Kidney Transplant Process
Westchester Medical Center enjoys a long and illustrious history in kidney transplantation, having performed well over 2100 kidney transplants since the program opened in 1989. We are the only transplant program in the Hudson Valley region of New York, offering the complement of available modalities including deceased donor as well as living donor transplantation, with the latest state-of-the-art techniques in laparoscopic donor retrieval. We offer access to the UNOS kidney paired exchange program and support internal swaps as well.
There are a number of reasons why people need kidney and other organ transplants. In general, transplantation is necessary to preserve life in the case of critical organ failure such as heart, liver and bone marrow. Transplantation enables most patients with kidney failure to be free from dialysis and provides improved quality as well as extended life expectancy.
Kidney transplantation involves an operation to implant the donor organ. In most cases, the native kidneys are not removed. Immediately before the surgery and for the lifespan of the transplanted kidney, the transplant recipient receives immunosuppressive therapy to prevent rejection of the organ.
In general, kidney transplantation involves four phases:
- The evaluation and listing phase
- The pre-transplant waiting phase
- The transplant surgery
- The postoperative care and maintenance phase
The Kidney Transplant Evaluation at Westchester Medical Center
There is a formal process that all transplant centers--including Westchester Medical Center--must perform to determine if a patient is eligible for a transplant. The transplant process begins with a comprehensive evaluation of the patient conducted by a multidisciplinary team consisting of the nephrologist (kidney doctor), surgeon, transplant coordinator, social worker, nutritionist and financial coordinator. Patients are scheduled for appropriate testing, such as stress tests, echocardiograms and breathing function tests. Additional examination or testing may also be necessary.
After the initial evaluation and testing is completed, the transplant team reviews the results to determine if the patient meets the criteria for transplantation. Patients and their referring physicians are eventually notified of the team’s decision to place the patient on the national waiting list for an organ.
All prospective patients receive comprehensive education about the kidney transplantation process. As part of that process, the transplant coordinator will explore the possibility of identifying a living donor, perhaps a family member or friend with each patient. It is also possible that living donors might be found among co-workers, or someone from your church or place of worship. Patients who receive a transplant from a living donor (as compared to a transplant from deceased donor) generally can be transplanted much sooner and can expect better outcomes. If someone is interested in becoming a living donor, there is a separate, but similar process of evaluation. Following evaluation and listing, patients are expected to return to the Westchester Medical Center's Transplant Center every 12-18 months for reevaluation. This is done to ensure that candidates remain medically suitable to undergo transplant, as medical conditions often change over time. Ongoing communication between the referring physician, the Transplant Center and the patient is crucial in ensuring that patients remain healthy for transplantation.
Waiting For a Kidney
The amount of waiting time for a deceased donor kidney varies significantly, based on factors such as blood type and antibody levels in the blood. The transplant team can give you a better sense of your individual situation during your evaluation.
There are several ways to shorten the waiting time for a transplant – the most important of which is transplantation with an organ from a living donor. Most transplant programs encourage candidates to consider living donor transplantation. Living donor transplant not only shortens wait time, but also results in significantly longer graft survival and function. Even if an individual donor proves to be incompatible with a particular candidate, there are still possibilities for getting transplanted through an exchange between donor and recipient pairs.
Kidney transplantation has many advantages, such as a lifestyle free from dialysis and fewer fluid and dietary restrictions. Kidney transplants, when successful, usually provide a better quality of life for most people, and they are less expensive than dialysis in the long run.
The Kidney Transplant Center at Westchester Medical Center regularly performs living donor kidney transplants which provides improved graft survival rates, a decrease in immunosuppressive therapy and the ability to plan the time of transplantation. Today's kidney donors also benefit from minimally invasive procedures, reducing surgery and recovery time.
Our kidney transplant team works closely with other specialists at Westchester Medical Center, including those in oncology, OB/GYN, pediatrics, cardiology, etc., to ensure that each patient receives the best possible care. We offer patients unique access to all their medical treatments in one location. Each patient is assigned a dedicated patient coordinator to bridge the gap between the various medical specialists involved in that their care.
Post-operative Kidney Care
Patients must be ready, willing and able to take responsibility for their health (self) care or must have a family member who will do this for them. Self-care includes taking all medicines as directed, completing all scheduled testing and check-ups, showing up at all appointments as directed by their health care providers--and rescheduling if an appointment is missed. Kidney transplantion patients have to take a number of essential medications to maintain the health of their transplanted organ, prevent infection, and treat common medical conditions such as hypertension, diabetes, and elevated cholesterol. Following transplantation, dietary changes are likely necessary and have to be followed. For example, if a patient experiences any fever or illness he/she must report this immediately to the transplant center physician or nurse. If the patient or family experience any problems obtaining medicines or if there is a change in insurance coverage, they should promptly call the transplant staff so that they may help resolve these issues. If a patient receives any new medicatioin prescribed by another physician, the Medical Center's Transplant staff should be notified promptly as there may be significant drug interactions with essential transplant-related medication you might already be taking.
A successful transplant operation is not the end of the transplant experience – it is only the beginning. The best is yet to come! Transplant is a lifelong partnership between the patient and the transplant team. Transplant patients are followed by our team at Westchester Medical Center very closely for the first few months after surgery, and then less frequently as time goes on. Even as patients transition back to the care of their referring doctor, the transplant team continues to see patients annually, for life.
A kidney transplant is a precious resource and often gives patients a new lease on life. It is important that patients keep appointments at the Transplant Center, follow the advice of the team on nutrition and a healthy lifestyle, and faithfully take their medications.
