How do I find out whether I am eligible for a kidney transplant?
The dialysis unit at the Fahad Bin Jassim Kidney Center will be able to provide you with information on kidney transplantation. Following discussion about its advantages and disadvantages, a decision can then be made about your suitability for transplantation.
Is there any age limit for inclusion on the transplant list?
There is no upper age limit for kidney transplantation although it is important that whenever it is considered, the potential benefits should outweigh the disadvantages. The transplant operation and the subsequent treatment can be testing and therefore a patient needs to be fit enough to withstand the entire process. The decision on the appropriateness of transplant surgery is made by the individual concerned in consultation with their doctors.
How long will I have to wait for a kidney?
This question is always difficult to answer as waiting time is influenced by several factors, including amongst others, blood group, age and rareness of genetic type. On average, patients who are listed for a deceased donor transplant wait approximately 7 years, but this cannot be guaranteed. Patients who receive live donor kidney transplants usually have much shorter waiting times than those who receive kidneys from deceased donors. Your doctor will know the details of your case and should be able to give you an indication of how easy it will be to find a kidney. Any prediction however will always be an approximation.
How are kidneys allocated?
Kidneys are allocated based on, among other considerations, the match between the donor and recipient blood groups and genetic type (called the tissue type or HLA type). For a patient with a rare tissue type, there will be fewer donors with a tissue type that matches that of the patient well, compared to patients with more common tissue types. Furthermore some patients have antibodies directed against certain tissue types, which means that some, or even most, donor kidneys are not suitable for these patients. Pregnancy, blood transfusions or previous failed transplants can induce these antibodies.
How do I find out if someone would be suitable as a donor?
The suitability of an individual for living kidney donation depends upon their willingness to donate, their overall health, the presence of any other significant medical problems that might affect renal function and whether both of their kidneys function normally. Your doctor can discuss living donor transplantation in greater detail with you and will meet any parties interested in kidney donation for further discussion. Appropriate verbal and printed information will be provided.
Will a living donor experience any adverse effects and how quickly will the donor recover to full health?
Although living kidney donation is associated with a very small risk of death, the vast majority of live donors will quickly recover from the operation. Patients can expect to be in hospital for five to eight days and will normally not work or undertake work-like activities for between four to six weeks. Evidence is available that long-term health is not affected by kidney donation and this is one reason why we in Qatar are keen to increase the number of living donors.
When the donor is deceased, what is the difference, if any, between kidneys retrieved from ‘heartbeating’ donors and those retrieved from ‘non-heartbeating’ donors?
‘Heartbeating’ donors are patients who have suffered permanent and irreversible brain injury such that their heart will stop beating in the next week or so. Once the patient’s relatives have given permission for donation and tests demonstrate irreversible brain injury and the patient has been certified dead, the donor is taken to the operating theatre for retrieval of the kidneys and other viable organs whilst the heart is still beating. In a patient who suffers a cardiac arrest and cannot be resuscitated, it is occasionally possible to flush the kidneys and liver with a cold preserving solution and then remove these organs quickly before irreversible damage occurs. In this situation, the heart is no longer beating, hence the term ‘non-heartbeating’. The most recent information indicates that success rates for ‘non-heartbeating’ donor transplants are very similar to those achieved for ‘heartbeating’ donor transplants.
What kind of factors will affect the success of my own transplant?
The success of transplantation is influenced by a number of different factors, some of which are within the control of the patient. Living donor kidney transplants are on average more successful than transplants from deceased donors. Transplants done relatively soon after starting dialysis are on average more successful than transplants performed two or more years after a patient starts dialysis. The degree of matching between the donor and the recipient is also important, but is less so for living donor transplantation. For this reason, most units are happy to perform a living donor transplant even if the tissue match is relatively poor. The age of the donor is another factor that affects the success of a transplant. Transplants of kidneys from younger donors tend to survive longer than transplants from older donors. Most kidneys that fail in the first year after transplant do so because of rejection. After one year, there are a number of reasons for graft failure and these include death of the patient with a functioning transplant and graft loss due to the patient's poor compliance with the medication prescribed to them. The risk of death is influenced, not surprisingly, by just by patient age but also smoking, obesity, the presence of other significant diseases such as diabetes and heart disease, and the overall level of fitness of the patient. Patients who do not smoke or give up smoking, maintain a healthy body weight and exercise regularly are more likely to have many years of good quality life with a well-functioning kidney.
