Getting a Kidney Transplant

When should I start the process to get a kidney transplant?

If your kidneys are failing, a kidney transplant may be a treatment option for you. The balance of risks and benefits varies, though, depending on your age and other health problems. If you want a kidney transplant, you must contact a transplant center and ask for a transplant evaluation. Getting on the list to receive a kidney is not automatic. Only a kidney transplant team can provide an evaluation and tell you if you are definitely eligible (or not eligible) for a kidney transplant.

You can contact one or more kidney transplant centers and start the evaluation process when your nephrologist or another doctor tells you that you will need dialysis within two to three years. Most kidney transplants are successful — more than 90% of transplants are still working one year later. Recent studies have found that the odds of good results are somewhat better with a "preemptive" transplant, done before dialysis is needed. Preemptive transplant requires a willing living kidney donor — probably a relative, spouse or friend. According to data from the Organ Procurement and Transplantation Network (OPTN), in 2004, 6,647 kidney transplants came from living donors while 9,357 came from cadaver donors.

If you do not have a living donor, you can ask to be placed on a national waiting list to receive a cadaver kidney from someone who has recently died — usually in an accident. After your evaluation is complete and you are placed on the list, credit for waiting time begins you’re your glomerular filtration rate (GFR) drops to 20 mL/min or lower. Long waiting times — often years —are common for kidney transplants from cadaver donors.

Can I get on the kidney transplant waiting list before I start dialysis?

Yes, you may want to be evaluated for a transplant before you start dialysis. As mentioned above, if you have a living donor, and can get a kidney transplant before you need dialysis, studies have shown good results for preemptive transplants that are done before dialysis is started.

Even if you don’t have a living donor, you may want to begin the evaluation process as soon as you know you are in the later stages of chronic kidney disease. After your evaluation is done and you get on the waiting list, credit for waiting time starts when your kidney function drops to less than about 20%. This is measured by a glomerular filtration rate (GFR) of 20 mL/min or less. Your doctor will determine your GFR. DaVita.com features a GFR calculator and GFR tracker. If you know a creatinine level you can use these online tools.

How will my doctor treat kidney transplant rejection?

If you have acute or chronic kidney transplant rejection, your doctor may change your medicines, or even admit you to the hospital. For example, if your cyclosporine dose is harming your transplanted kidney, your doctor might lower your dose and change your other medicines. All medicine changes must be made by your transplant team.

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