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Eligibility
Kidney transplantation is usually considered for patients with end-stage kidney disease. Each patient is assessed for their suitability based on established medical criteria.
A patient who does not meet the guidelines for transplantation, based on assessment, should be offered or may request a second opinion from an alternative program.
Patients may only be considered for a transplant if their glomerular filtration rate is below a certain level and if there is evidence of progressive and irreversible deterioration in kidney function.
Conditions that may impact eligibility or prevent a transplant
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Co-morbid Health Conditions: If you have other serious health issues that make surgery very risky or lower your chances of surviving after the transplant, you might not be eligible.
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Compliance: You must be able to adhere to therapy, medications and treatments. This is measured in the pre-kidney transplant workup phase (for example, attending dialysis or taking medications as prescribed). Individuals who are unable to adhere may be deemed ineligible.
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Kidney Disease Cause: If your kidney disease is likely to return after a transplant, you might not be eligible.
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Post-Transplant Care: If you do not have a safe and reliable plan for care after the transplant, you may not be eligible.
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Mental Health and support: Cognitive issues or psychiatric history don't automatically disqualify you, but you need to be able to give informed consent and have a support system. You must be free from substance abuse for at least 6 months. If you have untreated, severe mental health issues that would prevent you from adhering to therapies, you may not be eligible.
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Specific Diseases: Systemic diseases causing kidney failure may not be a problem, but the severity of other health issues, including cancer, lung disease, heart disease, blood vessel disease and digestive disease may impact eligibility. Certain diseases will need to be treated before a transplant can proceed.
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Peripheral Vascular Disease: Patients with large uncorrectable abdominal aneurysms, severe occlusive common iliac disease, active gangrene or recent atheroembolic events are not candidates for kidney transplantation.
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Gastrointestinal Disease: Patients with acute pancreatitis within 6 months, active inflammatory bowel disease or active peptic ulcer disease are not candidates until successfully treated.
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Age and Health: Older age alone doesn't disqualify you, but your overall health and ability to survive the wait for a transplant are considered. Cognitive delays are also evaluated individually.
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Weight and BMI: Patients under a certain weight are not eligible. Patients with a BMI under 35 are usually accepted. Those with a BMI over 36 are evaluated individually.
Risks and Benefits
Kidney transplantation is an elective procedure with the potential to improve a patient’s life, but there are no guarantees.
Benefits
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No more regular dialysis treatments.
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More freedom to travel and eat a wider variety of foods.
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Better chances of living longer compared to staying on dialysis.
Risks
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Surgery risks, including possible heart attack, stroke, lung infection, blood clots, and surgical site infections/bleeding.
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Increased risk of infections and cancers due to immunosuppressive drugs.
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Higher chance of developing cancers, especially skin cancer.
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Possible weight gain, bone problems, and increased risk of developing diabetes.
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There is an approximately 15% risk of the body rejecting the new kidney, but this can usually be treated with medication.
Survival rates vary based on a number of factors but are generally better with a living donor kidney. A deceased donor kidney will usually last 10 years, and a living donor kidney will usually last 20 years, on average.
There is a 5% risk of death within the first year after the transplant, but this risk decreases over time.
Kidney Transplant Assessment
What to Expect
You'll meet with a doctor who specializes in kidney transplantation. The appointment can last between 60 to 120 minutes and will take place at Kingston General Hospital.
During the appointment, the doctor will review your health history and perform a physical exam. They will explain the risks and benefits of a kidney transplant and discuss the necessary tests.
You will be asked to complete bloodwork as well as provide a urine sample, if ablere. Remember to come prepared to your appointment with any questions you may have for the Transplant Team.
You'll also meet the Recipient Transplant Coordinator for further instructions and education for next steps, including the kidney transplant workup.
Kidney Transplant Workup
The kidney transplant workup is a series of appointments and tests to determine if you are eligible for a transplant. It includes:
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An appointment with your family doctor to receive specific tests. If you don't have a family doctor, alternatives will be provided.
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Dental clearance.
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A social work assessment, completed over the phone.
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Other tests and clinic appointments, including an ECG, echocardiogram, abdominal/pelvic ultrasound, chest x-ray, transplant surgeon assessment, and cardiologist assessment.
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Additional tests and clinic appointments, if necessary.
If you cannot make an appointment or test that has been scheduled for you, it is your responsibility to call the location where the test is booked and rebook.
Review Process
The transplant team will review all test results and, if more tests are needed, you'll be informed. Once all tests are complete, you'll be notified if you are suitable for a kidney transplant.
Frequently asked questions
What are my responsibilities as a potential kidney transplant candidate?
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Attend all appointments. Missing any clinic visits, tests, or consultations can make you ineligible.
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Ensure you can pay for your medications. The Social Worker may be able to help you find coverage.
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Follow medical treatments. Stick to your dialysis schedule and take all prescribed medications. Keep your blood work, blood pressure, and fluid levels under control.
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Avoid substance abuse. Illegal drug use or substance abuse makes you ineligible.
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Be prepared: You need to be physically, emotionally, and mentally ready to handle the responsibilities of a kidney transplant.
What happens if I am unsuitable as a recipient?
The Transplant Coordinator or Nephrologist will explain why you are unsuitable. You can request a second opinion from another transplant center in Ottawa or Toronto.
What happens after completing my tests?
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Your health will be carefully reviewed to ensure a transplant is safe for you.
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The Transplant Coordinator and Nephrologist will decide if you can be added to the transplant waitlist or proceed with surgery if you have a live donor.
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You will receive a call from the Transplant Coordinator with the next steps.
Kidney Transplant Listing Process
Deceased donor waitlist
If eligible for kidney transplantation, you'll be educated about the process via phone and receive information by mail. If you haven't heard from the Recipient Transplant Coordinator, you're not yet on the waitlist.
Trillium Gift of Life manages organ donation and transplantation in Ontario, ensuring fair distribution of organs. They match donors with patients. For more info, visit their website.
While on the Waitlist you will need to:
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Provide blood samples three times a year to match with potential donors. If you're on hemodialysis, this will be done during your sessions.
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Maintain good health: quit smoking, keep a healthy weight, and stay close to your dry weight to reduce complications.
Live Donor Information
The process for receiving a kidney donation from a live donor is different.
If someone wants to donate a kidney, give them the KHSC Live Donor Coordinator's number: 613-549-6666 ext. 7028.
Find more information on how to find a live donor on the Kidney Foundation website.