A kidney transplant is an operation that places a healthy kidney in your body. The transplanted kidney takes over the work of the two kidneys that failed, so you no longer need dialysis.

During a transplant, the surgeon places the new kidney in your lower abdomen and connects the artery and vein of the new kidney to your artery and vein. Often, the new kidney will start making urine as soon as your blood starts flowing through it. But sometimes it takes a few weeks to start working.

Many transplanted kidneys come from donors who have died. Some come from a living family member. The wait for a new kidney can be long.

If you have a transplant, you must take drugs for the rest of your life, to keep your body from rejecting the new kidney.

Some people with kidney failure may be able to have a kidney transplant. During transplant surgery, a healthy kidney from a donor is placed into your body. The new, donated kidney does the work that your two kidneys used to do.

The donated kidney can come from someone you don’t know who has recently died (deceased donor), or from a living person—a relative, spouse, or friend. Due to the shortage of kidneys, patients on the waiting list for a deceased donor kidney may wait many years.

A kidney transplant is a treatment for kidney failure; it’s not a cure. You will need to take medicines every day to make sure your immune system doesn't reject the new kidney. You will also need to see your health care provider regularly.

A working transplanted kidney does a better job of filtering wastes and keeping you healthy than dialysis. However, a kidney transplant isn’t for everyone. Your doctor may tell you that you’re not healthy enough for transplant surgery.

In the U.S., an estimated 14 percent of the population has chronic kidney disease, and roughly 661,000 Americans have kidney failure. Of these, 468,000 people are on kidney dialysis, and almost 200,000 live with a functioning kidney transplant.

MedlinePlus and the National Institute of Diabetes and Digestive and Kidney Diseases have helpful information about how kidney transplants and other options can help.

What are kidneys?

Your kidneys are two bean-shaped organs that filter out waste and extra water, make hormones, and do other important things to keep you healthy. They are located on either side of your spine and are each about the size of your fist.

What causes kidney failure?

Diabetes and high blood pressure are the main causes of chronic kidney disease, which is the gradual loss of kidney function. Other conditions that affect the kidneys include autoimmune diseases like lupus and inherited diseases like polycystic kidney disease.

Some people live with kidney disease for years, others quickly progress to kidney failure. Kidney failure means that your kidneys have lost most of their ability to function–less than 15 percent of normal kidney function.

Medication and other methods of managing kidney disease help some people maintain kidney function for years. Others progress quickly to kidney failure.

Dialysis and kidney transplants are two treatments used to replace failing kidneys. Dialysis takes the place of your kidneys by helping remove waste and water from your blood, but doesn't fully replace everything your kidneys normally do.

Can a transplant help?

When your kidneys have failed, a transplant may also be a good option. Compared to dialysis, a working transplanted kidney does a better job of filtering waste, replacing your failed kidneys, and keeping you healthy.

However, a kidney transplant isn't for everyone. Anyone interested in a kidney transplant should be evaluated by a transplant center, as some people may not be healthy enough for transplant surgery.

While a transplant is a good treatment for kidney failure, it's not a cure. You need to take medicines daily so your body doesn't reject the new kidney. You also need to see your health care professional regularly.

Getting a transplant

Your health care professional will refer you to a transplant center for tests to see if you're healthy enough to receive a transplant. Living donors, such as family or friends, need to be tested to make sure they're healthy enough to donate a kidney.

If you have a living donor, don't worry about being a perfect "match." Today, innovations such as kidney exchanges allow transplant surgeons to get around incompatibilities and make many living donor transplants possible.

If you don't have a living donor, you'll be placed on a waiting list to receive a kidney. You'll have regular blood tests while you wait for a kidney. The center must have a recent sample of your blood to match with any kidney that becomes available. As soon as a kidney is available, you must go to the hospital to have your transplant. Donated organs need to be used in a specific amount of time or they may not be usable.

During surgery

Surgery usually takes three to four hours. The damaged kidneys are not usually removed.

If a family member or friend is donating the kidney, you'll schedule the surgery when it's best for you, your donor, and your surgeon. One surgeon will remove the kidney from the donor, while another prepares you to receive the donated kidney.

After surgery

Many people report feeling better right after having transplant surgery. For others, it takes a few days for the new kidney to start working.

You will probably need to stay in the hospital for several days to recover from surgery–longer if you have any problems. You'll have regular follow-up visits after leaving the hospital.

If you have a living donor, the donor will probably also stay in the hospital for a couple of days, although probably less time than you will.

Transplant rejection

Transplant rejection often begins before you feel any symptoms. Rejection occurs when the immune system attacks the "foreign" transplanted kidney.

