Going from dialysis to kidney transplant

When should I start the process to get a kidney transplant?
If your kidneys are failing, a kidney transplant may be a treatment option for you. The balance of risks and benefits varies, though, depending on your age and other health problems. If you want a kidney transplant, you must contact a transplant center and ask for a transplant evaluation. It is not automatic. Only a transplant team can tell you that you are definitely eligible (or not eligible) for a transplant.

You can contact one or more transplant centers and start to be evaluated when it seems likely that you will need dialysis within two to three years. Most kidney transplants are successful-more than 90% of transplants are still working one year later. Recent studies have found that the odds of good results are somewhat better with a "preemptive" transplant, done before dialysis is needed. Preemptive transplant requires a willing living kidney donor- probably a relative, spouse, or friend. In 2001, 42% of kidney transplants came from living donors.

If you do not have a living donor, you can ask to be placed on a national waiting list to receive a cadaver kidney from someone who has recently died-usually in an accident. After your evaluation is complete and you are placed on the list, credit for waiting time begins when your glomerular filtration rate (GFR) drops to 20 mL/min or lower. Long waiting times-often years-are common for kidney transplants from cadaver donors.

Can I get on the kidney transplant waiting list before I start dialysis?
Yes, you may want to be evaluated for a transplant before you start dialysis. After your evaluation is done and you get on the waiting list, credit for waiting time starts when your kidney function drops to less than about 20%. This is measured by a glomerular filtration rate (GFR) of 20 mL/min or less. Long waiting times-often years-are very common for kidney transplants from cadaver donors.

Will my kidney doctor automatically put me on a transplant waiting list?
No. Your kidney doctor will not automatically put you on the transplant waiting list. If you want to be evaluated for a transplant, ask your doctor for a referral to a transplant center. Contact your private insurance to help determine which centers are contracted with your plan.

Who pays for transplant costs?
If you want to get a kidney or kidney-pancreas transplant, your employer health plan may cover it (and Medicare would be secondary). If your plan does not cover a transplant, Medicare will pay 100% of the hospital charges and 80% of Medicare's allowable rate for outpatient care like doctors' fees. Medicare will also pay for a living kidney donor to be evaluated, but your donor may have costs that aren't covered like travel or time off of work. Transplant requires costly anti-rejection drugs too. If your employer health plans covers drugs, these will be paid for. If not, Medicare covers 80% of these drugs for three years (longer for people who are elderly or disabled).

Ask your dialysis or transplant center to help you figure out what your insurance will pay and how much you will be expected to pay out-of-pocket, or call DaVita Guest Services at 1-800-244-0680 from 6 a.m. to 5 p.m. (PST).

Can anyone give me a kidney, whenever I want?
In the past, only a close relative such as a parent or sibling could give you a kidney. Now more distant relatives, spouses, and even friends and neighbors can be donors. If you have a willing living kidney donor, you will both need to be evaluated for general health and to see if your blood type and immune system are matched closely enough with the donor. How close the match needs to be depends on the rules and protocol of each transplant center.

If I have a transplant, will I be able to stop taking pills and seeing doctors?
No. A kidney transplant is a treatment, not a cure for kidney disease. When you have a transplant, you must take pills to suppress your immune system for the life of the transplant. These pills keep your body from rejecting your new kidney. You will also need to see doctors regularly to monitor your health and your transplanted kidney.

If my transplant fails, can I go back to dialysis?
Yes. You may be able to go back to either hemodialysis or peritoneal dialysis, depending on your medical history.

I am in Stage 4 kidney disease and can't have a transplant. Can I do dialysis for the rest of my life?
The questions, "How long can someone live?" and, "How well can someone live?" are very common when you need to go on dialysis and you're scared. Yes, dialysis is something you can do for the rest of your life. Some people have done dialysis for 30 years or more without getting a transplant. How long you can live on dialysis and how well you can do will depend on a number of things, including:

How healthy you are, other than kidney disease
How positive your attitude is (optimists live longer, depression can be treated)
Whether you receive good quality medical care and dialysis
How much you learn about dialysis and take an active role in your care.

Nobody lives for 30 years or more on dialysis by accident-it takes a lot of knowledge and effort. You are doing the right thing by visiting this website. Sign up for kidney classes! You may also want to check into joining a kidney patient organization, like a chapter of the National Kidney Foundation or the American Association of Kidney Patients. Or learn more about kidney disease by visiting Kidney School.


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