Published On: Fri, Sep 20th, 2013

Kidney Transplant: Acceptable, Comprehensible and Indestructible

surgeryKidney Transplant: Acceptable,

Comprehensible and Indestructible

Author: Jenn Smith-Williams, Co-Founder of Kidney Contenders

The kidney is removed from the living donor’s body and handed over to the transplant surgeon.

The transplant surgeon puts the removed donor’s kidney inside of a sterile bowl and takes the kidney to a nearby table to clean it up before taking it to the recipient where the kidney transplant will be performed. The veins and the arteries are visible, and now the transplant is ready to proceed.

How did it begin?

Each kidney transplant recipient has his or her own story as to why kidney transplant was required to restore their renal function. The scenario mentioned in the beginning of this article briefly describes a routine kidney transplant procedure, one that became active in the U.S. during the 1950’s and remains active more than fifty years later. Recipients receive kidney transplants from either living donors and/or cadaveric donors.i

While the medical procedure itself advances with modern technology, most of the activities leading up to the transplant remain the same: review the history and do a physical assessment, run laboratory tests to ensure for satisfactory metabolic processes (including blood typing), go through a psychological-social evaluation, and proceed with the transplant. The outline of this procedure appears simple; unfortunately, it is not; there is time and effort as well as willing recipients that must be taken into account before a kidney transplant can take place.

The United States Renal Data System reports that in 2010, more than 16,000 Americans underwent a kidney transplant through either a living or cadaveric kidney donor.ii The United States Renal Data System addresses the rise in the number of Americans waiting for a kidney transplant; this indicates that there is an increase in kidney failure in Americans. Not every American waiting for a kidney transplant is new to this procedure. While kidney transplant is a solution, the process is not an absolute. For instance, a recipient’s immune system can reject the transplanted kidney, regardless of whether it comes from a living donor or a cadaveric donor, because white blood cells can attack what they recognize as a foreign object that poses a threat to the well-being of the body. This point is crucial and is why organ donors must be of a compatible blood-type match with the recipient.

Why is blood-type match crucial?

A recipient’s blood type determines how well the recipient’s immune system will react to the donor’s “foreign” organ. Blood type and blood in general, is a mandatory fluid in the human body. The heart pumps the blood. Blood transports molecules throughout the body. The blood enters the kidneys. There are many kinds of molecules, including the broken down nucleic acid waste product molecules that are distributed in the bloodiii, that must be transported to the functional units of the kidneys called the nephrons. These waste products will become part of the urine. The nephrons filter these waste products from the blood stream, reabsorb the water and the nutrients, and then secrete wastes into a final urine product. The final urine product is then expelled through the pelvis of the kidney, though the ureter, and then into the bladder.

What happens when the kidneys become damaged and can no longer function on their own accord?

A nephrologist determines if the individual has acute kidney failure or chronic kidney failure. If the laboratory test results indicate to the nephrologist that the individual has chronic kidney failure, kidney transplant is an option and dialysis is an option. Some individuals opt for a kidney transplant if they have family members and/or friends whose blood type is a match. Some individuals unfamiliar with transplantation, or do not have active family members and friends, opt for dialysis. The individual with chronic kidney failure has to the right to choose either option, but while dialysis is abundant and readily available, a transplant is normally advised when there is a properly matched kidney found. Kidney transplant is evolving to include research that will allow nephrologists to expand on how transplant occurs, whether it be with a donor’s organ or by one that is self-created by using the individual’s own stem cells to produce a new one inside of their body. Medical scientific research is always expanding on human biological theory and most nephrologists do applaud this.

Richard Lewis, MD, a surgical and program director at St. David’s North Austin Medical Center in North Austin, Texas, sat down with Kidney Contenders for a Q&A session to discuss his expertise on kidney transplant and why it is acceptable, comprehensible, and indestructible.

Q: Dr. Lewis, please explain to Nutricula Magazine readers the reasons why you chose to be a nephrologist. Did your interest result from certain teachers or medical textbooks while you were a medical student?

A: Teachers stimulated my interest in kidneys and kidney transplant. The mystery of the kidneys, how complex they are and how they work, also motivated me as a trainee to move into that direction. My first experience working in kidney transplantation, and what transplantation could do for people, is also why I decided to focus my career in nephrology. The complexity of the kidneys allowed me to do medicine, surgery and research.

Q:Were you interested in research that just focused on transplantation, or were you interested in other areas that affect the health of the kidneys?

A: I was interested in basic laboratory work which focused on the physiology of kidneys, certain injuries to kidneys, and their responses to certain types of agents that could help them recover from various types of injuries. In my early career as a nephrologist, I studied a wide range of subjects, including how to make a kidney transplant work better. One of the investigations was conducted on the drug cyclosporine.

Q:How does the drug cyclosporine correlate with kidney transplants?

A: Cyclosporine is the product of a fungus, and it was first investigated as an anti-fungal agent in Switzerland. In the early days of kidney transplant, medicines that were used to protect against rejection were broad-acting suppressors of the immune system. In contrast, Cyclosporine left other white blood cells that fight off bacterial infection alone. This was a major discovery in the world of transplantation, and it improved the ability to transplant kidneys in patients who were previously considered to be at extreme high risk. It also opened the door to allow for the transplant of other organs such as hearts and livers.

Q: How do you explain to kidney transplant recipients the importance of maintaining the transplant, and what type of medications are required to sustain these transplants?

A: The goal for the recipients is to restore their energy level and well-being. I emphasize the importance of appreciating and remaining mindful of the sacrifice that a family member, a friend, or an anonymous donor made in order to provide them the opportunity to regain their energy level and well-being. They are taking responsibility for a very complex biological machine.

Q:Is there a shelf-life for kidney transplants, and is transplant the best option at this time?

A: The most successful kidney transplants survive for decades. Statistical studies are conducted on the rate of longevity, and they include those recipients who die with their kidney transplant. Living donor kidney transplant chances of functioning after one year are in the 97% range. Kidney transplant failures beyond one year are usually due to wear and tear damage that involves scar formation within the organ, patients not taking their prescribed medications to prevent rejection, and patient death despite a well-functioning transplant. The leading cause of death in this third situation is usually due to cardiovascular disease, which also speaks to the importance of maintaining a healthy diet and life-style following a kidney transplant. From the standpoints of life expectancy as well as quality of life, successful transplant is by far the best possible treatment for kidney failure.

iU.S. Department of Health and Human Services

http://organdonor.gov/about/organdonationprocess.html

ii U.S. Renal Data System

http://www.usrds.org/2012/view/v2_07.aspx

iiiChapter 18 Material Exchange in the Body

Part 5 Physiology Processes

Concepts in Biology, 11th Edition

Eldon D. Enger, Frederick C. Ross, David B. Bailey

 

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