In preparing the following information presented to you by the Association for the Advancement and Preservation of the Public Kidney Patients in Israel are many partners: Professional Counseling – Dr. Farhuqui Victor – Key Director of Nephrology and Hypertension, Carmel Medical Center. Tal Kaminsky Rosenberg – Clinical Dietitian. Nepromor – Nephrology Institute Network, Atid Nephrology Forum Management Team – Dietitians Association in Israel. Writing & Editing – Katz-Vodi Selait marketing communications.
In some cases of chronic kidney failure, a kidney transplant can be performed during which a healthy kidney is transplanted into the patient’s body. Unlike other organs taken exclusively from the dead, one kidney can also be taken from any living donor. Live donor transplantation has the advantage of dead transplantation because more thorough matching tests can be performed. According to the statistics, the chances of success of an live donation are higher than the chances of success of a kidney donation from a deceased donor.
Registration of transplant candidates from across the country is done exclusively at the National Transplant Center. Prior to any transplant surgery in Israel, from a living donor or a deceased donor, individual approval from the National Transplant Center – the Ministry of Health, is required. By law, the patient can choose the hospital where the transplant will be performed and the unit staff will register the patient accordingly. Kidney transplants are currently taking place at the following medical centers: Tel Aviv Medical Center (Ichilov), Hadassah, Rabin Medical Center (Beilinson), Rambam and Soroka.
The waiting list for transplant from a dead donor is managed by the Center in a computerized manner. The position in the list is determined based on criteria established by the Center’s Steering Committee and includes patient age, medical urgency, donor-to-patient tissue matching, waiting time for transplant, and additional medical criteria. The position in the list is constantly changing in accordance with the changes in the data, for example: worsening of the patient’s medical condition, subtraction or extra waiting.
There is no age restriction for kidney transplantation. As a rule, registration for kidney transplant is only possible after dialysis. When a patient is enrolled in a transplant, the length of waiting time will be considered from the start of the dialysis treatments (and not by the date of the transplant registration). A patient on dialysis who enters the waiting list at a certain age, and “past” an age group due to the long wait, will continue to receive the score according to the age group he enters the list (the more waiting the young person gets the more points).
The surgery takes 3-6 hours, the surgeon inserts the new kidney through the back to the lower abdomen, close to the urinary bladder. The new kidney is connected to large blood vessels that pass through the lower abdomen and ureter connects to the urinary bladder. The blood flows to the new kidney and so the urine is created. Do not remove the natural kidneys unless there is a disease that justifies it such as: infection, hypertension, or large polycystic kidneys that make it difficult for a proper operation. After surgery, the patient is admitted to the transplant unit and remains monitored at the transplant clinic.
After transplantation from a live donor, the kidney begins to function immediately, however, in many cases of transplantation from a deceased donor, further dialysis is required until the kidney recovers and begins to function. Most kidney transplants continue to function for many years, a small portion do not function at all immediately after transplantation or cease to function after several months due to severe acute rejection or other medical reasons. Some of the diseases that have damaged the original kidneys can also appear in the transplanted kidney, in which case most of the transplanted kidneys are not alive, several years after the transplant, a slow rejection process called “chronic rejection” begins, eventually it is necessary to return to dialysis or a second transplant. To prevent rejection, it is necessary to take antidepressants since transplant surgery and continue as long as the transplanted kidney is functioning.
The extent to which the donor’s tissue matches the implant’s tissue has a crucial influence on the survival expectancy of the implanted kidney. This adjustment applies to two systems: blood type and tissue classification. In addition, antibody level testing is performed to ensure that the transplanted antibody does not reject the transplanted organ tissue.
A transplant candidate should undergo a series of tests such as: heart function, lung function, echocardiography, dental examination, blood and neck and leg blood tests, hepatitis B and C and AIDS viruses, medical evaluation and donor-transplant matching tests.
When a kidney donation is received, glands are taken from the donor’s body and transferred to the National Laboratory for tissue classification. The laboratory has blood samples for all kidney and pancreas transplant candidates (the samples are sent there once a month).
Cells are extracted from the glands that are tested against the blood samples of the transplant candidates with the same blood type as the donor. This test is called “crossover”. Only waiting for a transplant, whose cross-examination with donor cells is negative, can get kidney or kidney and heart from this donor.
Among those found to be a priori, four criteria are determined: age, duration of waiting (counted in the months since dialysis), genetic similarity (HLA), and antibody level (PRA). When the donor is over 60, patients over 60 will be transplanted.
Reaction from Avi Avraham, Chairman of the Association for the Advancement and Conservation of Kidney Patients’ Rights for the publication of the National Transplant Center’s data for 2012:
“The data from the National Transplant Center for 2012 indicate a sharp decline in the number of kidney transplants in the State of Israel. Since 2011, there has been a 54% decrease in the number of deceased kidney donations and an 8% decrease in the number of live kidney donations. On the other hand, there is a consistent upward trend in the number of dialysis patients and the number of patients awaiting kidney donation. The data is difficult but not surprising, the association has already warned about the seriousness of the situation on a special debate initiated last July in the Knesset, and earlier in the framework of the State Comptroller’s report released last April.
There is an urgent need to increase the number of live donors. This is the best solution for removing the patient from the dialysis cycle and creating a dramatic improvement in his health and quality of life and that of his family. Animal transplantation has medical benefits over a dead transplant and in light of lengthening queues is more practical than a passive gift for a deceased kidney donor.
The association carries out intensive advocacy activities on this topic among patients at dialysis institutes all over the country, however, there is room for more extensive and strenuous action at the national level as well. We urge the Ministry of Health to direct the National Transplant Center to divert budgetary and explanatory resources from investing in the Adi Card Signature Campaign to promote animal donation.
At the same time, we urge the Knesset to positively review the Transplantation Law in a way that will also allow non-first-time donors to donate under the State’s supervision. “
For details: Salit Katz Efudi, spokeswoman for the Association for the Advancement and Conservation of Kidney Patients’ Rights
A living donor must be a family member, spouse, relative or acquaintance. The donor should be checked by a physician to make sure his kidney function is healthy and his health allows him to contribute. Like any kidney transplant, there is a risk to the donor, but if the donor is healthy the risk is minimal. Completely a person who donates a kidney to the transplant returns home after surgery to recover and soon returns to full function without the need for medication.