The routine blood tests that you have at the transplant center will reveal early signs of rejection. You may develop high blood pressure or notice swelling because your kidney isn't getting rid of extra salt and fluid in your body.

If you think you may have transplant rejection, contact your health care professional immediately. Rejection can often be treated, but only if it is detected early. Your health care professional will treat early signs of rejection by adjusting your medicines to help keep your body from rejecting your new kidney. Rejection does not necessarily mean you will lose your transplant.

Additionally, when you're taking anti-rejection medicines, you're at a greater risk for infection.

Anti-rejection medicines can dull symptoms of problems such as infection. Call your transplant center right away if you aren't feeling well or have:

• a fever of more than 100 degrees
• drainage from your surgical scar
• burning when you pass urine
• a cold or cough that won't go away

Lupus patient shares organ donation experience with mother

Alison Lee was diagnosed with lupus at 16 years old.

Alison Lee is a fighter. She has fought lupus, kidney failure, and cancer—all in just 35 short years.

Alison was diagnosed with lupus at 16 years old. Lupus is a disease in which your immune system attacks your healthy cells and tissue by mistake. Lupus may affect the kidneys and can lead to kidney failure.

However, Alison didn't experience serious lupus symptoms until she was in her mid-20s, when she started to have anemia (or lack of red blood cells), shortness of breath, and heart issues.

At that point, she was living in New York City and doing things many other 20-somethings do: working, hanging out with friends, and enjoying life.

Kidney failure

But things got worse in 2014 when her lupus started to damage her kidneys. She remembers feeling fatigued and very weak.

"When going to dinner with my friends a few blocks away, I would need to stop and take a break and sit on a bench because I couldn't walk three blocks," Alison said.

She also noticed decreased urine output. Her kidneys started to fail. She remembers feeling fatigued and going in and out of the hospital.

"I would go through an entire day at work without having to pee at all. I knew something was going on," Alison said.

Finally, in 2014, she decided to leave her job because she felt so sick. In 2015, she started kidney dialysis because her kidneys were unable to work well enough to keep her healthy.

"Because my heart had been struggling for so many years, my doctors said it wouldn't be able to handle a kidney transplant," Alison said.

"Dialysis was really difficult for me. At the beginning it was like a full-time job because you need to drain and refill the fluid every four to six hours. It was difficult to have a normal life," she added.

However, the dialysis improved Alison's health dramatically.

Preparing for a transplant

After six months on dialysis, she was healthy enough for a transplant. She had a transplant evaluation and asked family members to be tested to see if any of them would be good potential donors.

Alison was one of the lucky ones when it came to finding a donor. Her mom, sister, and brother all offered to donate.

"Of course, my mom being my mom said she would donate," Alison said.

Her mom wouldn't have it any other way. "My mom is so selfless, and she has helped me throughout all of my health issues in the past," Alison added.

Despite her fears, Alison said the excitement about the future outweighed her concerns about the surgery.

"The whole transplant experience was straightforward and easy. The hospital wanted to make sure I understood everything that was happening with the transplant and also post-transplant," Alison said. "I was more excited about the prospect of the future than scared about the procedure."

After surgery, Alison woke up and had to pee a lot, which was a good sign. It meant her kidney was working well. Her blood work was also positive.

Alison's mom, who was in her sixties at the time, also did well. She was back up and helping take care of Alison during her recovery just three days after surgery.

A difficult recovery

While the transplant surgery was straightforward, Alison's recovery wasn't easy.

About a month after surgery, she discovered a lump growing behind her ear. She ended up contracting lymphoma, a cancer of the lymph nodes. While very rare, a drug Alison needed to prevent rejection of her transplant allowed a slow-growing lymphoma she had before the transplant to transform into a more aggressive lymphoma.

"It's not common, but I had some history of a slow growing lymphoma in my past, so they knew this was a risk. Coupled with my recovery from transplant, I also had to go through the biopsy and the chemo treatment that I did for about four months," Alison said.

Despite the difficult battle of recovery coupled with chemotherapy, Alison's positive attitude and family helped her each step of the way. An unexpected benefit from her chemo was decreased rejection of her transplanted kidney. "The chemo was surprisingly beneficial for my transplant. I was given lots of fluid which helped to keep the new kidney hydrated. Also, the chemo itself essentially killed my immune system, preventing it from attacking the new kidney," Alison said.

The next chapter

Alison is in remission but still deals with related health issues. She works closely with the Lupus Research Alliance, focusing on patient advocacy and sharing her story and message of hope with others. She recommends other people struggling with health issues find a support group or organization.

