What do cadaveric kidney recipients do when their kidney fails?

[KidneyHelpPLEASE]

Unless you are really old I wondered why would anyone take a deceased kidney? Even UNOS says they only last 10 to 15 years.

Do they simply get another transplant? You know what a PAIN it can be to get a hospital to approve you for the 2nd or 3rd time!

Are they forced to stay on dialysis till they die?? It's really scary to think of that you know?

[Michael]

Put yourself in the place of the recipient. What would you do?

You would go on dialysis, and you would get listed for another transplant.

[KidneyHelpPLEASE]

I'm asking because hospitals don't just approve you for another transplant automatically  like snapping your fingers! I've had a VERY difficult time getting approved for a 2nd transplant. There is always a chance they might not approve you then what? Just die stuck to a machine?

[Fr Pat]

     I believe that each patient is evaluated individually to see if he/she is a good candidate to receive a transplant (whether it is a first, second, or third). Some patients may need a kidney, but not be at present able to successfully receive one due to some medical condition. In the case of a second or third transplant I imagine that the hospital would look at whether the patient took good care of the previous kidney. Most recipients, of course, faithfully take their anti-rejection meds, get their check-ups, and follow the most kidney-friendly diet and life-style possible. But there have been some recipients who lost their first transplanted organ due to their own negligence, so the hospital would have to take that into account before approving a second transplant. So you are quite right that it is not just a matter of "snapping your fingers". It is a BIG decision especially because there are not enough organs to satisfy the needs.
   best wishes,
      Fr. Pat

[Orchidlady]

We found that centers all have different criteria for an acceptable candidate. You may want to try various different centers to see if you qualify for their program.

[KidneyHelpPLEASE]

I'm just saying I would have a fear getting a cadaver kidney because you KNOW it is going to fail! It's just a matter of when. Of course the exception is if you are very old then you may figure you will die with the kidney.

It's just a NIGHTMARE dealing with hospitals to get a 2nd transplant!

[Fr Pat]

    A kidney from a living donor is probably going to fail at some point also. On AVERAGE a kidney from a living donor tends to last about twice as long as one from a deceased donor, but the AVERAGES include kidneys that last for 30 years or more and those that fail or are rejected within weeks. Whether from a living donor or from a deceased donor, there is no guarantee about how long it will last.
     By the way, although some professionals continue to use the term "cadaveric kidney" most are changing to the term "kidney from a deceased donor" out of respect for the families of deceased donors. I have met some donor families who HATE to hear the term "cadaver kidney". One said "My daughter was not a 'cadaver'! She was a wonderful PERSON who generously agreed to donate her organs after death." So I try to remember to use the more respectful terminology of "organ from a deceased donor".
     Also, I have read about some patients who had the opportunity to receive a kidney from a living donor but chose to turn it down and wait for one from a deceased donor because they did not wish to allow anyone to take the risks of medical complications (or even death) in order to give them a kidney. So there is a great variety of thinking among all those involved.
   best wishes,
     Fr. Pat

[donor99]

Living donor kidneys no longer last 2X as long as a DD kidney...the new literature says they las t 12 -15 years depending on match...good KDPI kidneys have a half life of 12 years. We have polluted the live donor pool. If a recipient is 75 will the kidney last 20 years...no because the recipient wont. Will a 70 yo live donor kidney last 20 years/ not likely

[KidneyHelpPLEASE]

Can you please explain this KDPI? How have we polluted the live donor pool?

[CK]

We were told my kidney should last 24 years. 

People take a deceased donor kidney because they have no choice.  No one steps up to give them a live donation and they don't want to be on dialysis.   Living donations are still not the most common means of getting a kidney-there are risk to the donor and expenses they may not be able to afford.

[KidneyHelpPLEASE]

Yeah I understand that.

I'm just saying I'm looking for the best scenario possible.

[Clark]

http://optn.transplant.hrsa.gov/ContentDocuments/Guide_to_Calculating_Interpreting_KDPI.pdf

A Guide to Calculating and Interpreting the Kidney Donor Profile Index (KDPI)
What is the KDPI?
The Kidney Donor Profile Index (KDPI) is a numerical measure that combines ten dimensions of
information about a donor, including clinical parameters and demographics, to express the quality of the
donor kidneys relative to other donors. The KDPI is derived by first calculating the Kidney Donor Risk
Index (KDRI) for a deceased donor.
A donor with a KDPI of 90%, for example, has a KDRI greater than 90% of donors in the chosen reference
population. In this way, the KDPI is simply a mapping of the KDRI from a relative risk scale a cumulative
percentage scale. The reference population of donors is all deceased donors in the U.S. from whom a
kidney was recovered for the purpose of transplantation during the prior calendar year. Lower KDPI
values are associated with increased donor quality; higher KDPI values are associated with lower donor
quality.
What is the KDRI?
The Kidney Donor Risk Index (KDRI) is an estimate of the relative risk of post-transplant kidney graft
failure (in an average, adult recipient) from a particular deceased donor compared to the median (50th
percentile) donor. (Note that the choice of the median donor as the "reference donor" differs from the
age 40, non-diabetic, etc., reference donor described in the original KDRI publication1
.) A donor with a
KDRI of 1.28, for example, confers an estimated risk of kidney graft failure that is 1.28 times that of an
“average” donor. Lower KDRI values are associated with increased donor quality; higher KDRI values
are associated with lower donor quality.
What are the benefits of the KDPI?
KDPI is an improvement over the Expanded Criteria Donor (ECD)/Standard Criteria Donor (SCD)
dichotomy, in several ways:
• KDPI explicitly incorporates 10 donor factors (instead of 4 in the ECD definition) and is a more
precise measure of donor quality
• KDPI is a continuous “score” instead of a binary (yes/no) indicator
• KDPI illuminates the fact that not all ECDs are alike (see Figure 1):
o Some ECD kidneys have reasonably good estimated quality
o Some SCD kidneys actually have lower estimated quality than some ECDs

...

[Clark]

Over the past couple of decades our numbers have increased as laparoscopic surgical techniques have become standard and unrelated donors more accepted. Simultaneously, the population at large has become older and heavier, with more associated risk factors. We are a subset, tested for health and suitability, but on a case by case basis, with no generally accepted minimum standards. The "polluted" donor pool remark, unfortunately as the term is chosen, I interpret as describing that more and more donors are being accepted as surgical candidates despite characteristics that would have disqualified them in the past. KDPI is for the new deceased donor allocation system, but is informative about us, too.

[lawphi]

My husband is technically on his third transplant at 33. His first only lasted 24 hours due to a clot. 

He had high antibodies, but didn't have trouble getting listed. We finally got listed at Johns Hopkins for a kidney exchange. He received one quickly that way, but had plasmapheresis to remove his antibodies.

[willow123]

Put yourself in the place of the recipient. What would you do?

You would go on dialysis, and you would get listed for another transplant.

If you are desperate you will take any kidney you can get . . . my SIL has been waiting for a cadaver kidney for at least two years because she cannot match with any living donor (in Canada).  I think readers of these message boards might come away with the impression that if someone has a willing donor, they can definitely get a kidney through some procedure or another, but that is not always true.