What you can expect

Before the procedure

Finding a match

A kidney donor can be living or deceased, related or unrelated to you. Your transplant team will consider several factors when evaluating whether a donor kidney will be a good match for you.

Tests to determine whether a donated kidney may be suitable for you include:

• Blood typing. It's preferable to get a kidney from a donor whose blood type matches or is compatible with your own. Blood-type incompatible transplants are also possible but require additional medical treatment before and after transplant to reduce the risk of organ rejection. These are known as ABO incompatible kidney transplants.
• Tissue typing. If your blood type is compatible, the next step is a tissue typing test called human leukocyte antigen (HLA) typing. This test compares genetic markers that increase the likelihood the transplanted kidney will last a long time. A good match means it's less likely that your body will reject the organ.
• Crossmatch. The third and final matching test involves mixing a small sample of your blood with the donor's blood in the lab. The test determines whether antibodies in your blood will react against specific antigens in the donor's blood. A negative crossmatch means they are compatible and your body isn't as likely to reject the donor kidney. Positive crossmatch kidney transplants also are possible but require additional medical treatment before and after the transplant to reduce the risk of your antibodies reacting to the donor organ.

Additional factors your transplant team may consider in finding the most appropriate donor kidney for you include matching age, kidney size and infection exposure.

Living kidney donation

Finding a willing living kidney donor is an alternative to waiting for a compatible deceased-donor kidney to become available.

Family members are often the most likely to be compatible living kidney donors. But successful living-donor transplants are also common with kidneys donated from unrelated people, such as friends, co-workers or religious congregation members.

Paired donation is another type of living kidney donation if you have a willing kidney donor whose organ is not compatible with you or does not match well for other reasons. Rather than donating a kidney directly to you, your donor may give a kidney to someone who may be a better match. Then you receive a compatible kidney from that recipient's donor.

In some cases, more than two pairs of donors and recipients may be linked with a nondirected living kidney donor to form a donation chain with several recipients benefitting from the nondirected donor's gift.

If a compatible living donor isn't available, your name will be placed on a waiting list for a deceased-donor kidney. Because there are fewer available kidneys than there are people waiting for a transplant, the waiting list continues to grow. The waiting time for a deceased-donor kidney is usually a few years.

Staying healthy

Whether you're waiting for a donated kidney or your transplant surgery is already scheduled, work to stay healthy. Being healthy and as active as you're able can make it more likely you'll be ready for the transplant surgery when the time comes. It may also help speed your recovery from surgery. Work to:

• Take your medications as prescribed.
• Follow your diet and exercise guidelines.
• Don't smoke. If you need help quitting, talk to your doctor.
• Keep all appointments with your health care team.
• Stay involved in healthy activities, including relaxing and spending time with family and friends.

Stay in touch with your transplant team and let them know of any significant changes in your health. If you're waiting for a donated kidney, make sure the transplant team knows how to reach you at all times. Keep your packed hospital bag handy, and make arrangements for transportation to the transplant center in advance.

During the procedure

Kidney transplants are performed with general anesthesia, so you're not awake during the procedure. The surgical team monitors your heart rate, blood pressure and blood oxygen level throughout the procedure.

During the surgery:

• The surgeon makes an incision in the lower part of one side of your abdomen and places the new kidney into your body. Unless your own kidneys are causing complications such as high blood pressure, kidney stones, pain or infection, they are left in place.
• The blood vessels of the new kidney are attached to blood vessels in the lower part of your abdomen, just above one of your legs.
• The new kidney's ureter — the tube that links the kidney to the bladder — is connected to your bladder.

After the procedure

After your kidney transplant, you can expect to:

• Spend several days to a week in the hospital. Doctors and nurses monitor your condition in the hospital's transplant recovery area to watch for signs of complications. Your new kidney will make urine like your own kidneys did when they were healthy. Often this starts immediately. In other cases it may take several days, and you may need temporary dialysis until your new kidneys begin to function properly. Expect soreness or pain around the incision site while you're healing. Most kidney transplant recipients can return to work and other normal activities within eight weeks after transplant. No lifting objects weighing more than 10 pounds or exercise other than walking until the wound has healed (usually about six weeks after surgery).
• Have frequent checkups as you continue recovering. After you leave the hospital, close monitoring is necessary for a few weeks to check how well your new kidney is working and to make sure your body is not rejecting it. You may need blood tests several times a week and have your medications adjusted in the weeks following your transplant. During this time, if you live in another town, you may need to make arrangements to stay near the transplant center.
• Take medications the rest of your life. You'll take a number of medications after your kidney transplant. Drugs called immunosuppressants (anti-rejection medications) help keep your immune system from attacking and rejecting your new kidney. Additional drugs help reduce the risk of other complications, such as infection, after your transplant.