"It's good for me to interact with other lupus patients. It helps me to feel more comfortable with my disease," Alison said.

Alison also works part time and carves out time to travel and enjoy the little things. She recently traveled to Mexico for a yoga retreat.

"I think a positive attitude is really important," said Alison. "Even through all of this, I've never felt like I was dying or wasn't going to survive. Each issue just becomes another bump that I have to get through until things will get better."

If you want a kidney transplant, the process includes these steps:

• Tell your doctor or nurse you want to have a kidney transplant.
• Your doctor will refer you to a transplant center for tests to see if you’re healthy enough to receive a transplant. Living donors need to be tested to make sure they’re healthy enough to donate a kidney.
• If you don’t have a living donor, you’ll be placed on a waiting list to receive a kidney. You’ll have monthly blood tests while you wait for a kidney.
• You must go to the hospital to have your transplant as soon as you learn a kidney is available. If you have a living donor, you can schedule the transplant in advance.

Talk with your doctor

The first step is to talk with your doctor to find out whether you’re a candidate for a transplant. If you’re on dialysis, your dialysis team will also be part of the process. If you and your doctor think a kidney transplant is right for you, your doctor will refer you to a transplant center.

Get tested at a transplant center

At the transplant center, you’ll meet members of your transplant team. You’ll have tests to make sure you’re a good candidate for transplant.

Tests will include blood tests and tests to check your heart and other organs—to make sure you’re healthy enough for surgery. Some conditions or illnesses could make a transplant less likely to succeed, such as cancer that is not in remission, or current substance abuse.

You’ll also have tests to check your mental and emotional health. The transplant team must be sure you’re prepared to care for a transplanted kidney. You’ll need to be able to understand and follow a schedule for taking the medicines you need after surgery.

In a process called cross-matching, the transplant team tests the donor’s blood against your blood to help predict whether your body’s immune system will accept or reject the new kidney.

If a family member or friend wants to donate a kidney and is a good match, that person will need a health exam to make sure he or she is healthy enough to be a donor. If you have a living donor, you don’t need to be on a waiting list for a kidney and can schedule the surgery when it’s best for you, your donor, and your surgeon.

Testing and evaluation at the transplant center may take several visits over weeks to months.

Get on the waiting list

If your tests show you can have a transplant, your transplant center will add your name to the waiting list. Wait times can range from a few months to years. Most transplant centers give preference to people who‘ve been on the waiting list the longest. Other factors, such as your age, where you live, and your blood type, may make your wait longer or shorter.

A transplant center can place you on the waiting list for a donor kidney if your kidney function is 20 or less—even if you aren’t on dialysis. While you wait for a kidney transplant, you may need to start dialysis.

Have monthly blood tests

While you wait for a kidney, you’ll need monthly blood tests. The center must have a recent sample of your blood to match with any kidney that becomes available.

Have your kidney transplant

During kidney transplant surgery, a surgeon places a healthy kidney into your body. You’ll receive general anesthesia NIH external link before the surgery. The surgery usually takes 3 or 4 hours. Unless your damaged kidneys cause infections or high blood pressure or are cancerous, they can stay in your body. Surgeons usually transplant a kidney into the lower abdomen near the groin.

If you’re on a waiting list for a donor kidney, you must go to the hospital to have your transplant surgery as soon as you learn that a kidney is available.

If a family member or friend is donating the kidney, you’ll schedule the surgery in advance. Your surgical team will operate on you and your donor at the same time, usually in side-by-side rooms. One surgeon will remove the kidney from the donor, while another prepares you to receive the donated kidney.

Dr. Dorry Segev works with NIH to improve kidney transplant access across U.S.

Dorry Segev, M.D., Ph.D., pictured below, is working on multiple NIH-funded studies on organ transplantation.

Dorry Segev, M.D., Ph.D., is a leader in the field of organ transplantation. The Johns Hopkins University surgeon and research chair is working to improve transplant access and success for patients across the U.S.

Dr. Segev is currently working to address geographic disparities with kidney transplantation—making sure where you live doesn't impact your ability to get an organ. The research is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Dr. Segev's team is also working with the National Institute on Aging and the National Institute of Allergy and Infectious Diseases to expand organ donation to different populations, such as older patients and those with HIV.

He spoke to NIH MedlinePlus magazine about some of his recent research.

Who is a good candidate for a kidney transplant?

Anyone with kidney failure is a potential candidate for a kidney transplant. If you have kidney failure and can tolerate an operation and medicines to suppress your immune system—to keep your body from rejecting the new kidney—you can have a kidney transplant.

