Understanding who is eligible for kidney transplants and what options are available.
If you have advanced chronic kidney disease or are on dialysis, you may qualify for a kidney transplant. However, even if you meet these basic criteria, there are eligibility factors that vary by individual. The exciting news is that new treatments are making kidney transplants a reality for more people than ever before. Your doctor can guide you through the necessary evaluations and choices to help you find the transplant treatment plan that is the best fit for you.
Ensuring you are healthy enough for surgery
Receiving a new kidney can be lifesaving. You might feel relieved that your wait is over and overwhelmed with gratitude toward the donor. But at the same time, kidney transplantation is major surgery. Your doctor must make sure you are healthy enough to undergo the procedure and recovery process.
“Organs in general are a scarce resource,” said Kristin Smith, the associate nursing officer at the Vanderbilt Transplant Center. “So we have to make sure that people who are getting them are able to take care of them.”
Candidates for kidney transplant undergo various medical examinations and screenings to ensure they are physically healthy enough to undergo kidney transplant surgery. Tests may include bloodwork, imaging, routine cancer screenings, etc.
Finding the right treatment pathway
In some cases, Vanderbilt can work with patients to improve their health to increase eligibility for a kidney transplant or find ways to prevent potential complications.
“We’re the largest, most experienced transplant center in the nation in terms of the number of transplants we perform,” Smith said, “so we see a wide variety of patients with different unique needs, and we offer many pathways to transplant.”
For example, having a body mass index over 45 generally disqualifies patients from getting a kidney transplant for several reasons, including wound-healing concerns.
“We have partnered with our bariatric surgical clinic,” Smith said, “to provide a pathway for patients who may meet criteria for surgical weight loss programs to help them lose the weight that they need to become a candidate for transplant.”
Some patients struggle with the recovery process from transplant surgery.
“We are doing pioneering work to improve outcomes for these patients as well,” Smith said, “such as our PREDICT program, which uses genetic testing to predict which transplant patients are likely to develop serious side effects to some of the medications typically used as part of kidney transplants.”
Shortening wait times
Another way that Vanderbilt is increasing access to kidney transplants is by finding innovative ways to make more donor organs available.
“Vanderbilt does transplants using organs from donors who are infected with hepatitis C,” Smith said. Previously, this disqualified the organ for transplantation because of the infection risk for the recipient. “But now because of new treatment options available for hepatitis C and the high cure rate associated with these treatments, we are able to successfully use these organs, which tend to be from young, otherwise healthy individuals.”
Vanderbilt helps patients with a B blood type avoid longer wait times by performing A2-to-B blood type transplants. Additionally, patients in need of more than one organ transplant — such as heart-kidney, kidney-pancreas or liver-kidney — can undergo a dual-organ transplant and receive both new organs at once.
Increasing options for living donors
Vanderbilt’s living donor program is another resource that has greatly expanded the availability of organs and shortened wait times. Living donors give the gift of kidney donation while they are still alive. Their remaining kidney is able to safely meet their body’s needs.
“Vanderbilt has a robust living donor program,” Smith said. “We help facilitate making these connections, like options for paired donation — when a patient has a living donor who is not compatible to donate to them directly but agrees to donate to another recipient. Through these matches, multiple recipients can get a living donor transplant.”
Getting your home support team in place
Additionally, social workers are part of the Vanderbilt transplant team to help make sure you have everything you need for the road ahead. This includes a good support system at home to help you manage the complex medication regimen and many follow-up appointments.
“We really want to make sure that there’s somebody — or multiple people — who are able to support that person through the transplant,” Smith explained.
Additionally, the social worker will help determine whether a kidney transplant will place a burden — financial or otherwise — on a patient and look for ways to alleviate those burdens if possible.
In summary, kidney transplant is complex, but the transplant team at Vanderbilt Health works together with patients to make it a smooth and successful process.
The Vanderbilt Kidney Transplant Program is one of the largest programs in the country. Its surgeons have performed more than 6,000 pediatric and adult kidney transplants. The team has deep expertise with even the most complex cases. Clinics in Clarksville, Tennessee, and Madison, Alabama; and a telemedicine clinic in Jackson, Tennessee, bring expert kidney care closer to those communities. Vanderbilt surgeons also treat veterans by working with the Nashville VA to provide pre- and post-transplant care.
