Transplants at University Hospital - Michigan Medicine

Transplants at University Hospital In 1964, a team of surgeons at Michigan Medicine (MM) performed the first kidney transplant operation in Michigan. Our transplant surgeons do between 200 and 250 kidney transplants a year. This makes the MM team among the most experienced in the nation. Our kidney transplant team includes transplant surgeons, urologists, nephrologists (kidney doctors), physician assistants, nurse practitioners, nurses, transplant coordinators, social workers, psychologists, dietitians, pathologists, pharmacists and other specialized support staff. These professionals can help you have the best possible kidney transplant experience. In addition to an expert transplant team, MM also has the most comprehensive medical facility in the state.

Kidneys Normal Kidneys Kidneys filter waste products and excess water from your blood. They also make hormones that control your blood pressure and red blood cell count. They keep the water, salt and acid levels in your body balanced. Most people have two kidneys that are located toward the back and under the rib cage, where they are protected. There is one on each side of the spine. Kidneys produce urine that carries waste products out of your body. Each kidney is attached to a ureter, a tube-like structure. The urine travels through the ureter and empties into a bag-like organ called a bladder. The bladder can stretch to hold urine until it is full. It then signals your brain that you need to urinate. The urine leaves your body through a tube called the urethra. This tube exits through the penis in men and in front of the vagina in women.

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Kidney Failure Leading to Transplantation When your kidneys are unable to perform their normal functions you have kidney failure, also known as renal failure. Some of the primary causes of end stage kidney failure include:

?Diabetes mellitus ?Hypertension ? Glomerulonephritis ?Hereditary diseases like polycystic kidney disease or Alport's

syndrome

?Metabolic diseases or inborn errors of metabolism like oxalosis or

cystinosis

?Obstructive uropathy ?Medication toxicities ?Multisystem diseases like vasculitis, amyloidosis or systemic lupus erthymatosus ?Congenital malformations including vesical ureteral reflux, hypoplasia or dysplasia ?Other forms of irreversible acquired renal failure

Diseased kidneys do not do a good job of filtering toxins or removing water from the body. To stay healthy, people with diseased kidneys will need dialysis or a kidney transplant. Kidney transplantation improves the length and quality of life of people whose own kidneys have failed.

The Kidney Transplant Your transplanted kidney will be placed in your pelvis above the groin area. Your native kidneys do not normally need to be removed and therefore remain in your body. The incision for a kidney transplant is approximately four to 12 inches long and is located on the lower abdomen on the right or left side. The operation usually lasts two to four hours. After the transplanted kidney is connected

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to your blood supply, the transplanted kidney usually begins to make urine. The transplanted ureter is attached to your bladder. As the new kidney begins to work filtering waste products from your body, you will begin to feel better.

Kidneys for Transplantation ? Where Do They Come From? All kidneys available for transplantation are a result of a gift from one person to another. Kidneys can come from either deceased or living donors.

Deceased Donor Kidneys Deceased donor kidneys (and other organs) are donated after the death of the donor. The suitability of the donor is determined by many factors. These include many of the same criteria used for living donors such as medical history, general health, habits and so forth.

As of November 2019, there were 94,000 persons awaiting a kidney transplant on the wait list in the United States. At the University of Michigan alone, there are nearly 800 patients waiting. Unfortunately, in the year 2018 only 21,167 kidney transplants were performed in the United States. In 2014, 4,761 persons died waiting for a transplant. Because of a severe national organ shortage, alternative solutions to using deceased donor organs have been sought.

Donation After Brain Death (DBD) Most deceased organ donors are brain dead. They have suffered complete and irreversible loss of all brain function, and are clinically and legally dead. Mechanical ventilation and medications keeps their heart beating and blood flowing to their organs.

Donation After Cardiac Death (DCD) Some people with non-survivable injuries to the brain never become brain dead because they retain some minor brain stem function. If such individuals made the decision to be donors or their families are interested, organ donation may be an option. Donation in such cases involves taking the patient off the ventilator, typically in the operating room. Once the patient's heart stops beating, the doctor declares the patient dead and organs can be removed.