Many people with kidney failure on dialysis don't know about transplantation and don't realize they could be a good candidate.

On average, if you have a kidney transplant, you will double your remaining life expectancy compared to staying on dialysis. We've even shown substantial survival benefit and improvement in quality of life in older transplant recipients. Today, we're doing 10 times as many transplants in people over 65 than we did a decade ago. The outcomes are getting better every year.

When should a patient think about kidney transplantation?

When someone is heading towards kidney failure, even at stage 4 or stage 5 kidney disease, the default pathway is dialysis. But this is actually not the best pathway. In fact, we know that if you get transplanted before you even start dialysis, you'll have much better outcomes.

It's important for people who are heading towards kidney failure to prepare for transplantation. Find out as much as you can. Try to find a living donor. Take all the steps leading up to the transplant so that when you need the transplant, you're ready.

Can you tell us about the kidney transplant waiting list?

If you can't find a living donor, you are put on a list of more than 100,000 people across the country. Organs are distributed to patients based on a number of factors, like how long you've been on the list, your age, blood type, and where you live.

Here's the problem. There are some areas that have a high supply of organs and a low demand, and some areas with a low supply and a very high demand. For example, a dense urban area like New York City has a high demand, but low supply. A more rural area might have a low demand for organ donation (because there are fewer people) but have a high supply since high-speed motor vehicle crashes are often a major source of organ donation.

That means that where you live may determine if you get an organ on the waiting list, unless you're able to travel to other parts of the country. That can be both expensive and physically challenging for patients.

Can you tell us about your NIH research on improving transplant access?

The research we're doing, funded by NIDDK, is trying to address these geographic disparity issues by changing how the organ distribution system works in the U.S.

You might look at it in simple terms as "redrawing the map." It uses the same science that people use to organize school and voting districts. It helps equalize the distribution of supply and demand for organs so that where someone lives doesn't prevent them from receiving an organ.

We hope to better equalize access and, as a result, reduce organ discard and save lives overall.

This goes hand in hand with the effort to improve donor rates in the U.S.

What advice do you have for people interested in donating a kidney?

The advice I would give people is to learn as much as they possibly can about the actual risks of donation.

The risk of dying from donating a kidney is 3 in 10,000. That's incredibly safe. And the worries about kidney failure down the road after donating a kidney are much lower than you would think.

In 15 years after you have donated a kidney, on average in the U.S., the risk of getting kidney failure is about 30 in 10,000.

We're also using NIDDK funding to research health and wellness outcomes for donors. We're looking for ways to better counsel people on donation and monitor their health post-surgery.

What are some common misconceptions?

One is "I'm too old to donate a kidney." We're seeing more people donate in their 60s and 70s; personally, I operated on an 81-year-old who donated a kidney. In fact, it's almost safer to donate in your 60s and 70s than in your 20s. In your 20s, we don't know what's going to happen to you medically for the rest of your life.

Another misconception is that you have to be a match to be a living donor.

We used to say if you have a compatible living donor you can have a transplant. Today we say if you have a living donor you can have a transplant. Our ability to get around those blood incompatibilities has changed dramatically in the last 15 years.

Through kidney exchange and what's called kidney desensitization, we are often able to work around the incompatibilities or address them head on.

Something else that's important to know is HIV shouldn't stop you from receiving or donating an organ. These days we give transplants to hundreds of people who have the disease and there is a huge survival benefit from transplantation in HIV.

It's also a misconception, even in the HIV community, that you can't be a donor if you have HIV. We wrote a bill back in 2013, signed by President Obama, that now allows us to use those organs for people who have HIV and are on the waiting list, which is really important.

A successful transplant involves working closely with your transplant team. Members of the team include:

• You—you are an important part of your transplant team.
• Your family members—this may include your spouse, parents, children or any other family member you would like to involve.
• Transplant surgeon—the doctor who places the kidney in your body.
• Nephrologist—a doctor who specializes in kidney health and may work closely with a nurse practitioner or a physician’s assistant.
• Transplant coordinator—a specially trained nurse who will be your point of contact, arrange your appointments, and teach you what to do before and after the transplant.
• Pharmacist—a person who tells you about all your medicines, fills your prescriptions, and helps you avoid unsafe medicine combinations and side effects.
• Social worker—a person trained to help you solve problems in your daily life and coordinate care needs after your transplant.
• Dietitian—an expert in food and nutrition who teaches you about the foods you should eat and avoid, and how to plan healthy meals.

Your transplant team will be able to provide the support and encouragement you need throughout the transplant process.

