When your kidneys fail, there are currently two treatment paths available: dialysis or kidney transplantation. Neither is a cure, but both can prolong your life and help maintain its quality. A healthy donated kidney can filter wastes more efficiently than dialysis can, but not all patients are eligible for a transplant. Even those who are eligible face a lengthy and involved process prior to the actual surgery. Here are some basics from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) to help you understand what a kidney transplant could mean for you.*

How do I know if I’m eligible for a transplant?

If you’re interested in exploring kidney transplantation, the first step is to discuss this option with your physician. If a transplant is deemed to be a viable option for you, your doctor will refer you to a transplant center. 

At the transplant center, you’ll be given a number of tests to ensure that you’re a good candidate for transplant.

Factors that could render you ineligible for a transplant include:

• Cancer that is not in remission
• Current substance abuse
• Significant damage to other major organs
• Other physical, cognitive, or emotional health issues that could interfere with new organ acceptance, or your ability to follow and sustain your post-transplant medical and lifestyle regimen

What other factors can affect transplant eligibility?

Being an eligible recipient isn’t enough to guarantee a kidney transplant. You must also have a viable donor. A healthy, transplantable kidney may come from one of two sources:

• A living donor. A living donor is likely to be a family member or friend. A blood test will show if they are a good match. If so, the donor will need to be declared healthy enough to undergo the donation procedure. If you have a living donor, you can schedule your surgery in advance. 
• A deceased donor. A deceased donor may be someone you know, but is more likely a stranger who has recently passed away. 

If you don’t have a living donor, but you’re an eligible recipient, the transplant center will place you on a waiting list. Some centers won’t add you to the waiting list unless you’ve already tried dialysis. Others will add your name as long as your kidneys are functioning at 20% or less.

What is it like to be on an organ transplant waiting list?

Wait times can vary from a few months to several years, depending on:

• Your age
• Your blood type
• Where you live, in relation to a transplant hospital
• How many other people are on the list, and how long they’ve been on it
• The availability of a replacement kidney

While on the waiting list, you’ll get monthly blood tests, so there’s always a recent sample ready to match against possible donors. When an available kidney is found, you must go to the relevant hospital immediately for the transplant.

What actually happens during transplant surgery?

Kidney transplant surgery generally takes about three to four hours to complete. Your surgeon will place the healthy donated kidney into your lower abdomen—connecting the kidney to your blood vessels and bladder. The damaged kidneys don’t need to be removed unless they pose a danger to your safety and recovery.

Before you leave the hospital

You will likely spend several days in recovery at the hospital, even if there were no complications during surgery. During recovery, you will start taking your anti-rejection medications. These drugs suppress your immune system to prevent your body from rejecting the new kidney. You will need to take these daily for the rest of your life.

In addition, you’ll learn how to care for your new kidney through diet, a healthy lifestyle, and a medication regimen. You may also be given antibiotics to prevent infections.

After you leave the hospital

Once you leave the hospital, you’ll have frequent blood tests to monitor how well your new kidney is working. It may take a few weeks to start working. This isn’t necessarily problematic, but if it happens, you will need dialysis treatments to filter wastes and excess fluids until the kidney starts doing the work for you.

Even if the surgery appears successful, you’ll still need careful monitoring in the weeks and months immediately following the transplant. Some complications that could arise include:

• Bleeding 
• Infections 
• Side effects of the anti-rejection medications 
• Your body’s rejection of the donated kidney

What are some signs of kidney rejection?

Rejection of the new kidney may not occur right away, nor will you necessarily notice any immediate signs. New organ rejection often begins without any obvious symptoms. Your blood tests, however, will indicate that the new kidney isn’t filtering out wastes properly. As wastes build up again, you may also develop:

• High blood pressure, 
• Fluid retention and edema (swelling), and/or 
• Signs of infection. 

If you experience any of the following signs of infection, call your transplant center immediately:

• A fever of 100 degrees or higher
• Drainage from your scar
• A burning sensation when you pass urine
• A persistent cough or cold

Contact your surgeon or transplant center with any questions or concerns that you have about your surgery or recovery.

*National Institute for Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services. (2018, Jan.) Kidney Transplant.