Initially, the attending physician with the support of a coordinator of the DSO (Deutsche Stiftung Organtransplantation) will consider the possibility of a kidney transplant if there is an indication. The patient is then anonymously registered with the Eurotransplant mediation center in the Netherlands, where he or she is placed on a waiting list in order to receive a donor organ in the course of time. A recipient is selected by Eurotransplant, the organ removal and transport is taken care of by DSO.
The average waiting time for a cadaver donation of a kidney transplant is five to six years and depends on various criteria. Organs are allocated on the basis of a point system (ETKAS = Eurotranplant Kidney Allocation System), which includes tissue match between donor and recipient (HLA compatibility), blood group compatibility, medical urgency, waiting time, the presence of certain antibodies in the blood (PRA = panel reactive antibody) as well as distance between donor region and recipient center. In Germany, there is an organ donor card, which allows people to decide before they die whether they want to be considered as a donor or not.
Before the kidney transplantation, the patient must receive sufficient vaccination protection, both in the case of cadaver donation and living donation, which includes polio, diphtheria, tetanus, hepatitis B, pneumococcus and influenza. These vaccinations are necessary before a kidney transplantation, since the patient receives medication to suppress the immune system (immunosuppressive drugs) after an organ donation. This also increases the risk of contracting bacterial or viral infections, which can be prevented by vaccination.
People close to the recipient (e.g. relatives) can donate one of their kidneys (living donation). The personal relationship is a prerequisite for the approval of the living donation by an ethics council in order to exclude financial reasons as the cause of the donation. Even in the case of living donations, the donor must meet certain health criteria and there must be blood group compatibility as well as tissue compatibility (HLA compatibility) between donor and recipient in order to make a kidney transplantation possible.
If a patient is allocated an organ – cadaveric or living – this is usually surgically transferred together with the ureter to a specific region in the pelvis, the fossa iliaca (fossa = pit). The renal blood vessels are then sutured together and the (new) ureter is connected to the bladder. Except in special cases, the recipient’s own kidneys are left in the body during kidney transplantation.
In most cases, the transplanted organ begins to function during the operation. After the operation, preventive medication against certain pathogens (Pneumocystis jiroveci, Cytomegalovirus) is administered and a lifelong immunosuppressive therapy (suppression of the immune system) is started. The latter includes the administration of steroids, calcineurin inhibitors, purine synthesis inhibitors and proliferation inhibitors, all of which are immunosuppressive drugs with different modes of action.