Increased-Risk Donors Some donors have been determined to have increased-risk behaviors such as IV drug abuse, long-term stay in a correctional facility, prostitution, etc. (either now or in the past). These donors are determined to be at increased risk of transmission of certain diseases (i.e., HIV, hepatitis C, hepatitis B) to a recipient. All donors, whether they are increased-risk or not, are tested for disease. These tests can detect a donor infection as recently as one week ago.

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The results of these tests are back before the organs are donated. Increased-risk donors who test negative and are not now engaging in increased-risk behaviors carry a very low risk of transmission of infection and are therefore used as kidney or pancreas donors. The true risk of transmission is not known but is probably much less than one percent. If a kidney from a increased-risk donor is offered to you, this will be discussed with you at the time of the offer. While we generally recommend accepting such an offer, you will have the option to accept or decline.

Kidney Allocation

Questions and Answers for Transplant Candidates About the Kidney Allocation System

United Network for Organ Sharing (UNOS) is a non-profit charitable organization that manages the nation's transplant system ? known as the Organ Procurement and Transplantation Network (OPTN) ? under contract with the federal government. As the OPTN, UNOS helps create and define organ sharing policies that make the best use of donated organs. This process involves continuously evaluating new advances and discoveries so policies can be adapted to best serve patients waiting for transplant.

The kidney allocation system was revised in 2014 as a result of years of review and consensus building among transplant professionals and people who have personal experience with donation and transplantation. Their primary goal was to make the system better without making major changes to the parts of the systems that work well.

The policy as implemented addressed a number of goals to promote organ utilization and equity, notably:

?Improving utility by better matching estimated length of kidney function to estimated time

a candidate may need a transplanted kidney

?Enhancing equity by basing transplant waiting time on dialysis, rather than the previous

method of beginning waiting time at listing with a transplant hospital

?Increasing transplant opportunities for highly immunosensitized candidates by providing

them additional priority, especially those with a CPRA score of 98 or higher

?Increasing transplant opportunities for blood type B candidates (many of whom are ethnic

minorities) by facilitating kidney offers to them from donors with blood subtype A2

?Broadening distribution of shorter-longevity kidneys to increase their utilization

More than four years after KAS implementation, the system continues to shape access to transplantation nationwide. UNOS will continue to study the system closely to make sure it is performing as expected. UNOS will address any issues that suggest that the policy is not meeting needs, or if other issues arise.

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How Are Kidneys Classified? Every kidney offered for a transplant has a Kidney Donor Profile Index (KDPI) score. This is a percentage score that ranges from zero to 100 percent. The score is associated with how long the kidney is likely to function when compared to other kidneys. A KDPI score of 20 percent means that the kidney is likely to function longer than 80 percent of other available kidneys. A KDPI score of 60 percent means that the kidney is likely to function longer than 40 percent of other available kidneys.

If you have been listed for some time, you may have heard of a kidney being classified as "standard" or "expanded criteria." These classifications are no longer used.

What Goes Into a KDPI Score?

?Age ?Height ?Weight ?Ethnicity ?Whether the donor died due to loss of heart function or loss of brain function ?Stroke as cause of death ?History of high blood pressure ?History of diabetes ?Exposure to the hepatitis C virus ?Serum Creatinine (a measure of kidney function)

How Will Transplant Candidates be Classified? Each kidney candidate will get an individual Estimated Post-Transplant Survival (EPTS) score. This is a percentage score that ranges from zero to 100 percent. The score is associated with how long the candidate will need a functioning kidney transplant when compared to other candidates. A person with an EPTS score of 20 percent is likely to need a kidney longer than 80 percent of other candidates. Someone with an EPTS score of 60 percent will likely need a kidney longer than 40 percent of other people. Your transplant team can calculate your EPTS score for you.

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