Kidney Transplant

WHAT YOU SHOULD KNOW:

• Kidney transplant is surgery to replace a damaged kidney with a new kidney from a donor (another person). The kidneys are two bean-shaped organs found under the ribs on each side of the upper abdomen (stomach). The kidneys remove wastes and other unwanted chemicals from the body. These wastes are flushed from the body as urine. When the kidneys are badly damaged, these wastes build-up in the body and cause harm. This may cause seizures (convulsions), trouble breathing, increased blood pressure, body swelling, confusion, fainting, or even death. A new kidney may be needed to replace the damaged kidney to keep the body working.
  
  
• The new kidney may come from family members, spouse, close friends, or even someone you do not know. In most cases, surgery is done at the same time between you and your donor. An incision (cut) will be made on your abdomen and your new kidney will be placed. The blood vessels will be connected and the ureter will be attached to your bladder. The ureter is the narrow tube that connects the kidney to the bladder where urine is temporarily stored. Your new kidney should begin to work as soon as blood flows through it. With a kidney transplant, you may resume your usual activities and prevent more serious health problems.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

There are always risks with surgery. You may bleed more than the usual, get an infection, have trouble breathing, or get blood clots. Nerves, blood vessels, muscles, intestines, and other organs may get damaged. You may have problems with your ureter or bladder which may cause urine to leak out. Your body may also reject the new kidney from your donor. There is also a risk that your condition may worsen or you may die during surgery. You will need dialysis for the rest of your life if you do not have a kidney transplant. Ask your caregiver if you have questions about your surgery, condition, medicines, or care.

GETTING READY:

Weeks before your surgery:

• Your caregiver may suggest that you have counseling about your surgery and condition. He may talk to you or your family about your expectations, benefits, and possible outcomes of the surgery.
  
  
• Tell your caregiver about all the other diseases you may have. These may include diabetes (high blood sugar level), cancer, bleeding disorders, or heart problems. Your caregiver may need to treat you before your surgery to prevent possible problems. He may also start you on dialysis treatment or need you to continue your dialysis until your surgery.
  
  
• If you are a woman, tell your caregiver if you know or think you are pregnant.
  
  
• You may need to have different blood and urine tests. It is important to check if you and your donor have compatible blood types or other matching factors. These tests will check whether your body will accept or reject your donor's kidney. You may also need an electrocardiogram (ECG), echocardiogram (echo), or stress tests. Imaging tests, such as x-rays, computerized tomography (CT) scan, magnetic resonance imaging (MRI), ultrasound, or arteriography may also be done. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test
  
  
• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to continue using aspirin or any other prescribed or over-the-counter medicine before or after your surgery.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• Ask your caregiver if you should get vaccines (shots) to keep from getting infections caused by certain germs. These shots should be completed at least four weeks before your surgery. Ask your caregiver which vaccinations are right for you.
  
  
• You may need a blood transfusion if you lose a large amount of blood during surgery. Some people are worried about getting AIDS, hepatitis, or the West Nile virus from a blood transfusion. The risk of this happening is very low. Blood banks test all donated blood for AIDS, hepatitis, and the West Nile virus. You may be able to donate your own blood before surgery. This is called autologous blood donation. This must be done no later than three days before surgery. You may also ask a family member or friend with the same blood type to donate blood for you. This is called directed blood donation.
  
  
• If you have diabetes, ask your caregiver for special instructions about what you may eat and drink before your surgery. If you use medicine to treat diabetes, your caregiver may have special instructions about using it before surgery. You may need to check your blood sugar more often before and after having surgery.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  
• Bowel preparation: You will need to clean out your bowel to get ready for this surgery. Your caregiver may ask you to do one or more of the following:
  
  
  • You may need medicine called an enema. An enema uses warm water that is put into your rectum to help empty your rectum. Ask your caregiver how to do this, and follow the directions on the package.
    
    
  • You may be given 8 to 12 (eight-ounce) cups of special bowel prep medicine to drink. Drink one eight-ounce cup of bowel prep medicine every 10 minutes until you are passing clear fluids. Ask your caregiver for more information about this medicine.
  
  
• You may be given medicine to help you sleep.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• Ask your caregiver before taking any medicines on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• Bowel preparation:
  
  
  • Do not eat or drink anything on the morning of your surgery. Your bowel needs to be totally empty during your surgery. If you need to take medicines, you may have them the morning of your surgery with few small sips of water.
    
    
  • You may need an additional enema, using warm water, the morning of your surgery.
    
    
  • You may also be asked to drink 4 to 8 (eight-ounce) cups of special bowel prep medicine. This may need to be done if you drank the bowel prep medicine the night before.
  
  
• If you wear contact lenses, do not wear them on the day of your procedure or surgery. Glasses may be worn.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

TREATMENT:

What will happen:

• You may be given medicine to help you relax or make you drowsy. You will be taken on a stretcher to the operating room and then moved onto a special bed. Your abdomen, side, and genital areas will be cleaned with soap and water. Sheets will be put over you to keep the surgery area clean. Caregivers may give a general anesthesia to keep you asleep during surgery. An endotracheal (ET) tube connected to a breathing machine may be put into your mouth. This goes down the windpipe to keep your airways open and help you breathe during your surgery. A catheter may be inserted to drain your urine.
  
  
• Your caregiver will make an incision on your abdomen. The new kidney will be sewed in place by connecting its blood vessels to your own blood vessels. The ureter of the new kidney will be attached to your bladder. Your damaged kidneys will be left in place unless they are causing problems such as infection or high blood pressure. Thin rubber tubes will be put near the kidney to drain blood from your incisions. Your incisions will be closed with stitches (threads) or surgical tape and covered with bandages.

After your surgery:

• You will be taken to the recovery room or an intensive care unit (ICU). The ET tube may be removed after you are awake and can breathe well on your own. The catheter that drains your urine may need to remain for awhile. Caregivers will watch you closely for any problems. The bandages used to cover your stitches keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your surgery to check your wound and drains.
  
  
• You will have several tubes in place, which might make it hard to move. All of these tubes are important to help your caregivers watch you closely for any problems. The drains are taken out when the incision stops draining. Do not get out of bed until your caregiver says it is OK. Your family may be allowed to visit you in the ICU for a short visit several times a day.

Waiting room: This is a room where your family and friends can wait until you are ready for visitors. If your family leaves the hospital, ask them to leave a phone number where they can be reached.

CONTACT A CAREGIVER IF:

• You cannot make it to your appointment on time.
  
  
• You have a fever (increased body temperature).
  
  
• You have a skin infection or an infected wound on or near the area where surgery will be done.
  
  
• You have questions or concerns about your surgery.

SEEK CARE IMMEDIATELY IF:

• You have more pain or have trouble passing urine.
  
  
• Your signs and symptoms are getting worse.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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