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Sample Consultation for Live Donor Kidney Transplantation

This hypothetical consultation about live donor kidney transplantation is presented for purposes of general information. Please see your doctor to discuss your individual case and the exams and treatments that are best for you.

Background

The need for a kidney transplant can arise from a number of different medical situations in which a person’s kidneys are no longer functioning. In our example, the patient is a 38-year-old man who has end-stage renal disease and needs a kidney transplant. He has family members and friends who have expressed willingness to donate a kidney for him. Read more about kidney transplantation at the Kidney Transplant Program at UC San Diego Health System.

Consultation

Doctor: Hello. How are you?

Patient: I’m all right, thank you. This is my wife; she wanted to be here with me today.

Doctor: How do you do? I’m glad you are both here. As we go on, please feel free to ask any questions that you may have.

Patient’s Wife: Thank you.

Doctor: Then let’s begin. As you know, I have had a call from your nephrologist. He tells me that you have been on dialysis for a long time and he’s referring you to be evaluated for a kidney transplant.

Patient: Yes. The dialysis is three times a week for three hours, and it is difficult. It is also a big commitment of time. I am working and we have young children.

Patient’s Wife: And I’m worried about how long he can continue like this.

Patient: We both are.

Doctor: Yes. Many patients with end-stage renal disease, as you have, find it very difficult to continue with dialysis and lead their normal lives and keep up with their responsibilities.

Patient: It sure is.

Patient’s Wife: He has several people who are willing to donate a kidney to him.

Doctor: Yes, your nephrologist told me that you are interested in a living donor transplant. It’s very good that you have individuals who are willing to be tested to find out if they are a good match.

Patient: I didn’t expect them to come forward, but they did. I feel very fortunate.

Doctor: We will talk about the process of having a living related donor for your kidney. First, as you know, I am going to evaluate you today to find out if you are a good candidate for a kidney transplant. I will go over your records and your tests, and then I’ll do a history and physical examination. Then we’ll talk about the operation itself and what is involved, both for you and for a living donor, if we find that one of the people close to you is a good match for you.

Patient: All right.

Doctor: I’ve reviewed your medical records, all of your blood test results and reports. I see you had an ultrasound scan that showed your kidneys are small and shrunken, which explains why you are having these problems. I also see that you have a high blood pressure problem, because when the kidneys don’t work, the blood pressure goes up. You’re taking some medications to control the blood pressure.

Patient: That’s right.

Doctor: When did you start having problems with your kidneys?

Patient: Almost seven years ago. I had a severe case of the flu, with a very bad cold and a cough. Then my face and arms and legs started swelling. I went to my primary care doctor and she ran tests on my blood and urine. The results showed that my kidney function was not good, so she referred me to the nephrologist.

Doctor: And what did he find?

Patient: He found that I had chronic inflammation of the kidney.

Doctor: Yes, that is glomerulonephritis.

Patient: And then things got progressively worse. I’ve been on dialysis for over a year. I’d really like to go ahead with a transplant if you think I am a good candidate.

Doctor: I understand. Let’s go over your medical history in more detail, and then I will examine you. Then I will be able to decide whether we can do this surgery in your case, and you and I will discuss what is involved in the surgery.

Patient: All right.

The doctor then takes a detailed history from the patient, asking him to describe all of his prior illnesses, injuries, and surgeries, his family history, and the details of his diagnosis and treatment for the glumerulonephritis. He learns that the patient is an actively working bank employee who has no heart problems, does not smoke or drink alcohol, does not use drugs, and has a supportive family. He also performs a physical examination, takes the patient’s blood pressure, and records his height and weight.

Doctor: All right. On examining you, I see that your abdomen is soft, your chest and heart are good. You have good circulation in your extremities, which is encouraging because we connect your kidney to the artery that takes blood to the foot. If your circulation is good, that reassures me that your kidney is going to work fine.

Patient: Good.

Doctor: Also, I see that you are slightly overweight. I am going to refer you to be seen by our dietitian. Our Center for Transplantation has an dedicated dietitian to work with you to get your weight down to make the operation easier on you.

Patient: Okay.

Doctor: Now let’s talk about the operation itself and how you would prepare for it.

Patient: Good. We both have a lot of questions about what it involves for me and for the donor.

Doctor: First, the process of a kidney transplant workup involves some additional blood tests for you, which I will order today.

Patient: If I had no living donor, or if nobody is a good match, then what happens?

Doctor: When your blood tests are complete we would put you on the list for a kidney transplant from a deceased donor. When you are on the list, there is a chance that there will be a kidney out there that will match you perfectly. So then we would get a call, and if you are a good match you will get that kidney.

Patient’s Wife: How long is the wait for a kidney if you are on the list?

Doctor: A typical waiting time is about four years for a kidney transplant, but it could be longer, it could be less, depending on what is available. But I know that you have near and dear ones who want to donate a kidney for you.

Patient: Yes, my brother and two of my friends from church.

Doctor: Good. So I’m going to introduce you to our live donor coordinator, who is dedicated to working with patients like yourself who have live donors. She’ll explain the entire process to you. It involves getting your donors tested in detail anatomically and also evaluating them mentally to make sure they are ready for this procedure understanding the risks and benefits of giving a kidney for transplantation. And then if they have any questions she will address those.

