KIDNEY TRANSPLANTS

In the 1930s doctors started testing a new procedure. Once believed to be impossible in medicine organ transplants are now a reality. Several groundbreaking surgeons worked on kidney transplants. They would take a healthy kidney from a living person or someone who had just passed away and put it into a patient who was close to death because of kidney failure. However these early surgeries had a big challenge: patients' immune systems would quickly see the new kidney as something strange and begin to attack it. Only a small number of patients lived beyond the first few days.

In 1954 Joseph Murray tried a new kind of kidney exchange that no other doctor had attempted. The surgery went well and the patient lived for another 8 years with the new organ. This was possible because the organ came from his identical twin. Today in the US more than 100 000 kidneys are transplanted each year.

How does this surgery work now? Kidneys are amazing organs that work hard every day. They filter enough blood to fill a whole bathtub! Besides getting rid of waste and extra fluid through urine the kidneys also help control how many red blood cells are made along with vitamin D and other hormones. Some health issues can cause the kidneys to work harder which can slowly damage them over time. In diabetes high blood sugar levels can lead to more kidney filtering which causes swelling and inflammation. High blood pressure can narrow and harm the delicate blood vessels in the organ. As time passes some people may completely lose the ability of their kidneys to work. They need a treatment called dialysis to stay alive. Dialysis takes a lot of time and can lead to serious health problems. A kidney transplant provides a long-lasting solution and greatly enhances a person's quality of life. After a patient gets the go-ahead for surgery the hunt for the right organ starts.

In the past the main challenge was to find a donor whose immune system was very similar to the patient’s almost like an identical twin. This similarity helps lower the chances of the body rejecting the organ. Today, because of medical progress, a family member friend or even someone you don't know can donate one of their kidneys to a patient. New medications can successfully reduce a patient's immune response. Before and long after the transplant this means that patients and their donors do not have to match perfectly anymore.

"The more similar the match is the better it will be."

Another choice is a paired organ exchange. In this process two or more pairs of donors and patients who cannot use each other’s kidneys are matched. This way each patient can receive a kidney that is a better match from someone in the other pair. After finding an organ the surgery is simple. The doctor takes out the kidney from the living donor using small cuts and sometimes with the help of robots. The doctor makes a cut in the patient's lower belly to place the new organ from the donor. The doctors connect the artery and vein of the new kidney to the patient's own blood vessels to allow blood to flow. They also attach the kidney's ureter to the patient's bladder. The damaged kidneys usually stay in the body helping with the filtering process. After the surgery doctors watch the patient carefully for a few days to make sure the new kidney begins to filter blood and produce urine by itself.

Most donors leave the hospital the day after their procedure and can return to their regular activities within a few weeks. Although every surgery has some risks most kidney donors continue to live normal and healthy lives with few or no problems from having just one kidney.

"However not every patient will find a living donor who is ready to help."

In the United States about 90 000 patients are on the national waiting list to receive a kidney from someone who has passed away. Even though a lot of people sign up to be organ donors only a small percentage actually end up donating their organs. Three percent of people will die in situations where they can donate their organs. Because there aren't enough organs available around 17 patients lose their lives each day while waiting for a new kidney. Doctors are working hard to find new ways to help patients. They are looking into new treatments and exploring the possibilities of lab-grown 3D printed and even artificial kidneys.

In the 1930s, medical professionals started to explore a procedure that had long been deemed impossible: organ transplantation. Many innovative surgeons concentrated on the kidney, taking a healthy one from either a living or recently deceased donor and implanting it into a patient suffering from kidney failure. However, these initial surgeries encountered a significant challenge: the recipient's immune system would swiftly identify the new kidney as a foreign entity and try to reject it. As a result, very few patients managed to survive beyond the first few days.

Then, in 1954, Joseph Murray pioneered a groundbreaking approach to kidney transplantation that had never been attempted before. The operation was a tremendous success, allowing the patient to live for an additional eight years with the transplanted organ. The crucial element that made this achievement possible was that the kidney was sourced from the patient’s identical twin. Today, more than 100,000 kidney transplants are conducted each year in the United States, highlighting the remarkable progress made in this field that was once thought to be "medically impossible."

How does kidney surgery work today? Kidneys are remarkable organs that filter an impressive amount of blood daily—about the volume of a bathtub! They not only eliminate waste and excess fluid through urine but also play a crucial role in regulating red blood cell production, vitamin D, and various hormones. However, certain health issues can cause the kidneys to overwork, leading to gradual decline. For instance, in diabetes, elevated blood sugar levels can increase kidney filtration, resulting in swelling and inflammation. Similarly, high blood pressure can damage the delicate blood vessels within the kidneys. Over time, this can lead to complete kidney failure, necessitating dialysis for survival. Unfortunately, dialysis is a lengthy process and can come with significant health risks.

A kidney transplant, on the other hand, provides a more lasting solution and greatly enhances quality of life. Once a patient is deemed suitable for surgery, the search for a compatible organ begins. In the past, finding a donor with a similar immune system to the patient—like an identical twin—was a major challenge to minimize the risk of rejection. However, advancements in medicine now allow family members, friends, or even strangers to donate a kidney. New medications can effectively manage a patient’s immune response both before and after the transplant, meaning perfect matches are no longer necessary, although closer matches are still preferable.

Another innovative option is a paired organ exchange, where incompatible donor-recipient pairs are matched, allowing each patient to receive a more suitable kidney from another pair. Once a compatible organ is located, the surgery is relatively simple. The living donor's kidney is removed using minimally invasive, often robotic techniques, while the transplant recipient has an incision made in their lower abdomen to implant the new organ.

The artery and vein of the new kidney are linked to the recipient's blood vessels to establish proper circulation, while its ureter is connected to the patient's bladder. Typically, the original kidneys are left in place to assist with filtration. After the procedure, the patient is monitored closely for several days to ensure the new kidney begins filtering blood and producing urine independently. Generally, this new kidney can function for about 12 to 20 years. Some individuals may undergo multiple kidney transplants throughout their lives, potentially having four or even five kidneys at different times.

For donors, most are able to leave the hospital the following day and can return to their regular activities within a few weeks. Although all surgeries come with risks, the majority of donors go on to live normal, healthy lives with few complications from having just one kidney. However, not every patient has access to a willing living donor. In the United States, around 90,000 individuals are currently on the national waiting list for a kidney from a deceased donor. While many people sign up as organ donors, only about 0.3% will pass away in situations that permit organ donation. This shortage of organs results in approximately 17 patients dying each day while waiting for a new kidney. Fortunately, medical professionals are continually pushing the boundaries of what is achievable, investigating new treatments and the possibilities of lab-grown, 3D printed, and artificial kidneys.