Many people report feeling much better right after having transplant surgery. For some people, it takes a few days for the new kidney to start working. You probably will need to stay in the hospital several days to recover from surgery—longer if you have any problems after the transplant. You’ll have regular follow-up visits with your nephrologist after leaving the hospital.

If you have a living donor, the donor will probably also stay in the hospital for several days. However, a new technique for removing a kidney for donation that uses a smaller cut may make it possible for the donor to leave the hospital in 2 to 3 days.

Before you leave the hospital, you need to learn how to stay healthy and take care of your donor kidney. You will have to take one or more anti-rejection medicines—also called immunosuppressants. Without medicine, your immune system may treat your donor kidney as foreign, or not your own, and attack your new kidney. Anti-rejection medicines may have side effects.

You may also need to take other medicines—for example, antibiotics to protect against infections. Your transplant team will teach you what each medicine is for and when to take each one. Be sure you understand the instructions for taking your medicines before you leave the hospital.

Blood tests help you know your donor kidney is working. Before you leave the hospital, you’ll schedule an appointment at the transplant center to test your blood. The tests show how well your kidneys are removing wastes from your blood.

At first, you’ll need regular checkups and blood tests at the transplant center or from your doctor. As time goes on, you’ll have fewer checkups.

Your blood tests may show that your kidney is not removing wastes from your blood as well as it should. You also may have other symptoms that your body is rejecting your donor kidney. If you have these problems, your transplant surgeon or nephrologist may order a kidney biopsy.

The donated kidney may start working right away or may take up to a few weeks to make urine. If the new kidney doesn’t start working right away, you’ll need dialysis treatments to filter wastes and extra salt and fluid from your body until it starts working.

Other problems following kidney transplant are similar to other pelvic surgeries and may include

• bleeding
• infection, especially a bladder infection
• hernia
• pain or numbness along the inner thigh that usually goes away without treatment

Transplant rejection is rare right after surgery and can take days or weeks to occur. Rejection is less common when the new kidney is from a living donor than when it’s from a deceased donor.

Transplant rejection often begins before you feel any changes. The routine blood tests that you have at the transplant center will reveal early signs of rejection. You may develop high blood pressure or notice swelling because your kidney isn’t getting rid of extra salt and fluid in your body.

Your health care provider will treat early signs of rejection by adjusting your medicines to help keep your body from rejecting your new kidney.

Transplant rejection is becoming less common. However, your body may still reject the donor kidney, even if you do everything you should. If that happens, you may need to go on dialysis and go back on the waiting list for another kidney. Some people are able to get a second kidney transplant.

Seek medical care right away

When you’re taking anti-rejection medicines, you’re at a greater risk for infection. Anti-rejection medicines can dull symptoms of problems such as infection. Call your transplant center right away if you aren’t feeling well or have

• a fever of more than 100 degrees
• drainage from your surgical scar
• burning when you pass urine
• a cold or cough that won’t go away

Some anti-rejection medicines may change your appearance. Your face may get fuller, you may gain weight, or you may develop acne or facial hair. Not all people have these side effects.

Anti-rejection medicines weaken your immune system, which can lead to infections. In some people over long periods of time, a weakened immune system can increase their risk of developing cancer. Some anti-rejection medicines cause cataracts, diabetes, extra stomach acid, high blood pressure, and bone disease.

When used over time, these medicines may also cause liver or kidney damage in some people. Your transplant team will order regular tests to monitor the levels of anti-rejection medicines in your blood and to measure your liver and kidney function

You have more choices about what to eat after you receive a kidney transplant than you would if you were on dialysis. However, you will need to work with a dietitian to develop an eating plan that can change in response to your medicines, test results, weight, and blood pressure.

Medicare, the Federal Government health insurance program, will pay for transplant and care for 3 years after the transplant. Medicare will also pay for your donor’s surgery and his or her care.

Paying for medicines

Medicare and private insurance may help pay for your medicines. Additionally, drug companies give discounts to people who can show that they can’t afford to pay for their prescriptions. Talk with your transplant social worker to find out what resources may be available to help you pay for your transplant.

If you've had a kidney transplant, chances are you'll want to return to a normal life as soon as possible. And most people can live active lives after having a kidney transplant. The key is moderation. Your body will require time to heal and adjust to your medications, which may have side effects. Exercise is important to regaining and retaining your health, but consult with your doctor about what level of activity is right for you. You'll need to rest, too, by taking naps and pacing your activities. By living a healthy lifestyle and with the support of family, friends, and healthcare practitioners, chances are good you'll have the new life you want.