Patient: Is it better if my living donor is related to me?

Doctor: Yes, it is better to have someone from the family, but if there is a friend who is willing to donate a kidney, we can test them as well.

Patient: Do you do both operations at the same time?

Doctor: If your donor is found to be a compatible donor, it will be set up so we do both operations in the same day.

Patient: What is the donor’s surgery like?

Doctor: The donor’s kidney is removed using laparoscopy. Wetake the kidney out with a minimally invasive procedure so the scars are really small.

Patient: You don’t have to do an open surgery to remove the kidney?

Doctor: Rarely. If there are problems at surgery we will make a larger incision to take the kidney, but this is uncommon. The donor operation lasts about three hours.

Patient’s Wife: Once you remove the kidney from the donor, what happens?

Doctor: Once the kidney is removed, we clean it and then in the other room the other surgeon will be operating on you and will put the kidney inside you.

Patient: What kind of incision will you use on me?

Doctor: The incision is going to be made in the lower part of the abdomen, so it will be hidden beneath your underclothes.

Patient’s Wife: How long does the operation take?

Doctor: Usually the operation lasts between 2-1/2 and 3 hours. In majority of cases, the kidney starts working right away and starts to make urine right away, and hopefully you will not need dialysis any more after that.

Patient: That would be wonderful.

Patient’s Wife: And one kidney, that is enough for him to be healthy?

Doctor: Yes.

Patient’s Wife: Will you take out both his kidneys before you transplant the new one?

Doctor: No. Unless there is a reason to take out your kidneys, we leave your kidneys where they are. That is why we put the new kidney lower down.

Patient: So I will have three.

Doctor: Yes, you will have three.

Patient: Is it a painful surgery?

Doctor: When you wake up after surgery, we will give you enough medication so that you are not hurting. When we discharge you home, we will send you with some oral medications to keep you comfortable while you are recovering.

Patient: How long will I be in the hospital?

Doctor: Typically after the operation you will have a catheter for 4-5 days and you would go home in 6-7 days depending on whether the organ is working well

Patient’s Wife: What are the risks of the operation?

Doctor: There are risks related to the operation itself, such as bleeding or clots. The kidney could thrombose, meaning that there is a blood clot in the kidney that might kill the kidney. There could be a leak around the ureter that might require us taking you back to the operating room,. Other general complications include wound infection, clots in the lungs, pneumonia, and general urinary infections, but we take all precautions to make sure the patients don’t get any infections.

Patient: Will there be any restrictions on my diet?

Doctor: There are some restrictions during the first week after the surgery because you are recovering from a big operation. After that, you will be able to eat whatever you want.

Patient: If the transplant is successful, what can I expect as far as how I will be feeling?

Doctor: In general, if the transplant is successful, you will be near normal, provided you continue to take your medicines.

Patient: What medications will I have to take after the surgery?

Doctor: While you are in the hospital, and you are recovering, the nurses will go over with you all the medications and precautions you will need to take. We will want to make sure your blood pressure is appropriate, make sure you have a blood pressure cuff at home and that you can measure your blood pressure regularly at home. You will be taking anti-rejection pills.

Patient: I have a blood pressure monitor and I know how to use it.

Doctor: Good. The nurses will also go over all the medications that you are supposed to take. We want to make sure that you take your medications on time. Typically you will be taking 6-7 types of pills when you are discharged from the hospital. Three months after the operation, you will probably be down to about 4-5 types of pills. We expect you to continue taking those medications and be available to make changes when we call you with your lab tests.

Patient: How often do I need to have the lab tests?

Doctor: You will be coming in to see us twice a week for blood tests so we can monitor your anti-rejection medications.

Patient: And if I have a living donor, what will it be like for them?

Doctor: Most patients from a donor operation go home in about 2-3 days and are back to work in about 3-4 weeks. Your donor will be monitored at one week, two weeks, six weeks, then six months and one year just to make sure that the donor operation went fine and there are no problems with the donor operation.

Patient: And I will be monitored for the rest of my life.

Doctor: Yes, the recipient is monitored lifelong. It is a long-term relationship. We have to make sure the kidney is working well. If you have a nephrologist in the community, we will be discharging you to your nephrologist in three months’ time, but we will bring you back in for periodic checks.

Patient: What are the side effects of the medications I would have to take after the transplant?

Doctor: Some of the side effects of the anti-rejection medications include loss of hair, which is reversible. The medication could affect your kidney, and we make sure that we give you just the right amount so it does not hurt your kidney. Sometimes patients get infections, and sometimes long-term patients can get tumors because of the anti-rejection medications, but that is rare. That is why we monitor you very closely.

Patient: What is the success rate of the operation?

Doctor: It is very good, the 1-year survival rate is about 90%, and 5-year survival, is about 80%.

Patient: I would definitely like to proceed with this surgery, and have my brother and my friends evaluated as possible donors.

Doctor: Good. My coordinator will contact you to set those things up. If you have any further questions at all, please do not hesitate to call me.

Patient: Thank you very much, Doctor.

Resources

See Kidney Transplant Program at UC San Diego Health System