Conditions + Treatments

What is a Kidney Transplant?

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A kidney transplant is an operation performed to replace a diseased kidney with a healthy one. In some cases, it’s done in combination with other organ transplants, such as intestines or livers. The kidney may come from an organ donor who has died or from a “living donor,” a family member or an individual who is willing to donate and is a suitable match.

If a child has severe end-stage kidney disease that no longer responds to treatment, a kidney transplant is likely the best option. A transplant can offer a longer and healthier life; however, like any surgery, it does carry its own risks, and there are many demands post-transplant.

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Options for kidney transplant candidates

Living-donor kidney transplants

A living kidney donation takes place when a living person donates a kidney for transplantation to another person, which is possible because people are able to live with just one healthy kidney.

The living donor can be a family member, friend or a match with an unknown person that is arranged based on medical compatibility with the recipient.

A kidney from a living donor offers significant advantages. They last nearly twice as long as kidneys transplanted from deceased donors and recipients recover faster, because a living-donor kidney usually begins functioning immediately.

At the Boston Children’s Hospital Pediatric Transplant Center, this procedure is done in collaboration with Brigham and Women’s Hospital. Potential donors are evaluated in advance to find the donor who is most compatible with the recipient.

For living donor/recipient pairs who are incompatible, there is the option of a paired exchange through the United Network for Organ Sharing (UNOS) program, which matches incompatible donor-recipient pairs through a nationwide pool. A donor will swap their kidney with another recipient-donor pair.

Deceased donor transplants

About half of the kidney transplants performed at Boston Children’s come from living donors, but patients who do not have the option of a living-donor transplant will be placed on the waiting list for a deceased donor. In most cases only one kidney is transplanted, but in rare situations, a child may receive two kidneys from a deceased donor.

Here at Boston Children’s, we’ve developed techniques that allow us to transplant kidneys from adults into infants and children. Our surgeons have successfully transplanted an adult kidney into a one-year-old baby weighing about 14 pounds.

Why is a kidney transplant recommended?

The kidneys are a pair of bean-shaped organs located in the lower portion of the abdomen, just below the rib cage and next to the spleen. These organs, which receive blood flow from the large renal blood vessels, perform the life-sustaining job of filtering out harmful waste products and excess fluid.

When the kidney loses approximately 90 percent of its filtering ability, that a person has end-stage renal failure. The kidney may fail to function properly for multiple reasons. Conditions that lead to end-stage renal failure include:

Kidney transplantation is an option for individuals who are no longer responding to treatment or who are unable to live without dialysis.

Evaluation for kidney transplant

An evaluation is necessary to confirm a transplant is the appropriate treatment, determine the level of urgency, review options — living donor vs. deceased donor — and identify the risks and benefits for potential donors.

If a child is being evaluated for a transplant, he or she will meet and work with a number of health care professionals from the Pediatric Transplant Center. The evaluation typically takes place as an outpatient, during which time the child undergoes a series of tests. These may include:

  • blood tests
    • blood type (a recipient and donor must have compatible blood)
    • kidney and liver function
    • tests to check for exposure to viruses, bacteria and infections, such as Hepatitis A, B and C; HIV; Cytomegalovirus; Epstein Barr Virus and Herpes simplex virus
  • a renal ultrasound
  • a bladder x-ray to identify any problems that might interfere with the functioning of the new kidney

Our kidney transplant team will consider all information from interviews, medical history, physical examination and diagnostic tests to determine whether the child is a good candidate for a kidney transplant and to determine the best time for the child to be placed on the transplant waiting list. If he or she is a transplant candidate, we make sure the family is fully educated about the risks and benefits, and the child will be placed on the United Network for Organ Sharing waiting list, or in the case of a living donor, the transplant surgery will be scheduled.

We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

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