So often, we talk about medical care like it’s clear-cut: You have a problem, you see a doctor, and, hopefully, you get a solution. But it’s not always that simple. Finding the problem itself can be a challenge, and when it comes to the right treatment, it’s often about understanding tradeoffs.
If you have a loved one with chronic kidney disease, it’s no different. The kidneys are so important because they remove waste from the body. And they keep really busy doing it -- they filter about 45 gallons of blood every day. So when they stop working as well, waste and fluids build up. That leads to problems like high blood pressure and kidney failure.
Someone with chronic kidney disease has two main options. They can get a transplant to receive a healthy kidney from a donor. Or they can start dialysis, a treatment where blood gets filtered either by a machine or in the belly with the help of a special tube.
You might think that a transplant is more of a last resort, the thing to do when you’ve run out of options. But that’s hardly the case. For most people, doctors prefer transplant over dialysis.
Why do doctors prefer transplants?
The reason is simple: People who get transplants generally live longer than those who get dialysis. For example, an adult who’s 30 and on dialysis might live another 15 years. With a transplant, that number jumps to 30-40 years.
Not only do people who get transplants usually live longer, they also tend to have:
- Better quality of life. They don’t spend hours each week getting dialysis, and they’re more likely to go back to work.
- Fewer limits on their diet
- Fewer long-term health problems from the transplant than people have with dialysis
- More energy
Also, dialysis can take a toll on the body. It can cause problems ranging from anemia, where you have fewer red blood cells, to heart disease.
If transplants are better, why do so many people get dialysis?
Mainly because there are many more people in need of kidneys than there are donors. Many people go on dialysis because they need to. They have no other choice while they’re on a waiting list for a donor kidney. And for them, dialysis is a lifesaver. Some people may also be too old or have too many health issues to get a kidney transplant.
Are there people who shouldn’t get a transplant?
Anyone from children to older adults can get a kidney transplant, but not everyone is healthy enough for one. If your loved one has any of these conditions, they’re not likely to get a transplant:
- Active or recently treated cancer
- Illness that might limit their life to just a few more years
- Infection that can’t be treated or keeps coming back
- Serious health condition -- like severe heart disease -- that means they’re not healthy enough for surgery
- Very overweight
The following problems could also prevent a transplant:
- Drug or alcohol abuse
- Poor functional status
- Hard time remembering to take medicine
- Mental health problems that aren’t easily managed
Even if your loved one is older or has a health condition like diabetes, your doctor can help you understand if a transplant is a safe option. Some people can take steps to improve their health -- like losing weight or quitting smoking -- to make a transplant possible.
Generally, transplant centers will not do transplants in patients over the age of 75 to 80 years of age.
What are the risks?
The main ones are:
Kidney rejection. There’s a chance that the body will reject the donated kidney. Your loved one will take medicine for the rest of their life to prevent this from happening, and newer drugs greatly lower the odds of it.
Side effects from medicine. Like any medicine, the drugs used to prevent transplant rejections can have side effects. They generally work by making your immune system less active, which makes you more likely to get infections and can raise the odds of getting cancer. Other side effects may include acne, bone disease, and high blood pressure.
Surgery. Any surgery, including a kidney transplant, has risks, such as bleeding and infection.
Even with these risks, kidney transplant usually leads to a longer and higher-quality life than dialysis. Most people spend just 3-4 nights in the hospital after a transplant and don’t have any major issues with the surgery.