shortage of donor kidneys limits the availability of
kidney transplantation. Another 30,000 to 45,000
people are eligible for kidney transplantations and
await donor organs. A donor kidney may be a
cadaver organ donation (donated after a person’s
death) or come from a person who has two healthy
kidneys and offers to donate one to the recipient.
In the United States, the federal health-care
program Medicare pays for 80 percent of most
expenses related to kidney transplantation for
those who meet the qualification criteria. The U.S.
Centers for Medicare and Medicaid Services Web
site (www.cms.hhs.gov) provides comprehensive
information about eligibility and covered services.
Private health insurance and other public pro-
grams also provide coverage for kidney transplan-
tation costs, though coverage varies among
carriers and programs.
Donor KidneysThe primary source of donor kidneys is cadaver
donation—people who authorize the donation of
their organs when they die. In the United States
the United Network for Organ Sharing (UNOS)
administers the nationwide cadaver donor organ
collection and distribution program, the Organ
Procurement and Transplantation Network
(OPTN). People eligible for kidney transplantation
register with OPTN through regional organ trans-
plantation centers. OPTN follows strict guidelines
intended to ensure equitable access to donor
organs. People may wait several months to several
years for a matched cadaver donor kidney, as the
OPTN system distributes organs to matched recipi-
ents who are the sickest.
The wait time for a living donor kidney trans-
plant is typically significantly shorter, often only
several months, because as soon as the transplant
team confirms the intended donor is a match the
surgeries (donation and transplantation) can take
place. Living organ donation does not fall within
OPTN. Only the intended recipient may receive
the kidney from the living donor. The living donor
is often a family member though may be a
stranger who is a strong match with the recipient.
Donor-Recipient Match
The donor kidney must match the recipient as
closely as possible in three ways. First, the donor
and the recipient must have the same BLOOD TYPE.
Second, the donor and the recipient must match
HUMAN LEUKOCYTE ANTIGENS(HLAS), which are pro-
teins on the surfaces of leukocytes (white BLOOD
cells), as closely as possible. Every person has six
HLAs. The more HLAs that match between donor
and recipient, the higher the likelihood that the
recipient’s body will accept the donor kidney
(though all organ transplant recipients take lifelong
immunosuppressive therapy). Transplant surgeons
like to see a match of three or more HLAs. Third,
the donor’s blood must not initiate an ANTIBODY
response with the recipient’s blood (called a nega-
tive crossmatch), which the transplant team tests
by mixing samples of blood from each in a test tube.Surgical Procedure
The transplant surgery generally takes three to
five hours. With the person under general ANES-
THESIA, the transplant surgeon makes an incision
in the lower abdomen, placing the donor kidney
in the abdominal cavity below the native kidneys.
The surgeon attaches the donor kidney’s arteries
and veins to the recipient’s iliac ARTERYand iliac
VEIN, respectively, and the donor kidney’s URETER
to the BLADDER. Depending on the reason for the
ESRD, the surgeon may either leave or remove
the recipient’s nonfunctioning kidneys. After
returning to full consciousness in the recovery
room, the recipient typically remains in the hospi-
tal for three to five days. The transplanted kidney
may begin functioning immediately or take sev-
eral weeks. The recipient undergoes RENAL DIALYSIS
until kidney function becomes adequate.Risks and Complications
The risks of transplantation surgery include bleed-
ing during or after the operation and postopera-
tive INFECTION. Because the transplanted kidney is
lower in the abdomen than the native kidneys it
lacks the protection of the rib cage and is more
vulnerable to traumatic injury. Rarely the recipi-
ent’s body may immediately reject the donor
organ, in which case the transplant team must
operate again to remove it. Most people recover
fully from the surgery without complications,
though there is always the risk of organ rejection.
Many kidney transplant recipients experience
episodes of organ rejection that the transplantkidney transplantation 203