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Organ Donation - April '08
Transplant Nephrology: Ensuring the best outcomes
Deepak Malhotra, MD, PhD
Several factors are taken into account when someone is donating or receiving a kidney. Transplant nephrologists at The University of Toledo Medical Center keep the donor’s and recipient’s best interests in mind when they determine if they are possible candidates for kidney transplant surgery.
“The nephrology team sees patients considering a kidney transplant and we want to make sure they are medically stable to have the procedure,” says Deepak Malhotra, MD, PhD, chief of nephrology at UT Medical Center. “We evaluate recipients and some living donors to make sure they are suitable to get or give a kidney to help maximize the chances for the best possible outcome.”
On the recipient side
Before patients are considered to receive a kidney transplant, nephrologists look at their medical history and perform extensive physical examinations. “If they’ve had any medical problems, we make sure they get the proper screening and treatment,” Dr. Malhotra says. For example, if a patient had a tumor or heart disease, doctors make sure they are able to have the anticipated transplant procedure. Testing can take weeks or months, depending on the severity of the medical conditions. “The most important aspect is making sure patients are healthy enough to receive a transplant kidney,” he says. “Fortunately, if they have various health conditions, such as heart disease, they may be able to have the proper procedures performed to make them suitable for the transplant process.”
After the initial informational session, recipients make an appointment with UT Medical Center’s transplant team at which time a history is taken and a physical examination is performed. The transplant team includes a surgeon, transplant nephrologists, transplant coordinators at UT Medical Center and Life Connection of Ohio, financial specialists and social workers. “We come together as a team to make sure all levels of medicine and coordination are in sync at every level,” Dr. Malhotra says. “If everything is satisfactory, we put the potential recipient on the transplant waiting list.”
The amount of time a recipient is on the waiting list depends on their blood type, presence of antibodies against various antigens, and location of the recipient. “Patients wait for about two years in the Northwest Ohio area, but it’s five to six years on the West and East Coasts,” says Dr. Malhotra. “Each year we re-screen recipients on the waiting list to make sure new conditions haven’t developed.”
On the donor side
The process for a kidney donor is much shorter and less complicated. “Instead of seeing a team, donors meet and discuss the process with the surgeon,” says Dr. Malhotra. “A medical history is taken and a physical exam is performed for any pressing medical complications. If they have heart disease or diabetes, for example, we don’t want to take their kidney because it could cause them harm in the future.”
With recipients and donors, the perfect candidate is void of health conditions. “Since the most common cause of kidney failure is diabetes, most of our patients have diabetes as well as sequela of that condition, such as heart disease and/or vascular disease,” Dr. Malhotra says. Despite a patient’s health, post-surgery kidney rejection is still a possibility. “Even after a successful transplant, recipients are monitored for kidney rejections and other complications,” Dr. Malhotra says. “We can treat most rejections using medications or other procedures.”
Specialists at UT Medical Center give patients pre- and post-care in order to ensure the best outcomes. “We work together as a team, whether it’s with patient care or a research study,” says Dr. Malhotra. “This interdisciplinary approach helps patients have the best outcomes possible.”
For more information on the paired kidney donation program or organ transplant services, please call 877-451-2299.
