Getting the Go-Ahead
When a kidney from a deceased donor is available, Lifecenter Northwest, the organ procurement organization in the Pacific Northwest region, will call your transplant nurse coordinator.
Both a nurse coordinator and a transplant surgeon are on call 24 hours a day at Seattle Children's Hospital. The coordinator will call the transplant surgeon to discuss the history and condition of the donor to determine if this donor organ would be a good match for your child.
If the organ is a good match, the transplant nurse coordinator will contact you to see if your child is able to undergo the transplantation operation. The coordinator must make sure that your child does not have any new health problems that require delaying transplantation.
Current United Network for Organ Sharing (UNOS) policy requires that the transplant center (your Seattle Children's transplant team) decide whether or not to accept the kidney offer within ONE HOUR.
We will make every effort to contact you. We will first call your home phone number. Then we will page you. You must answer all pages that you receive, even if you do not recognize the number.The number may be the coordinator's home or cell phone number. We must also have a list of contacts (family, friends, work, school, etc.) to call. We may call the local police to help find you.
When we contact you, the coordinator will discuss:
- If your child is well enough for surgery
- How you will get to the hospital
- How long it will take you to arrive
- When to have your child stop eating and drinking to prepare for surgery
- Where to park and check in at the hospital when you arrive
If we are unable to contact you within one hour, you will miss a very important opportunity for transplant. The kidney will be offered to the next person on the transplant list, and your child will remain on the waiting list.
Preparing for Surgery
If the kidney is coming from a deceased donor, we will check your child's viral status and give your child a dialysis treatment. Then we will do a crossmatch test to make sure that your child doesn't already have an immune response (antibodies) to the donor's kidney.
The crossmatch is done by mixing your child's blood with cells from the donor.
If the crossmatch is positive, it means that your child has antibodies against the donor kidney and should not receive this particular organ because the kidney will be rejected.
lf the crossmatch is negative, it means your child doesn't have antibodies to the donor kidney and is eligible to receive this organ.
If your child is receiving a kidney from a living donor, we will do the final crossmatch at a clinic visit a few days before the date of the scheduled transplant surgery.
We will not begin medications to suppress the immune system until your child's crossmatch with the donor kidney is known to be negative.
If your child is receiving a kidney from a deceased donor, the time of surgery is planned to match the kidney's arrival at Children's. The kidney cannot live long outside a body, so it must be removed from the donor, transported to Children's and then transplanted into your child within a few hours.
At the hospital, we will perform blood tests and a chest X-ray to make sure your child's condition is stable enough for surgery.
We will start an intravenous (IV) line to give your child medicines and fluids. An IV is a small needle inserted into your child's arm so that we can easily inject medicines and fluids into a vein.
You may stay with your child until the anesthesiologist has put your child to sleep. We will then take your child to the operating room. At this time, you can check in at the Pediatric Intensive Care Unit (PICU) front desk. There, you will be given a pager, so that operating room staff can let you know how your child is doing during the surgery.
There are many places for you to wait at the hospital during your child's surgery, including the hospital cafeteria, the chapel, the Family Resource Center and family waiting rooms in the PICU and near the operating room.
Kidney Transplantation Surgery
Kidney transplantation involves placing the donor kidney into your child's abdomen, usually on the lower right side, just above the pelvis. When the kidney is removed from the donor, important blood vessels (the renal artery and renal vein) that bring blood to and from the kidney, as well as the ureter, are removed with it.
During the transplantation, these blood vessels are attached to an artery and vein in your child to re-establish blood circulation to the kidney. The ureter, which is the tube draining urine from the kidney to the bladder, is reattached to your child's bladder to allow the urine to drain in the normal manner.
In the normal position, kidneys are located high in the back of the abdomen and well protected by the ribs, behind other organs such as the liver and stomach.
Since it is usually not necessary to remove the existing diseased kidneys during the transplant, the donor kidney is placed in a lower position in the abdomen, just above the hip. In this position, the kidney's blood vessels are attached to the major arteries and veins of the lower body, and the ureter can be directly attached to the bladder.
In certain situations, removal of your child's diseased kidneys may be recommended beforehand or at the time of the kidney transplantation.
If your child has problems with kidney or urine infections or high losses of protein or water from the diseased kidneys before transplant, these problems may continue after transplant and interfere with the function of the new transplant kidney.
Also, if the existing kidneys are too large to leave room for the transplant, or if your child has extremely high blood pressure despite the best medical management, kidney removal may be recommended.
A stent may be placed in your child's ureter during the transplant surgery. A stent is an internal tube to help support the ureter-bladder connection as it heals, and to make sure urine flows easily from the kidney into the bladder.
The stent will need to be removed several weeks after the transplant. This procedure involves using a small scope to look into the bladder and remove the stent from the ureter, and is usually done as an outpatient day surgery procedure.
The function of the donor kidney is carefully assessed after transplant, and the kidney often begins to work within a few hours of surgery. Sometimes the kidney takes several days or weeks to recover. In situations of delayed kidney function, dialysis is continued until the transplant kidney starts to work properly.
The operating room staff will let you know how your child is doing during the surgery. They will contact you through the pager you picked up from the PICU.
After the Surgery
After surgery, your child will go to the PICU. You will be able to be with your child there.
Here are some of the things you may see attached to your child in the PICU:
A catheter (flexible tube)
The catheter is used to drain urine from the bladder. It will be in place for a few days.
A nasogastric (NG) tube
This tube passes through the nose and into the stomach. It may be needed for a day or so to keep your child's stomach drained.
Two or more intravenous (IV) lines
These lines give your child fluid and medicines during and after the surgery. Your child will have one or more IVs for two to three days, until your child is eating and able to take medicines by mouth.
A drainage tube
This tube is sometimes used to drain blood and fluid from around the new kidney.
Some of these tubes and lines will be removed when your child leaves the PICU. Others may stay in longer.