Kidney Matters - Issue 7 Autumn 2019

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can gain an advantage in survival (quantity not just
quality of life) with a transplant compared to dialysis.
Unfortunately not everyone is suitable for
transplantation and dialysis may be needed. Most
people can remain on dialysis for many years and
have a good quality of life. However dialysis is unable
to replicate all the normal functions of the kidney,
and inevitably this takes its toll. Sadly, this means
that people seldom live as long and may die while on
dialysis, particularly elderly people and those with
other health problems.
Transplantation – living versus deceased
donation
Every kidney that is transplanted is a ‘second-hand’
kidney, generously gifted by the first owner. In the
future it may be that we can ‘grow’ or ‘print’ new
kidneys but we are not at that stage as yet. Currently
a kidney is given by someone who is alive and in good
health (a living donor), or someone who has died for an
unrelated reason (a deceased donor).
Typically the outcomes after living donation are
better. Of all the people who received their first kidney
transplant in the UK between 2004-2006, nine in 10
(91%) of those who had a kidney from a living donor
were still alive 10 years later. This is compared to nearly
eight in 10 (76%) of those who had a kidney from a
deceased donor. While the latter is substantially better
than dialysis, the results after living donor
transplantation are persistently better every year and
in every transplant unit in the UK.
There are two primary reasons for the difference: the
quality of the kidney and the ‘quality’ of the patient at
the time of transplant (i.e. how healthy he/she is).
When a kidney is donated from someone who had died,
it can have additional injury before it is transplanted.
Firstly, it tends to be people who are less healthy and
may already have poorer kidney function (e.g. smokers,
people with diabetes or high blood pressure) who die
in a situation when donation might be possible (e.g. not
from ‘old age’). Secondly, a catastrophic event, severe
enough to result in death, has occurred and often this
affects the kidneys. Thirdly, unlike in living donation,
a deceased-donor kidney cannot be immediately
transplanted as it has to be transported to the patient,
and there may be delay e.g. with additional tests or
need for dialysis before the transplant takes place. If
there is a prolonged time before transplantation, the
transplanted kidney will not work for as long.