Diseases We Treat
A kidney transplant is necessary when a patient is diagnosed with end stage renal (kidney) disease (ESRD). Some of the more common causes of ESRD include Diabetes, Hypertension (high blood pressure), Polycystic Kidney Disease, Lupus and Glomerulonephritis.
Kidney Transplant Donor / Living Kidney Donor
Kidney transplantation is an option for people suffering from End Stage Renal Disease. A successful transplant improves quality of life, freeing the person from chronic dialysis treatments and a restrictive diet.
Kidneys become available for transplant in two ways – from deceased donors or from living donors. Deceased donors are unrelated individuals who have recently died and donated their organs for transplantation. Living donors can be related individuals (from immediate or extended family) and unrelated individuals (persons with a longstanding relationship with the patient.) Patients who have no suitable living donor wait on a list for a deceased donor kidney to become available. In most cases the wait is several years!
Those patients who are fortunate enough to have a willing and healthy living donor can electively plan their transplant at a convenient time for both donor and recipient. Additionally, the success rates of living donor kidney transplants are higher than those of cadaver (deceased) kidney transplants.
Who May Be a Donor?
A living donor can be:
- A member of a person's immediate family – a parent, sibling, son or daughter (18 years or older)
- An extended family member (aunts, uncles, cousins)
- An unrelated person (spouses, adopted/step family members, or friends)
A person must be physically and emotionally healthy to donate a kidney. One should not assume that a pre-existing medical problem will prevent donation. The transplant team will carefully evaluate the potential donor to determine eligibility. The living donor must be an individual who truly wants to donate.
Donating a kidney is a very special act and truly a gift of life for a waiting recipient. It is very important that you feel comfortable about this entire process. Always feel free to ask questions or discuss your concerns with any member of the Transplant Team at Westchester Medical Center.
Living Kidney Donation
An individual who is interested in donating their kidney must be in good health and must get blood tests to check compatibility with the potential kidney recipient. This is followed by a complete medical evaluation which includes a history and physical, blood and urine tests, cardiovascular tests, cancer screening tests as appropriate for age, CT scan to check the anatomy of the kidneys and possibly other tests as needed.
This extensive testing is done to protect the donor. The donor is not responsible for any costs related to evaluation or surgery. A donor advocate, who is a volunteer not affiliated with the transplant program, reviews all the information with the donor to ensure that the potential donor is not being coerced to donate a kidney. After the evaluation is completed, the donor’s results are presented to an independent panel that review and decide whether or not it is safe for the donor to give a kidney. The transplant is then scheduled.
The donor’s kidney is removed using a minimally invasive technique known as laparoscopy. The donor usually remains in the hospital for one to two days, after which he or she is required to return to the Transplant Center for evaluation one and then two weeks after surgery, followed by regularly scheduled appointments for one year following donation. After that, the donor should follow up with his or her physician to be monitored at least once per year.
Approximately 45,000 hemodialyses are done each year by the physicians at Westchester Medical Center.
Our physicians are experts in all areas of kidney disease including kidney transplantation and kidney dialysis.
Dialysis is a procedure that cleans and filters the blood when the kidneys are not working. Healthy kidneys clean the blood by filtering out extra water and waste products. When the kidneys fail, the body holds fluid and harmful wastes build up.
Dialysis is used to treat people with kidney failure, known as acute renal failure or chronic renal failure. Treatment is needed to replace the work of the failed kidneys. Once both kidneys fail, a person will die as a result of not having the filtering process. Dialysis is way to keep a person with kidney failure alive. A person waiting for a kidney transplant would be a candidate for dialysis.
There are two main ways to filter the blood:
- In peritoneal dialysis, a special tube is put into the abdomen through the skin. A cleansing solution called dialysate travels through the tube into the abdomen. After several hours, the fluid gets drained from the abdomen. It takes wastes from the blood with it. This process may be repeated several times a day. Or it can be done during the night while the person sleeps.
- In hemodialysis, blood is filtered using a special dialysis machine. Blood removed from the body through a blood vessel travels through tubes into the dialysis machine. The machine filters out wastes and extra fluids. The newly cleaned blood flows through another set of tubes and back into the body.
Both types of dialysis require surgery to prepare the person's body:
- For peritoneal dialysis, a surgeon places a small, soft tube called a catheter into the abdomen. This tube stays in place.
- For hemodialysis, the surgeon creates new access to the bloodstream called a fistula. This provides a way for blood to be carried from the body to the dialysis machine. The access may be either inside the body, usually in the arm, or outside the body, usually in the neck.
Usually, repeated dialysis is needed for survival. Most people who need dialysis have kidneys that are permanently damaged.
For more information about the dialysis services offered at WMC call (914) 493-7701.
Thomas Diflo, MD – Chief of Intra-Abdominal Transplant and Hepatobiliary Surgery
Hiroshi Sogawa, MD – Surgical Director, Kidney Transplant, Transplant Surgeon
Daniel Glicklich, MD – Medical Director, Kidney Transplant, Transplant Nephrologist
Robyn Matloff, MD – Medical Director, Pediatric Kidney Transplant, Pediatric Transplant Nephrologist
Mohammad Mustafa, MD – Transplant Nephrologist
Dmitry Samsonov, MD – Pediatric Transplant Nephrologist
Gregory Veillette, MD – Transplant Surgeon
Abhay Dhand, MD – Director, Transplant Infectious Diseases
Rajat Nog, MD – Transplant Infectious Diseases
Bettina Knoll, MD – Transplant Infectious Diseases
Martha Gamboa, MD – Transplant Psychiatrist
Leanne Forman, MD – Transplant Internist