American Medical Association Family Medical Guide - American Medical Association [545]
Because the kidney damage is irreversible, the only effective treatment for most people is either dialysis (see page 818) or a kidney transplant (see below). However, some people with end-stage kidney failure may be too ill for either treatment. Doctors treat anemia with regular injections of erythropoietin and prescribe other medications as needed to relieve specific symptoms.
Dialysis and kidney transplantation have significantly improved the chances of survival for people who have end-stage kidney failure. More than half of the people with end-stage kidney failure who are treated with dialysis or a kidney transplant continue to lead active, productive lives 10 to 15 years after the initial diagnosis.
Kidney transplants
A kidney transplant is relatively straightforward and less risky than many other organ transplants. While rejection of a transplanted heart, liver, or lung can be fatal, rejection of a kidney is not necessarily life-threatening because a person whose body rejects a transplanted kidney can be kept alive with dialysis. In some cases, a kidney transplant may be performed primarily to improve a person’s quality of life rather than as a lifesaving measure. Of people who have a kidney transplant, more than two thirds are alive 2 years after surgery, with the transplanted kidney functioning normally. In about one sixth of recipients, the transplanted kidney is rejected, but they are able to go back on dialysis until another kidney becomes available for transplantation.
Transplants
Organ transplantation is the surgical removal of an organ, such as a kidney, liver, or heart, from one person to transfer to another. An organ is transplanted when a person’s own organ has failed because of a serious medical condition or injury. Doctors recommend transplantation only after all other measures have been tried or considered; replacing the organ may be the only way doctors can save a critically ill person’s life. Organs that can be transplanted include the kidney, liver, heart, lungs, pancreas, and intestine. Kidney transplants are the most commonly performed procedures, followed by liver transplants. Sometimes surgeons transplant two organs at once, such as the heart and lungs, or a kidney and the pancreas. Surgeons can transplant not only organs but also body tissues such as the cornea (the transparent outer covering of the eyeball), bone or cartilage, skin, heart valves, and veins in the leg.
Surgery to replace damaged body organs with healthy ones has become routine, and several thousand transplants are performed every year around the world. Most replacement organs come from the bodies of people who have died. The donor’s surviving relatives must consent to the medical use of the organs after death, or the donor must have agreed in advance, while still alive, to donate his or her organs (see page 544). (Many state and national organizations provide organ donor cards for people who are willing to donate their vital organs.) Organs such as the kidneys or parts of the liver or lungs can be obtained from living donors, who are usually family members of the person who needs the transplant.
Quick action is of critical importance in organ donation. For instance, a kidney must be removed within 30 minutes of a donor’s death and can be kept in storage for only 15 to 18 hours before transplantation. Hearts must be transplanted from donor to recipient within 4 to 5 hours.
More than 50 organ-procurement organizations in geographic regions across the country coordinate the retrieval of donated organs. People who are candidates for a transplant are placed on a waiting list, and the waiting time can be several years, depending on the demand for a particular organ and the availability of donor organs. Strict government regulations determine which person on the list has the highest priority. The rules vary by type of organ but, in general, when an organ becomes available, it goes to the person on the local waiting list who has the most urgent need