If your child experiences kidney failure, which can happen for several reasons, your child’s doctor may suggest a kidney transplant as an alternative to dialysis. A kidney transplant takes two people – a donor and a recipient – and both will inevitably have questions. Below are commonly asked questions and answers that recipients and donors may have.
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What are the differences between living and deceased donor kidney transplants?
A deceased donor kidney transplant is when a kidney from a person who has recently died is removed and placed into recipient with kidney failure who is waiting for a new organ. Consent is obtained from the donor’s family, or from the donor (donor card).
A living donor kidney transplant is when a living donor (family, friend or someone unknown) chooses to donate their kidney to someone with end-stage renal disease.
- Living donation allows for coordination of the donor and recipient schedules; for example, scheduling during school vacations or lighter periods at work.
- Living donor kidney transplants have better long-term graft and patient outcomes.
- Wait time for a kidney transplant may be shorter for patients, if living donor options are available.
What is a preemptive kidney transplant?
A pre-emptive kidney transplant is performed before a child or adult with progressing chronic kidney disease is started on peritoneal or hemodialysis.
When can my child get a kidney transplant?
Before your child is able to get a kidney transplant, they will need to have a detailed evaluation at a transplant center. The evaluation helps the transplant team determine if and when a kidney transplant is the right choice. In general, a child must reach a certain size prior to receiving a kidney transplant, so the decision about when the time is right for kidney transplantation depends on each child’s unique needs and risks.
Here, we perform kidney transplants in children starting in toddlers and ranging through young adulthood. We continue to care for children and young adults with kidney transplants until they transfer to adult transplant centers.
How can I get my child on the kidney transplant waitlist?
Our transplant team will first complete a comprehensive kidney transplant evaluation, taking numerous factors into account including your child’s test results and medical history. Once your child is evaluated and approved, they will be placed on the United Network for Organ Sharing (UNOS) transplant list. The decision whether and when your child is a candidate for listing will be discussed with you by your healthcare team after the evaluation process.
What does the evaluation for transplant look like?
Each transplant center has its own guidelines for deciding if your child is a good candidate for a kidney transplant. However, at every center, you and your child can expect to have:
- A medical and surgical assessment. The transplant team will review your child’s medical and surgical history carefully. You will be asked about any illnesses, surgeries and treatments your child has had in the past. You will also be asked about your family’s history, and if any problems are found, they will be looked into further.
- A physical exam. The transplant team will need to make sure your child is healthy enough for transplant surgery, and that a transplant is the best choice for your child.
- A psychosocial exam. Getting a new kidney has many benefits, but it also has risks. One purpose of the psychosocial exam is to make sure you and your child are emotionally prepared for the surgery, post-transplant care and for living with a new kidney. You and your family may have some unexpected feelings during this journey, so our psychosocial exam helps make sure you will be able to cope with the physical and emotional aspects of your child’s transplant.
- Laboratory and radiologic testing. The transplant center will need to know your child’s blood and tissue type in order to match your child to a suitable kidney.
What are the average wait times for a patient at CHCO for kidney transplant?
Once your child is added to the national organ transplant waiting list, they may receive a new kidney that day or may wait many months. Our median wait list time for a kidney transplant at Children’s Colorado is currently 4.7 months. Factors affecting how long your child may wait include how well they match with the donor, how long they have been listed and how many donors are available in the local area compared to the number of patients waiting.
What are my child’s restrictions after kidney transplant?
There are not many restrictions that our care team will recommend because our goal is to have transplant recipients lead full and typical childhoods. We encourage shared decision making about day-to-day activities and sports. When traveling internationally after kidney transplant, we recommend that all vaccinations are up-to-date, and that travelers have identified possible local international health-care facilities, should they be needed.
How do you choose the best donor kidney for my child?
Many different medical and logistical characteristics are considered for an organ to be distributed to the best-matched potential recipient. While the specific criteria differ for various organs, matching criteria generally include:
- Blood type and size of the organ(s) needed
- Time spent awaiting a transplant
- Relative distance between donor and recipient
- Medical urgency of the recipient
- Degree of immune-system match between donor and recipient
Who can donate a kidney to my child?
There are many options for potential kidney donors to take into consideration:
- Donor must be over 18 and under 55.
- Donors must be in good overall physical and mental health status.
- Donors must have blood compatibility with the recipient.
Our most common living donors are parents, siblings and/or friends of the family. In the last two years, 45% of kidney transplant recipients at Children’s Colorado received kidneys from living donors.
What is an altruistic (non directed) living donor?
In non-directed donation, the donor does not name the specific person to get the transplant. The match is arranged based on medical compatibility with a patient in need. Some non-directed donors choose never to meet their recipient, and some candidates choose not to meet their donor. In other cases, the donor and recipient may meet at some time, if they both agree.
What is paired exchange?
A paired kidney exchange, also known as a “kidney swap” occurs when two or more donor/recipient pairs share organs for better compatibility matches. Participating in a paired exchange allows for recipients to receive better matched kidneys and also helps patients receive kidney transplants sooner, rather than continue to wait for the right matched organ.
What are the side effects of a pediatric kidney transplant?
The main side effects of a kidney transplant come from the anti-rejection medicines (immunosuppressants) our transplant team prescribes to keep your child and their kidney transplant healthy. Children with a kidney transplant must take this medicine to keep their bodies from rejecting their new kidneys. Common side effects include weight gain, increased blood pressure and increased risk of infection. Your doctor will work with you to decrease side effects for your child by adjusting various medicine dosages.
What is the success rate of kidney transplants?
Here at Children’s Colorado, our success rates are comparable or even better than national outcomes. Transplant outcomes are updated by the Scientific Registry of Transplant Recipients (SRTR) every six months, and we will share our outcome data with you during your kidney transplant evaluation.
Does a pediatric kidney transplant cure kidney disease?
A kidney transplant does not cure kidney disease in children, but it does treat it for as long as the new kidney lasts. Your child will need to take anti-rejection medicine for as long as they have the donated kidney. There are some diseases that may return after a kidney transplant, but our multidisciplinary team will establish a specific plan to monitor your child’s health and achieve overall remission of the disease.
What is the Kidney Donor Profile Index?
The Kidney Donor Profile Index (KDPI) is a scoring system for kidneys from deceased donors. It scores the donor kidney based on the donor’s age, health and cause of death. The lower the number, the longer the kidney is expected to function in the new recipient. For example, a kidney with a KDPI of 20% is likely to last longer than 80% of other recovered kidneys from deceased donors.
What is an artificial kidney transplant?
Researchers are working to develop and test implantable artificial kidneys. These could eventually provide an alternative to living and deceased donor kidneys and eliminate the time recipients wait to receive a transplant. The artificial kidney device would perform the main functions of a natural kidney and could serve as a permanent replacement. A child with an artificial kidney would not need to take immunosuppressant drugs to keep their body from rejecting it. Researchers have been working on an artificial kidney for quite some time and it will still be several years before one may be ready for use.