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Organ Donation and Transplantation - Can everyone on dialysis have a kidney transplant?

 

Key Points

  • Do expect to have a lot of tests to make sure you are suitable for a transplant
  • Do expect to have an AIDS test before going on the transplant list
  • Do expect to have a pregnancy test if you are in a child bearing age.

  • Do not expect a transplant to solve problems such as heart disease
  • Do not expect to go onto the transplant list automatically – you may not be suitable

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Who can have a transplant?

About 50% (one in two) of people with kidney failure are suitable for a transplant, provided a suitable donor kidney can be found. People who will probably not be considered suitable include those with serious heart disease or who have recently had cancer.

Most renal units do not have an age limit for kidney transplantation. People are considered on merit (ie their suitability for a transplant), rather than age. However, having said that, most units would think very seriously before transplanting someone over 65 years old. The main reason is that older people often do not tolerate the transplant operation very well. Also, the drugs that are needed after a transplant are often too strong for older people. As you get older a transplant will not increase your life expectancy.

Doctors do not feel that transplants can be given to anyone who wants one, whatever the risks. This is because there is a shortage of kidneys for transplants, and so transplants should not be wasted. Also, a kidney given by a donor family should be used as carefully as possible, respecting their gift. Therefore, if someone with kidney failure wanted a transplant, even knowing there would be a high chance of dying after a risky operation, doctors may feel this is not ethical and can refuse to put someone on the transplant list.

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Is it necessary to be on dialysis before a transplant?

Some renal units will not put people onto the national waiting list for a transplant kidney until they are stable on dialysis. However, most units will offer the chance to go onto the list before this point and this is usually when the kidney function (GFR) is 15% and below.  Also, if someone has a transplant that is failing, they may be put onto the list and given a new kidney before they have to go back on dialysis.

The national waiting list/register is for what is known as a deceased donor transplant. This type of transplant uses a kidney that has been removed from someone who has died. Most of the transplant kidneys in the UK come from this source. The remainder are what are known as ‘living related transplants’ or LRTs, or ‘living unrelated transplants’. For some patients, the possibility of obtaining a transplant kidney from a living donor will be the best chance of having a transplant operation before dialysis is needed.Altruistic donors are live donor transplants where a person donates their kidney to a stranger.

Some renal units are undoubtedly better organised in terms of transplantation than others. So, some units do carry out transplants before dialysis. Some units also make more effort to obtain kidneys than others, and some units are keener on LRTs than others. For all these reasons, people in some units may wait less time for a transplant, and are more likely to have a transplant before they need dialysis, than is usual in other units. Efforts are being made to measure the differences between kidney units, and to set criteria so that the system becomes equal for everyone.

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Testing for viruses

Before anyone can be put forward for a transplant, they will have to be tested for various viruses. These include HIV (the virus that causes AIDS), hepatitis B, hepatitis C and cytomegalovirus (known as CMV). It is important to test for these viruses because they may be dormant (sleeping, causing no symptoms) in a patient’s body. After the transplant, they may be ‘woken up’ and cause illness.

If someone is positive for the HIV test, they will not immediately be put on the transplant list. This is because research has shown that people with HIV can get AIDS and die soon after a transplant. Someone who refuses the HIV test will not be put on the transplant list. If someone has HIV, it may be possible for them to have a transplant, but they need to have a careful assessment from the kidney and HIV specialist doctors. If the drugs for HIV have been effective and there is no detectable virus in the blood, and the CD4 cell count is normal, and there have been no serious infections for some time(6 months), a transplant may be possible.

If the hepatitis (liver infection) virus tests are positive, it may be possible to have a transplant, but further tests will be needed on the liver to make sure a transplant would be safe.

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Other tests for transplant suitability

Other tests are also necessary before someone can have a transplant. These include an electrocardiogram (ECG, an electric recording of the heart beat), and sometimes an echocardiogram (ECHO, a sound-wave/ultrasound picture of the heart) and a chest X-ray. Some renal units also insist that kidney patients who are diabetic also have a treadmill test (measurement of the ECG while walking fast) or a cardiac catheter test (a special X-ray picture of the heart).

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The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.

NKF Controlled Document No. 254: Can everyone on dialysis have a kidney transplant? written: 01/05/2000 last reviewed: 23/09/2016