What exactly is the procedure for a transplant?
What are the types of kidney transplants?
There are two types of kidney donation: living donation by a close relative or acquaintance, and post-mortem donation by an anonymous, deceased person.
Living donation -- who can donate to whom?
For a living donation, the donor and recipient must be related or have an emotional connection. This includes, for example, the following persons: "parents, children, siblings, spouses or partners, fiancées and persons who are close to the donor in a special personal relationship" (§ 8 para. 3 Transplantation Act Germany). In addition, the person must clearly be of legal age.
Removing a kidney from a living person is only allowed under very strict conditions. Under no circumstances may moral pressure be put on the living donor. He/she must also be in good health. In addition, the donor must be given a very detailed explanation by a doctor who is independent of the transplant team.
Living donation -- what is crossover living donation?
Crossover living donation has also been allowed, following a court ruling. Crossover living donation occurs when a planned donation between spouses and domestic partners is not possible for medical reasons. If two couples can be found in which the kidneys could be donated "crosswise", then this is also possible.
In concrete terms, this means that if the man of one couple cannot get a kidney from his wife for medical reasons and the same problem exists in another couple, but the healthy women of both couples could each donate a kidney to the man of the other couple, then this can also be done. However, a prerequisite for this is that there is already a personal connection between the couples in advance.
Living donation -- how does organ donation work?
If both kidneys are working equally well, the left, longer kidney is usually removed. The transplant is flushed with a preservation solution and stored at 4 degrees Celsius. Within 1-3 hours, the kidney is implanted in the recipient. If everything goes normally, the donor can leave the hospital after 7-10 days and return to their daily life after 1-3 months.
Living donation -- advantages and disadvantages
The long, frustrating and uncertain waiting period is eliminated, which is a great relief to the recipient. In addition, the donor is known. This makes this uncertain situation a little more familiar. It can also be better scheduled. Further, there is no need for transport times when the kidney is not in anyone's body. Living donations can also take place shortly before the start of dialysis, thus sparing the recipient either completely or upon transplantation of the dialysis treatment. These are all reasons why a living donation often has a higher success rate than post-mortem donations.
Despite all the research, rejection can still occur in some cases of living donation. Both persons should be aware of this in advance. For the donor, the procedure is also not without risks. By donating a kidney, the donor also becomes a kidney patient and must undergo regular examinations. The risk of leading to kidney failure or even requiring dialysis is relatively small.
How does a post-mortem donation work?
If you receive a kidney from a deceased person, then this is called a post-mortem donation. To do this, you need to get on the transplant list.
For a postmortem donation, the process is typically as follows:
Illness/accident with severe brain damage to a person.
Determination of irreversible brain death.
Notification of the donor to the German Foundation for Organ Transplantation (DSO) or equuivalent
Conversation with the relatives
Medical examination of the deceased person
Transfer of data for organ procurement -- Eurotransplant
Transport of the organs
Transplantation of the organs
What happens during transplantation?
From the time organs are removed, the clock is ticking. This is because an organ cannot survive for long outside a body, despite preservation flushing and refrigeration. A kidney is theoretically still transplantable up to 36 hours after removal. Other organs, by the way, are under much more time pressure: lungs and hearts, for example, must be transplanted within 4-6 hours. A liver normally has 8-9 hours.
How long does the new kidney actually work?
Meanwhile, the chances of success of a transplanted kidney are very good. On average, a transplanted kidney survives well over 10 years today. Even more than 20 years can be possible without further ado. Should the transplanted kidney stop working at some point, then it is time again for another option of kidney replacement therapy, i.e. dialysis.
Living donation is possible in the case of closely related persons or as a cross-over living donation.
Even though doctors are now very good at estimating the likelihood of success of a transplant in advance, a living donation is not guaranteed to be successful.
For a post-mortem donation, you have to undergo a series of examinations to get on the waiting list.