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Specialty Programs
Positive Crossmatch Kidney Transplants
The Transplant Center also offers services to the estimated 30 percent of patients waiting for kidney transplants who have become sensitized - developed antibodies to foreign tissue. Sensitized patients are at far greater risk for organ rejection because their antibodies are more likely to harm an otherwise suitable kidney.
Carolinas Medical Center uses plasmapheresis, which removes harmful antibodies and replaces them with fresh frozen plasma. After this treatment, an intravenous medicine called immune globulin is administered to help prevent the reoccurrence of antibodies. Depending on the amount of antibodies present, a patient might receive several treatments prior to the transplant, as well as several more following the procedure. After discharge from the hospital, The Transplant Center monitors patients closely for any sign of rejection.
This process is significant because, in many cases, it makes transplantation available to patients who otherwise would have been considered untreatable. Currently, Carolinas Medical Center is one of only a few centers across the nation offering this potentially life-saving treatment to patients.
Kidney Transplantation in the HIV-infected Population
Historically, it was believed that transplantation in the HIV-infected population was contraindicated. The widespread thought was that anti-rejection drugs would lower the immune system in patients who were already compromised, resulting in the exacerbation of the disease. Today, however, with the availability of highly-improved HIV medications, patients are living longer and transplantation in the HIV-infected population is being revisited. Although a study involving a selected group of HIV-infected patients has shown that these patients tend to have slightly higher rejection rates, the study also indicates that overall function of transplanted kidneys is virtually the same between HIV-infected patients and their non-HIV-infected counterparts. As a result, HIV-infected patients are now considered for the transplantation program. To qualify, patients must meet the routine criteria for candidacy, have an undetectable viral load, and have CD4 counts greater than 200 for at least six months. In addition, patients must be evaluated by an Infectious Disease physician.
Living Donor Kidney Transplantation
A transplant is the most effective way to ensure rehabilitation and long-term survival for an individual suffering from kidney failure. For these patients, a new kidney takes on an added importance - for some, a transplant means the chance to spend more time with their families; for others, it may mean the opportunity to return to work, the chance to travel, or perhaps the ability to achieve a once-impossible dream. For all, a new kidney simply means hope - hope for a longer, more productive life.
Statistics
Unfortunately, the odds are not in the favor of these deserving transplant patients. In fact, there are more individuals waiting for a deceased donor transplant than there are available donors. As of January 2007, there were over 69,695 people in the United States waiting for a kidney transplant; of these, only 15,000 will actually receive a transplant this year from deceased donors. (About 6,800 of these will be from living donors.) As a result of this shortage, more and more physicians are turning to living kidney donation to save the lives of their patients. The first successful living transplant was performed in 1954 with a kidney donated from a sibling. In the years since, living donation has been found to be not only a viable option for recipients, but also a positive experience for donors. In fact, several studies have been conducted on kidney donors, and the findings have been overwhelming: over 90 percent report that the experience was positive and worthwhile. Even more conclusively, many report that having gone through the surgery once, they would do it again for the chance to save a life.
Donor Qualification
Donating a kidney is a major decision and individuals should be aware of the risks and benefits to the recipient and the donor before undergoing transplantation. In an effort to become as educated as possible, arrangements can be made for transplant candidates to speak to others who have gone through the donation process.
Any healthy individual with a compatible blood type and a negative crossmatch may be considered as a potential kidney donor. If a blood relative (parent, child, sibling, half-sibling, aunt, uncle or cousin) is unable to provide a kidney, a spouse or "emotionally related" person may be considered to donate. Most transplant centers perform living unrelated transplants and a few have started exploring other options such as anonymous donation, positive crossmatch protocols, and more. Carolinas Medical Center does perform transplants from non-related donors and is exploring some of the other options as well.
The ideal living donor is between 18-65 years of age, and in good general health. He or she must have excellent renal function, and have no history of high blood pressure, cancer, or diabetes. An individual is not always excluded as a result of a medical condition, however, as some conditions may have no effect on the ability to donate a kidney. Of primary concern to the transplant team are the donor's overall health and emotional well-being.
Benefits of Living Donation
While living related donor transplants are considered the most beneficial, transplanted kidneys from living unrelated donors also have excellent success rates. Both types of living donor transplants are more likely to be successful than a deceased donor transplant. In fact, recent studies have shown that a kidney from an unrelated living donor lasts as long or longer than the best matched kidney from a deceased donor; in addition, the rejection rate for a living donor is significantly lower. It is also important to note that, when working with a living donor, transplant surgery can be scheduled when convenient - a benefit that shortens the dialysis period for a recipient who might otherwise wait years for a suitable deceased donor transplant.
Evaluation Process
A thorough evaluation is completed on any potential donor to ensure that the individual is physically healthy and has the motivation to undergo an invasive procedure. The transplant team will ensure confidentiality and provide the donor with medical professionals who have no conflict of interest.
Most importantly, the donation of a kidney must be a voluntary act. Family members determine who is willing to be considered for donation, and the individual circumstances of each potential donor are carefully evaluated. After such circumstances have been carefully considered, the donor is selected by a series of blood tests. In addition, the donor will be provided with an advocacy team to assist them throughout the transplant process.
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