Renal transplants

During this time, approximately one third of potential living donors are unable to donate to their potential recipients due to ABO or antigen incompatibility. Kidney paired donation (KPD) and kidney list donation (KLD) were the alternative options for candidates with incompatible donor (McKay, 2010, 103). The first KPD transplant was performed on South Korea in 1991. The United States performed its first KPD transplant in 2000 in Rhode Island Hospital while the first KLD occurred in England in 2001 (McKay, 2010, 104). The kidney is the most commonly transplanted organ in the world with more than 160,000 persons in the United States living with a transplanted kidney by the end of 2008 (Shoskes, 2011, 154). But despite this number, persons needing kidney transplantation still increases and a relative scarcity in terms of resource arise. A complete array of information about kidney transplantation was included in the databases of U.S. Renal Database System (USRDS), Scientific Registry of Renal Transplants Recipients (SRTR), United Network for Organ Sharing (UNOS), and Collaborative Transplant Study (Shoskes, 2011, 154). Procedures Before a patient undergo kidney transplantation, a series of laboratory tests and procedures are needed to perform and complete. Matching is the key tool is successful transplantation. The donor’s organ should match the recipient’s body in terms of ABO and antigen incompatibility to avoid risks of rejection. The patient with end-stage renal disease may choose from treatments such as peritoneal dialysis, hemodialysis, or transplantation. Transplantation is done if the patient wants the treatment or if according to disease severity, requires the transplantation procedure. The surgical team involves the pre-emptive living donor (LD) transplantation to minimize pre-operation transplant list and maximize operative choices. The LD transplantation decreases the risk of acute tubular necrosis due to ischemia, increases potential for matching, and offers opportunity to initiate and optimize immunosuppressive therapy, thereby reducing acute rejection episodes (McKay, 2010, 17). Background regarding the quality of the donor’s organ was predetermined and positive outcome was expected. Then, the transplant team prepares the patient for the procedure. However, if the patient has superior vena cava syndrome due to an AV graft in the previous hemodialysis, a different procedure is done by the nephrologists and cardiologists. The organ transplantation is divided into five separate procedures (McKay, 2010, 18) and discussed as follows: 1) Preparation – the surgeon discuss to the patient the surgical procedure. General anesthesia is introduced after and intraoperative measures are implemented. 2) Exposure – after prepping and draping, incision is made in the right or left lower quadrant. 3) Vascular Anastomoses – venous anastomoses first and arterial anastomoses must be last to avoid complications of bleeding and thrombosis. The kidney is chilled and topical iced is used liberally. Clamp is placed in the renal vein. 4) Ureteral anastomoses – is the preferred method to establish urologic continuity 5) Closing – wound/skin closure and measures to prevent complications. After completion of all the procedures in kidney transplantation, the patient is placed in the recovery area and post-operative interventions are applied. Health providers monitor for rejection signs post-operative