/her own donor can exchange with another recipient’s donor in order to receive a more compatible kidney.

    • Altruistic donor transplants, in other words, a stranger

  • Deceased donor transplants, Kidneys from patients who have died.

    • Deceased donor kidneys are given a score called the KDPI (kidney donor profile index), scored from 1- 100%, that tells transplant doctors the quality of the kidney.

    • PHS high-risk designation is given to donors known to have engaged in behaviors that may increase risk of diseases including hepatitis and HIV. Your transplant doctor will discuss the risks and benefits of these organs with you prior to receiving a transplant. High risk behaviors are IV drug use, prostitution, or incarceration.

    • These kidneys are placed in a separate category and are only used for a patient who, after hearing about the associated risks and benefits, agrees to accept that kidney. (See for more details.)

What are the advantages and disadvantages of living donor kidney transplantation?

  • Both short- and long- term results are excellent after Living donor transplantation. Kidneys almost always work well from the start and tend to last longer than kidneys from deceased donors.

  • Other advantages include -not having to wait, assurance of a good quality kidney, ability to plan the timing of surgery and the ongoing positive relationship that is often built between the donor and recipient.

  • Disadvantage is a living donor should be willing to donate a kidney. Not all patients have a living donor.

What are the advantages and disadvantages of deceased donor kidney transplantation?

  • Advantage of deceased donor transplantation is that no living person has to undergo surgery for kidney donation.

  • Deceased donor kidneys may not work quite as well from the beginning or last as long, when compared to living donor kidneys. There is often a wider range in the quality of deceased donor kidneys, longer waiting times for transplant, and unpredictable timing of surgery since transplant occurs when an organ becomes available.

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