Whats the LONGEST you can wait to implant a kidney?

[wants2help]

HI!
Does anyone know what the LONGEST time they can keep a kidney on ice before transplanting?  I worry about my husband and I both being "on the table" at the same time.  I know a "fresh"  kidney is best, but it would be nice to have the "luxury" of spacing two surgeries out at least by a few hours.  Probably not a smart option though if at the same hospital, right?  Just thinhking outloud.  :-)
My husband was told he would have to lose 40 pounds before surgery.  He meets the BMI criteria, but most of it is in his stomach, so they want him to lose extra due to where the pounds are.  I also have to lose approx. 40 pounds to donate. We'll both probably be ALOT healthier just from the weight loss alone!
Another thing- I am a O- universal donor.  The transplant coordinator said as long as the blood is compatible, they don't worry about tissue matching, cause the recipient needs anti rejection medicine either way, so as far as they were concerned, the donor needs to be healthy and compatiable blood, that was all.  Does that sound right?  I asked if it would be better coming from a sibling who was the SAME blood type, and probably same tissue type, and she said they only concern themselves with the blood compatibility. 
Questions questions questions.  You guys are a such a wonderful inspiration and so much useful information!  THANKS SO MUCH

[cupid]

I am donating next week and it is my understanding that I go first as the donor-they remove my kidney before they even prep the recipient for surgery-I guess for two reasons 1-the surgeon cannot be in two places at one time and 2-if for any reason the kidney is damaged on removal or something goes wrong, there is no reason to put the recipient under anesthesia.
I have read some places that blood type is the best criteria but I understood that some of the antigens need to match-not all six but some. And yes, the anti-rejection meds make it more lenient. I hope someone else chimes in on this too.

[Fr Pat]

     It is likewise my understanding that the donor kidney is removed and physically examined to make sure it is all right before they make any incision in the recipient. No sense opening up the recipient only to find that the donor kidney is not suitable. I believe that often the removal of the donated kidney and its implantation in the recipient are done by two different surgeons.
     In addition to being kept "on ice", if there is a longer delay before the implantation (for example to fly the kidney to another city) they can place the kidney in a special preservative fluid, or even have the fluid constantly pumped through the kidney, so that it can stay in excellent condition longer. (This is what I think I have read. If I've gotten any medical details wrong, somebody please correct me.)
    "Tissue matching" is the comparison of the detailed tissue type (not just the blood type) of donor and recipient, although differences can be overcome by the anti-rejection medications. I have heard that if the recipient has lost the function of the original kidneys because of a medical condition that attacked them, the doctors may even prefer a markedly different tissue type in the donated kidney because it might make it less likely for the same thing to happen again. Siblings MIGHT share the same genetic disposition to some kidney diseases, so SOMETIMES a donor from outside the family may be preferable. The condition of each patuient has to be considered.
    "Tissue matching" is not the same as "cross matching". In cross matching portions of the donor's and recipient's bloods are mixed to see if the recipient has, or has developed, antibodies that would attack the donor kidney even though the tissues are closely matched. So a "final cross-match" is usually done again shortly before the surgery to make sure no new antibodies have been developed by the recipient.
     Hope some of this info is helpful. Some hospitals do better than others in explaining the details.
         best wishes,
             Fr. Pat

[Orchidlady]

They could be referring to antigen matching for you. Since my husband's kidney failure was sudden, we had very little knowledge of kidney function or transplant issues prior to that time. I was quite surprised in that I had always thought only a blood relative could donate. They told us that, in this day and age, the anti-rejection drugs were so sophisticated that the only thing that mattered was the blood type and crossmatch. We were a 0/6 match on antigens and everything turned out just fine.

[CK]

We also were told that the antigens don't matter, it's all about the antibodies.

I am type A and my significant other (my recipient) is type O. Apparently, I am a subtype of A called A2, which has lower levels of some antigen that O's react to. My SO has low levels of Anti-A antibodies naturally and then they did plasmapheresis to reduce those antibodies to almost zilch both before and after the transplant.

They said they expect it to last 25 years and my Internet research confirms that in other places, they have been doing unrelated A2 to O transplants for over 10 years with great success.

