La preparación para el trasplante: evaluación, búsqueda del órgano compatible, costos y cirugía

El equipo de trasplantes

El equipo de trasplantes es un grupo de profesionales médicos que evalúan a los candidatos a un trasplante renal con el fin de decidir si cumplen los requisitos para recibirlo. Además se encargan de la atención médica anterior y posterior al trasplante. El equipo de trasplantes suele estar integrado por:

• Los coordinadores de trasplantes, que organizan la evaluación de los pacientes para el trasplante, preparan a los pacientes para el trasplante y organizan el tratamiento y la atención de seguimiento después del trasplante.
• Los médicos de trasplantes, son médicos que llevan la atención de los pacientes y les recetan los medicamentos. El médico de trasplantes no es el que hace la cirugía, pero es quien lleva la atención del paciente hasta el momento de la cirugía y después de esta.
• Los cirujanos de trasplantes, que son los médicos que hacen la propia cirugía del trasplante y colaboran estrechamente con el resto del equipo de trasplantes antes de la cirugía y en los días siguientes a esta.
• Los coordinadores financieros, que colaboran con los coordinadores de trasplantes y con las aseguradoras para comprobar que las finanzas del paciente estén en orden a todo lo largo del proceso del trasplante.
• Las enfermeras de trasplantes, que se encargan de la atención a los pacientes antes de la cirugía del trasplante y después de ella. Tienen un papel muy importante en la recuperación del paciente luego del trasplante.
• Los dietistas de trasplantes, enseñan a los pacientes de trasplante cuáles son las mejores opciones alimentarias antes de la cirugía del trasplante y después de ella. Pueden crear dietas especiales para los pacientes antes de la cirugía del trasplante y los ayudarán a adaptarse a la nueva dieta después de la cirugía.
• Los trabajadores sociales, que ayudan a los pacientes de trasplante a aprender técnicas con las que enfrentar de modo saludable las dificultades que pueden surgir antes y después de la cirugía del trasplante, como por ejemplo los problemas emocionales, el temor, los efectos secundarios físicos o las tensiones económicas. Además ponen a los pacientes en contacto con recursos disponibles en la comunidad y ayudan a solucionar problemas.

Por cortesía de la Organ Procurement and Transplantation Network (OPTN, Red de Obtención y Trasplante de Órganos).

Cirugía del trasplante

Quienes cuentan con un donante renal en vidapodrán programar la fecha del trasplante.

Si el receptor está en la lista de espera para una riñón de donante fallecido (es decir, un riñón de alguien que acaba de fallecer), en cuanto surja un riñón recibirá una llamada telefónica pidiéndole que acuda de inmediato al hospital. Una vez en el hospital le harán un análisis de sangre para comprobar que el organismo no vaya a reaccionar mal contra la sangre del donante. Si el análisis no detecta ningún problema, los médicos y las enfermeras prepararán a la persona para la cirugía del trasplante.

Es importante que esté consciente de que podría llegar al hospital, listo para el trasplante, y a la mera hora se descubra que el riñón del donante no está en condiciones de serle trasplantado. Si sucede esto, procure no desanimarse: ¡pronto podría aparecer otro riñón!

Durante la cirugía del trasplante

Lo colocarán boca arriba sobre la mesa del quirófano. Le administrarán anestesia, que es un medicamento para tenerlo dormido durante la cirugía. El cirujano le hará una incisión en el abdomen (la zona del estómago). Le colocarán el riñón en esta zona y le coserán a su vejiga el uréter (es decir, el conducto por el cual sale del riñón la orina) del donante. Lo habitual es dejar en su lugar los riñones del receptor. El cirujano cerrará la incisión y a usted lo trasladarán a la sala de reanimación. Esta operación demora de 2 a 4 horas.

Recuperación de la cirugía del trasplante

• Después de la cirugía del trasplante se recuperará en el hospital, bajo estrecha vigilancia. Normalmente pasará varios días de recuperación en el hospital.
• En unos casos el riñón trasplantado comienza a producir orina de inmediato; en otros, sobre todo cuando son riñones de donante fallecido, demora un poco. Si el riñón trasplantado no produce orina de inmediato, usted tendrá que seguir en diálisis hasta que comience a producirla.
• El equipo de trasplantes le ajustará los inmunosupresores y lo vigilará estrechamente por si aparecen señales de que el organismo no acepta el riñón trasplantado.
• El equipo de trasplantes suele recomendar a la persona que se pare y empiece a caminar poco a poco aproximadamente un día después de la cirugía.
• Una vez que se haya recuperado lo suficiente como para irse a casa sin problemas, lo darán de alta del hospital y proseguirá la recuperación en su casa.

Recuperación domiciliaria

• Una vez en casa, es de la máxima importancia que respete las instrucciones que le haya dado el equipo de trasplantes sobre cuidados corporales posteriores a la cirugía.
• Alguien lo tendrá que llevar a la casa y quedarse con usted al menos unos días después de la cirugía.
• No maneje hasta que el médico le haya dicho que puede hacerlo con seguridad.
• No haga nada que suponga esfuerzo o presión en la zona de la cirugía (por ejemplo, cargar cosas pesadas).
• Vigile con mucha atención su peso y su presión arterial.
• Llame de inmediato al médico si nota algo extraño o diferente en su salud.

La cicatrización de la herida quirúrgica suele demorar en promedio hasta seis semanas.

