5 Steps: How Do You Get a Kidney Transplant?

Once your physician determines you are a candidate for transplant, and you've determined you want to pursue it, there are some key steps to keep in mind as you go through the process. Here's a look at the path to receiving a kidney transplant, and how to make it a successful treatment option when you have end stage renal disease (ESRD).

1.  Finding an ideal kidney match

There are two types of kidney donors:

• Living donor: Elects to donate one of their kidneys and undergo surgery for its removal.
• Deceased donor: Allowed usable organs to be donated at their death.

Tests are needed to determine if the donor and recipient are a good match to help increase the chances of a successful transplant. There are three tests: blood type matching, tissue matching and crossmatching.

• Blood type matching: Matches your blood type to the potential donor's blood type.
• Tissue matching: Measures and defines certain proteins, called antigens, present in the patient and potential donor's blood and tissue proteins.
• Crossmatching: Performed by mixing a small amount of the patient's and potential donor's cells.

If you have a potential living donor and the transplant team has determined that person is a good match, they will also undergo a thorough medical evaluation at the transplant center. If things go well, you and your living donor will be scheduled for the transplant surgery.

If you do not have a living donor, you will be placed on the waiting list for a cadaver organ.

2.  Getting on the kidney transplant waitlist

First, your transplant center will determine if your insurance covers surgery and post-surgery medical needs. Then, if you do not have a living donor, your transplant center will place you on their waiting list for a kidney and register you for the national transplant waiting list at  United Network of Organ Sharing (UNOS). Here are some important things to know when you're on the waitlist:

• You will be required to list several phone numbers—home, work, family, friends and neighbors—where you can be reached if a kidney becomes available.
• The average wait time for a kidney transplant is more than three years.
• When you have ESRD, you must undergo dialysis until a kidney is found.
• When a kidney becomes available, the nearest transplant center is notified and it is logged into the UNOS database.
• Once you are called, you only have a few hours to get to the transplant center. Although a call is a good indication, it is not a guarantee of a kidney.
• Transplant surgery often takes place on very short notice.
• Living a healthy lifestyle and following your kidney doctor's (nephrologist's) orders can help you stay on the donor waitlist and be in the best condition possible for surgery.

Talk with your renal social worker about the possibility of enlisting with multiple transplant centers as well.

3.  Going through kidney transplant surgery

Different techniques for kidney transplant surgery have been developed over the years. Typically, a large incision is made into the recipient patient's side. Advances in surgical tools and techniques have allowed surgeons to make as small an incision as possible. Your transplant surgeon will discuss the procedure with you, their choice of technique and answer any questions you have.

Depending on your condition, your surgeon may opt to remove the damaged kidney(s) or leave them. After the surgery, you will be hospitalized for several days and closely monitored for complications.

Some newly transplanted kidneys begin working right away. Others may start working after a couple of days. If your new kidney isn't working right away you'll receive dialysis until it does. You will remain hospitalized until your doctors are satisfied the new kidney is functioning and you are healthy enough to be released. Your living donor can be discharged from the hospital after a few days.

4. Monitoring your kidney after transplant surgery

Initially, your transplant doctor and nephrologists will require many follow-up visits and tests for a couple of months after the transplant. They want to make sure your new kidney is healthy. Your doctors will also look for signs of complications such as:

• Infection
• Bleeding
• Narrowing of the artery, also called kidney stenosis
• Blood clots: clots in the artery or vein could prevent circulation and cause the kidney to fail
• Kidney rejection
• Weight gain
• High blood pressure
• Cancer: use of immunosuppressant medication may leave you vulnerable to disease

You will remain under the care of your nephrologist for routine visits.

5.  Caring for your kidney transplant

When you get a new kidney, it is critical to maintain healthy habits so your new kidney will function properly and give you years of use.

Part of the transplant aftercare is taking required medications. Your doctor will prescribe immunosuppressants, which you will need to take for as long as you have your new kidney. Any pre-existing health conditions you experienced before the transplant will need to be managed as well, especially conditions that contributed to your initial kidney damage such as diabetes or high blood pressure.

By keeping yourself healthy and following your doctors' recommendations, you may set yourself up for a successful kidney transplantation. Of course, there are no guarantees.

Know someone who would like to donate a kidney? Visit the National Kidney Registry to start the process.

Want to become an organ donor? Visit OrganDonor.gov to sign up.