Kidney Transplant

What is a kidney transplant?

A kidney transplant is an operation performed to replace an end-stage kidney with a healthy one. In some cases, it’s done in combination with other organ transplants, such as an intestine or liver.

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 end-stage kidney disease, a kidney transplant is often 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.

Options for kidney transplant candidates

Living-donor kidney transplants

A living-donor kidney transplant takes place when a living person donates a kidney for transplantation to another person. This is possible because people are able to live with just one healthy kidney. The living donor is often a family member or a friend. Although, sometimes, people are matched with a good-samaritan donor or a kidney-swap donor. To be a kidney donor, it is important that you are found to be compatible with the recipient, based on a variety of tests.

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. Typically, kidneys from living donors last nearly twice as long as kidneys transplanted from deceased donors. Recipients often recover faster, because a living-donor kidney usually begins functioning soon after transplant.

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 to find the donor who is most compatible with the recipient. Potential donors go through testing to confirm that they are healthy and able to continue to live a healthy life with just one kidney after donating.

To be a kidney donor at Boston Children’s, donors must be over 18 years old (preferably older than 24 years old) and younger than 60 years old. Our surgeons are able to transplant kidneys from adult donors into even very young children.

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

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 may be placed on the waiting list for a deceased donor.

Why is a kidney transplant recommended?

The kidneys are a pair of bean-shaped organs located in the back, just below the rib cage. 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, keeping you safe.

When the kidney loses approximately 90 percent of its filtering ability, the person has end-stage renal disease (ESRD). The kidney may fail to function properly for multiple reasons. Conditions that lead to ESRD 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 transplant. If he or she is a transplant candidate, we make sure the family is fully educated about the risks and benefits of transplant and the long-term care of this kidney. We are then able to schedule the living-donor kidney transplant or place the child on the United Network for Organ Sharing waiting list, or in the case of a living donor, the transplant surgery will be scheduled.