They are getting to a place where even blood type doesn't matter, which is amazing.

My SO had a double nephrectomy in addition to the transplant because he has PKD and his kidneys were enormous and causing him problems. They started him first while I was out cold waiting, apparently. Once his nephrectomy was done, they did mine and the transplant.

[jatopa]

Back to the original question...why would you even want to space out the two surgeries?   
There should be two teams of surgeons, two for each patient. 
WIth all of the pre-surgical imaging, there should be no need for direct visualization of the kidney prior to prepping the recipient.
My surgery started at 6:30 am.  Two hours into it, my brother was brought into the room next door.  His surgeons were watching my surgery on the monitor in their room, and put him out and opened him up so the kidney could go pretty much from me to him, with little time lost.
Regarding antigens, it does not seem to be as much of an issue as before.  We were a 0 out of 6 match.  Our niece was a 4 out of 6 match, but the transplant committee suggested keeping the younger kidney in reserve for the future if needed, and take the old one (mine.)
Best of luck to you!

[lawphi]

Antigens do and don't matter.  Lack of antigens in common will affect how long the kidney will last and how much medication is needed.  A 0/6 antigen match will lead to more antibodies in the recipient and make it extremely difficult to get a second transplant.  I recommend looking for a paired exchange.

In terms of spacing out the surgery, you won't be awake or alert for at least 12 hours after your surgery. 

[Orchidlady]

I respectfully disagree- it is a common misconception that the antigen match will affect the amount of medication taken. It has more to do with a person's individual ability to absorb and process medication, which can be affected by a number of different characterstics and factors.  We were a 0/6 match and my husband is on much less medication than some people with greater matches. Example: he is on 2mg twice a day of prograf and 2.5mg prednisone daily - period. We recently met a young woman who got a kidney from her mother at a 4/6 match - 4 prograf & 2 cellcept twice a day and 2.5mg prednisone. Quite a different antigen match, yet she is on much more medication.
There have been a number of people off and on this board who have agonized over the fact that they are "not a good match" at 0/6. I would say 0/6 is better than 0/0 - waiting for the sometimes years it takes to get a kidney. Don't sell yourself short at being a low match and think that you are somehow unacceptable or won't be able to give your recipient a well functioning, long lasting kidney. Transplant medicine and research has come a long way, not just with kidneys but many different organs. Know that what you are doing is a good thing whether you are 0/6 or 6/6.

[CK]

I respectfully disagree as well. We did our transplant 3 weeks ago, and were a 1/6 match and a different blood type entirely. My recipient was told that that didn't matter anymore, the meds are so good that it's antibodies that matter now. He was told they expect to get 25 years out of the transplant of an A-O with 1/6 match.

Also, I was awake 3 hours after my surgery, walking that evening and discharged the next day. They get things going pretty quick nowadays.

[Fr Pat]

     For kidney transplants blood types do not need to be the SAME, but COMPATIBLE. and the "+" and "-" does not matter. For example, an "A+" recipient is compatible to receive a kidney from another "A+", or from an "A-", or from an "O+" or from an "O-". As noted in above posts there has been some wonderful progress in doing transplants even when there is some incompatibility. A LOT of people out there still believe that they have to have identical blood in order to donate to someone, and sadly that stops many interested people from even offering. A lot of public education on kidney donation still needs to be done.
   Fr. Pat

[wants2help]

Thanks for all the wonderful replies!  If I infact can become a donor to my husband, I just hate the thought of not being "alert" to hear how he is doing, and not being there for him.  We have not tested anything- he was told to lose 40 pounds before they would operate on him, so he's been deferred for 6 months.  I needed to lose 28 pounds, but will aim for 40 or more, right along side my  husband.  All  I know is I am type O blood, and the coordinator said that was the biggest thing, the rest wasn't as important.  Just wish we could schedule surgies 24 hours apart, but I know a "fresh" kidney is best for my husband- just wish I could be there for him when he came out.
THanks again everyone!
Melissa

[jatopa]

Melissa,
You will be able to see him in the recovery room, and it will be wonderful that both surgeries are over.  Best of luck!

[That guy]

Well, my kidney had to be flown from Ohio to California, and last time I heard, the recipient is doing quite well.