While waiting for a transplant, most children are maintained on dialysis, which works as an artificial kidney. There are two options available for a donor organ: a kidney from a deceased donor or a kidney from a living donor. When an organ from a deceased donor becomes available, priority is determined based on the patient’s blood type, size and genetic match with the donor, plus the length of time he or she has been on the waiting list. The waiting list is maintained by the United Network for Organ Sharing (UNOS).
Living-related donation eliminates the need to wait for a compatible deceased donor, and the transplanted organs tend to last longer and function better. Donors can be living related donors (LRD) or living-emotionally related donors (LERD). LRDs can be any healthy blood relatives, ranked in the following order:
- An identical twin
- A sibling or parent
- Another blood relative (cousin, niece, nephew, etc.)
Typical LERDs are spouses, in-laws or close friends; they are not blood-related to the patient. All donors must be blood type and immunologically compatible, have normal kidney function, and be in overall good health.
Kidney Transplant Process
The average kidney transplant takes three hours. In most cases, surgeons use a laparoscopic technique to remove the kidney from a live donor, which minimizes postoperative pain and recovery time. Using an incision approximately two inches long and endoscopic instruments allows surgeons to avoid cutting through abdominal muscles, as is required in the open technique. The new kidney is inserted into the recipient through an incision in the lower abdomen.
The average pediatric kidney transplant can be performed in three to four hours. The new organ is inserted and connected to a vein, an artery and to the bladder. The donor spends between two and five days in the hospital and is then on limited activity for approximately six weeks.
Ongoing Commitment to Care
Rady Children’s understands that healing doesn’t happen overnight. That’s why the Kidney Transplant team is committed to educating and supporting every patient and family before, during and after the transplant process.
Once a child is referred to Rady Children’s, the transplant team spends considerable time explaining the benefits and drawbacks of the procedure to the patient and his or her family. A social worker evaluates the family’s ability to provide support, a critical element to the healing and recovery process.
Immediately after transplant, patients recover in the intensive care unit until stable enough to transfer to the intermediate care unit. In the immedicate care unit, the child and his/her parents learn to administer medications under the close supervision of the transplant coordinator, pharmacist and nurses. Nutritional counseling and physical therapy provide patients and their families with the tools to aid in a speedy recovery.
Transplant physicians and surgeons schedule weekly follow-up appointments to check up on the child’s progress once they are discharged from the hospital, in addition to frequent blood work. Patients are followed very closely after transplantation and communicate with the transplant team multiple times a week. The relationship that is created is one that is integral to the success of the transplant and the well being of the patients.