What are the options for children in need of a kidney transplant?
Like with adults, children in need of a kidney have two main options: a living donor kidney transplant and a deceased donor kidney transplant. A pediatric nephrologist and a transplant surgeon will discuss both types of kidney transplants with the family to help determine which approach is more suitable for their situation.
What’s a living donor kidney transplant?
In a living-donor transplant, an adult (18 or older) gives one kidney to the child. The donor can be either a family member or someone unrelated, such as an adult family friend. The potential donor will first undergo a series of tests to measure compatibility. When it is determined that it is time for the transplant to take place, both the donor and recipient will undergo surgery almost simultaneously; the donor kidney is removed in one room and then transferred to another to be placed in the child. Living donors can continue to lead a healthy and normal life with their one remaining healthy kidney. These types of transplants can be scheduled to best suit issues of health, school and convenience for both the donor and recipient.
What’s a deceased donor kidney transplant?
In a deceased donor transplant, the child receives a kidney from a healthy person who has died suddenly (usually accidents). In this situation, the deceased person's family has agreed to donate the kidneys for transplantation. The physician caring for the deceased person and a transplant surgeon will determine whether the kidney is suitable for the transplant recipient. It is not possible to predict when a deceased donor kidney will become available. Transplant candidates may wait for months or years for an opportunity to receive a deceased donor kidney. Some children may end up going on dialysis if their kidneys fail before a good match is found.
What are some benefits of a living donor kidney transplant?
Live donor grafts typically last longer than that of a cadaveric transplant; however, both can have great success. Another benefit of the living donor is the ability to plan ahead and ideally get the transplant as soon as it is needed, making logistics simpler and also increasing the likelihood of staying off of dialysis.
What happens before the living donor kidney transplant?
Transplant candidates may be asked to arrive a day or two before transplantation to undergo a physical examination by the pediatric nephrologist and some additional medical tests, including blood work, chest X-ray, urine test and an EKG. The child is usually admitted to the hospital the evening before surgery.
What should families bring to the hospital?
- Medical equipment your child uses, such as a blood pressure cuff/machine, any dialysis equipment and enough dialysis solution for one week.
- Comfortable, loose-fitting clothes for your child to wear after surgery, as well as slippers for use in the hospital.
- Favorite toys, stuffed animals, games, mylar balloons, videos and anything else to make your child comfortable and happy during the hospital stay.
- Other family members for support.
- Medical history if the child is not being transplanted in his/her regular hospital.
- Books, cell phone and charger, laptop and anything else parents, family and friends may need during the hospital stay.
What should not be brought to the hospital?
Latex balloons, fresh flowers and plants are not allowed in the hospital room. Often, children can’t eat many snacks or treats after their surgery.
What happens the day of the surgery?
For a living donor kidney transplant, patients are often admitted the evening before the surgery. They should arrive on an empty stomach.
What happens during the kidney transplant operation?
Kidney transplantation involves surgically placing another person's kidney (the donor) into a child's lower abdomen, usually on the lower right side. The transplanted kidney is placed in the pelvic area. In small children, the kidney is placed in the middle of the abdomen, also referred to as “intraperitoneal”.
Surgeons usually attach the donor ureter (the tube through which urine flows) to the child's bladder, allowing urine from the new kidney to flow in the normal manner. The child's own kidneys are usually not removed. The transplant surgery typically takes about four hours. The donor kidney should begin to function immediately.
What are parents doing during the surgery?
Often, parents are able to go into the OR with their child and stay there while the patient is given a mask for initial anesthesia before being put completely under.