This is an opinion column by Niagara Health nephrologist, Dr. Kathleen Quinn, originally published in the Niagara dailies.
I have had many rewarding moments as a nephrologist, but some of the most meaningful came during my fellowship in kidney transplantation. That experience changed how I think about kidney failure and how we talk about options with patients and families.
Across Canada, more than 50,000 people live with advanced kidney disease. About 30,000 depend on dialysis to survive. In Niagara, roughly 400 people are on dialysis.
Dialysis is life sustaining, but it is hard. Treatments are long and frequent. Many patients feel exhausted after each session. Over time, dialysis affects physical health, mental health and daily life. For patients who are eligible, kidney transplantation remains the best treatment. It offers longer survival and a better quality of life.
What a kidney transplant involves
A kidney transplant is a surgical procedure in which a healthy kidney from a donor is placed into the abdomen of a person with end stage kidney disease.
Normally, kidneys sit toward the back of the abdomen. During transplant surgery, the donor kidney is usually placed in the front of the abdomen near the pelvis. Most patients keep their original kidneys, which means transplant recipients technically have three kidneys, even though only one is functioning well.
Kidney transplantation in Niagara
Over the past two years, Niagara Health has assessed 57 patients for kidney transplantation. During that same time, 67 of our patients on the waiting list received a kidney transplant.
Before someone moves forward, we assess whether transplant surgery and the required medications are safe for them. Significant frailty, active cancer or serious heart disease can be barriers.
Eligible patients complete bloodwork, imaging such as ultrasounds and a cardiology assessment. Our transplant nursing team gathers this information and sends it to a transplant centre. For Niagara patients, surgeries are performed in Hamilton, Toronto and London. Teams at those centres review each case and decide whether the patient can be listed.
What it means to be listed
Being listed means a patient could receive a call at any time telling them a kidney is available and they need to come to hospital for surgery.
Across Ontario, about 1,400 people are waiting for a kidney transplant. The usual wait time for a deceased donor kidney is three to six years. Living donor transplants happen much sooner.
Living kidney donation
Many people are surprised to learn that living kidney donation is possible. If you have two healthy kidneys, you can donate one. A detailed medical assessment looks at your current health and your lifetime risk of developing kidney disease.
Eligible patients are often people who do not have diabetes, uncontrolled blood pressure, or significant kidney problems. Donors need to know their blood type, since donor and recipient usually share the same blood type, although exceptions exist. Additional testing confirms compatibility.
Living donation does not require a family relationship. Kidneys can be donated to friends or given altruistically to someone the donor has never met.
Kidneys from living donors typically function for 15 to 20 years.
In some cases, transplant can happen before dialysis is ever needed. This is known as a pre-emptive kidney transplant.
Deceased kidney donation
Deceased donation is a remarkable gift. Each potential donor is carefully reviewed to ensure the kidney is healthy enough for transplant. Kidneys from deceased donors usually function for 10 to 12 years.
In Ontario, patients generally need to start dialysis before being eligible for a deceased donor kidney transplant. While the testing process can feel long, it does not delay access. Time on dialysis matters. The longer someone has been on dialysis, the higher they move on the transplant list.
Anyone interested in organ donation can register online at beadonor.ca/register.
As a nephrologist, I see what transplantation gives patients: time, energy and independence. Understanding kidney donation is one way we can support people in Niagara who are waiting.