Benefits and risks of kidney transplant

For people with kidney failure, a kidney transplant can increase your chances of living a longer, healthier life. Because dialysis can only do part of what healthy kidneys do for your body, people who have a kidney transplant usually live longer than those on dialysis. A kidney from a transplant will not work as well as kidneys in a healthy person. But your health may be almost as good as a person with healthy kidneys, as long as you closely follow your doctor's orders after the transplant surgery.

Also, when you get a kidney transplant, you may avoid some of the complications that people on dialysis often have, such as bone problems and heart disease.

A kidney transplant can improve your quality of life. After your kidney transplant, you may have:

• More energy
• Fewer limits on what you can eat
• More free time from not having to go to dialysis
• More flexibility to travel
• Greater ability to work and hold a job

Risks with a kidney transplant are the same as with any major surgery. Risk does not mean these things will happen, but it means they could happen. Some of the risks are infection, bleeding, or damage to other organs. Also, the three connections between your new kidney and your body: the artery, vein and ureter (a tube that carries urine from the kidney to the bladder), might leak or become blocked. Read more about the kidney transplant surgery here.

Finding a match

Before having a transplant, you will need tests to see if the donor kidney is a match for your body. For the kidney to be a good match, the new kidney will need to be very similar to the other organs and tissues in your body so that your immune system will not attack it.

The job of your immune system is to find anything that should not be inside your body, attack it, then get rid of it to keep your body healthy. The immune system is meant to protect your body by fighting anything it senses can hurt you, such as bacteria from spoiled food or viruses like the flu. Because the donor kidney comes from another person's body, your immune system will notice right away that your new kidney is different than the rest of your body, then start to attack the new kidney as if it were a disease. To lower the chances of this happening, your transplant team will make sure that the new kidney comes from someone whose blood type works with your blood type.

There are four basic groups of blood types that people have: type O, type A, type B, and type AB. If your blood type is very similar to that of the new kidney, there is a lower chance that your immune system will try to fight the new kidney.

If your blood type is:

• O, you can only get a kidney from someone with type O blood.
• A, you can get a kidney from someone with type A or type O blood.
• B, you can get a kidney from someone with type B or type O blood.
• AB, you can get a kidney from someone with type A, type B, type AB or type O blood

Transplant team

The transplant team is a group of medical professionals who evaluate you to decide if you qualify for a kidney transplant. They also manage your medical care before and after the transplant. The transplant team is usually made up of:

• Transplant coordinators organize the patient evaluation, prepare patients for the transplant, and organize the treatment and follow-up care after the surgery.
• Transplant physicians are doctors who handle patient medical care, and prescriptions. The transplant doctor does not perform the surgery but provides the medical care for the patient leading up to and after the surgery.
• Transplant surgeons are the doctors who perform the actual transplant surgery and work closely with the rest of the transplant team right before and right after the surgery.
• Financial coordinators work with the transplant coordinators and insurance companies to be sure that patient finances are in order throughout the transplant process.
• Transplant nurses are responsible for patient care before and after the transplant surgery. They play a major role in the transplant patient's recovery.
• Transplant dietitians teach transplant patients about how to make the best food choices before and after the transplant surgery. They may create special diets for patients before the surgery and will help patients adjust to their new diet after the transplant surgery.
• Social workers help transplant patients learn healthy coping skills to deal with challenges they may have before or after the transplant surgery, such as emotional problems, fear, physical side effects, or financial stress. They also connect patients to community resources and help with problem solving.

Courtesy of the Organ Procurement and Transplantation Network (OPTN).

Transplant surgery

If you have a living kidney donor, you will be able to schedule the date of your transplant.

If you are on the waiting list for a deceased donor kidney (a kidney from someone who has just died), as soon as a kidney becomes available you will get a phone call telling you to come to the hospital right away. Once you get to the hospital, you will have a blood test to make sure your body will not have a bad reaction to the donor's blood. If the test does not show a problem, the doctors and nurses will prepare you for the transplant surgery.

It is important to know that you might arrive at the hospital, ready for your transplant, only to find out that the donor kidney is not healthy enough to give to you. If this happens, try not to be discouraged — another kidney could be available soon!

During the transplant surgery

You will be placed on your back on the surgery table. You will be given anesthesia, a medicine to make you sleep only while the surgery is being done. The surgeon will make a cut on your abdomen, or belly area. Your new kidney will be put into your body in this area, and the donor's ureter (the tube that carries urine from the kidney) will be sewn to your bladder. Usually your own kidneys will not be removed. The surgeon will close the skin cut and you will be taken to the recovery room. This operation takes 2 to 4 hours.

Recovering from the transplant surgery

• After the transplant surgery, you will recover in the hospital where you will be watched closely. You will usually spend several days recovering in the hospital.
• In some cases, you may start making your own urine right away. Sometimes, especially with deceased donor kidneys, this will take a bit of time. If your new kidney is not producing urine right away, you will need to stay on dialysis until this starts happening.
• Your transplant team will adjust your immunosuppressant medicines and watch you closely for signs that your body is accepting the new kidney.
• Usually, the transplant team will recommend that you get up and start slowly moving around one day after your surgery.
• Once you have recovered enough to safely go home, you will be released from the hospital and continue recovering at home.

Recovering at home

• Once you are at home, it is extremely important that you follow the directions given to you by the transplant team for taking care of your body after the surgery.
• You will need someone to drive you home from the hospital and stay with you at home for at least a few days after the surgery.
• Do not drive until your doctor has told you it is safe.
• Do not do anything that would put stress or pressure on the area where you had the surgery, such as heavy lifting.
• Watch your weight and blood pressure very closely.
• Call your doctor right away if you notice anything strange or different about your health.

On average it may take six weeks for the place of your surgery to fully heal.