What is kidney donation?

• The kidneys are a vital organ – life is not possible without them.

• The kidneys have several roles: maintaining a stable internal environment (homeostasis), normal blood pressure, excreting toxins and excess fluids from the body, and prompting the bone marrow to produce red blood cells by secreting the hormone erythropoietin.

• Every day the kidneys filter about 180 liters of blood and excrete about 2 liters of excess food products and waste, which leave the body as urine.

• Each kidney contains about 1.25 million nephrons, which are the functional unit and building block of the kidney, and where the kidney’s work is carried out.

• Impaired kidney function can throw off the balance of chemicals and electrolytes in the body. Too little or too much of these can cause damage.

• Healthy kidneys function at a level four times (!) higher than what the body actually needs. That is why a healthy person with one kidney can lead an entirely normal life.

• After a kidney donation, the remaining kidney goes through a process of adaptation to make up for the missing kidney, at the end of which the donor’s function returns to near-normal. This is why a kidney donor’s creatinine level rises, and after a while it comes back down (usually to a slightly higher level than before the donation).

• Patients whose kidneys have permanently stopped functioning (chronic kidney failure) are in life-threatening danger and must undergo dialysis treatment or a kidney transplant.

• The purpose of dialysis is not to cure the kidneys, but to provide supportive treatment and perform the functions the kidneys are responsible for.

• The most common form of dialysis is hemodialysis. This treatment usually takes about nine to twelve hours a week, generally spread over three days.

• Dialysis is not a perfect substitute for a kidney. The quality of life of a dialysis patient is very poor. The treatment is demanding and exhausting. Patients cannot function normally and are restricted in what they eat, and worst of all – they can hardly drink, even during heat waves.

• Beyond that, it is a complex medical process that can involve many complications, such as accelerated vascular disease, loss of what little kidney function remains, infections, bleeding, blood clots, a drop in white blood cell count, and more.

• Prolonged dialysis treatment can lead to further problems, because the filtering of toxins is not complete, and patients may develop various health problems such as loss of vision, drops in blood pressure, blocked blood vessels, and a buildup of fluids and toxins.

• The only way for a patient with kidney failure to return to health and normal function is a kidney transplant.

• A kidney transplant frees the patient from dependence on dialysis, extends life expectancy, and allows a return to a normal life.

• More than 85 years ago, doctors already understood that the way to save kidney patients was through transplanting kidneys from donors. At first, transplant experiments were carried out on animals, and later human donations began.

• Doctors discovered that the body may reject the foreign transplant, but in the early days there was no way to prevent this.

• The first successful transplant was performed in 1954 between twins with an identical genetic makeup, which is why it was accepted successfully even though no anti-rejection drugs had yet been developed.

• Nine years later, in 1963, in Israel, the first anti-rejection drug was developed.

• Kidney transplantation is the longest-established transplant procedure in Israel, and was first performed in 1964.

• The two transplants performed in Israel took place two days apart; one from a deceased donor, the second from a mother who donated to her son. Over the years it was found that a donation from a living donor is preferable to one from a deceased donor, and has higher success rates.

 

Why is a donation from a living donor needed?

A transplant from a living donor is preferable to a transplant from a deceased donor, for several reasons:

1. Better matching – thorough compatibility testing between donor and recipient can be carried out.
2. Graft survival and quality – studies show that a kidney from a living donor survives and functions in the recipient’s body far longer than a kidney from a deceased donor. A kidney taken from a living donor is in a “natural” state, and its condition is better compared with a kidney taken from a deceased donor. The result is better kidney survival. In addition, in a transplant from a living donor the donor goes through several months of screening, and the quality of the kidney is at its highest. By contrast, with a donation from a deceased donor the quality of the kidney is less certain.
3. Scheduling the transplant – when a patient has a high level of antibodies, a fairly common situation in kidney transplants, they must undergo preparatory treatment several weeks before the transplant in order to lower those antibodies. Only in transplants from living donors is it possible to schedule the donation surgery and the transplant close to the end of the antibody-lowering treatment.
4. Immediate function – a kidney from a living donor usually starts working immediately, often already in the operating room, before the transplant is even complete. By contrast, in transplants from deceased donors there are cases where the graft does not function for some time.
5. A shortage of donations – there are not enough transplants from deceased donors  to meet the high demand for kidneys. The long wait, which sometimes reaches seven years, causes a severe deterioration in the condition of those waiting for a transplant, and some patients die while waiting for a transplant.

 

What is the success rate of a kidney transplant from a living donor?

Success rates in kidney transplants are very high. More than 95% of transplants succeed, and the kidney survives for many years afterwards. About 80% of transplants survive five years after the donation, and about half of the transplants from living donors survive more than twenty-five years. There are cases in which the kidney has survived forty years or more.

Naturally, various complications are possible – mainly graft rejection – but thanks to today’s medical knowledge, including new drugs that have come into use, and thanks to the extensive experience accumulated in recent years, most rejection episodes are treated successfully. The purpose of these drugs is to suppress the patient’s immune system so that it does not attack the graft. The development of these drugs has removed the need to find a genetic match between donor and recipient, and the only requirements are usually blood type and tissue compatibility, which are quite common.

Today there is also the option of a combined kidney and bone marrow transplant, a procedure that is only possible when there is a genetic identity between donor and recipient (usually between siblings). In such a case, after a period the recipient may be able to stop taking anti-rejection medication, which is a very significant advantage.

Sometimes the original disease that caused the initial kidney failure returns and attacks the transplanted kidney. This depends on the type of disease the recipient has.

It is worth noting that the success rate of kidney transplants in Israel is among the highest in the world, and even the newest developments, introduced only recently, are already in use in the country.