Dialysis or transplant? During kidney failure, know your options

When your kidneys are no longer working effectively, waste products and fluid build up in the blood. When kidneys fail—often because of diabetes, high blood pressure or hereditary conditions—the damage can spread to other parts of the body.

If you’re living with kidney failure, or end stage renal disease, it’s important to understand your options so you can look forward with confidence. Dialysis and kidney transplantation are the most common treatments for severe kidney failure. Here’s what to know about each.

Kidney transplant

A kidney transplant is often the best option for many people experiencing kidney failure. Unfortunately, there is a shortage of organs available for donation. Many people who are candidates for kidney transplantation are put on a waiting list and require dialysis until an organ is available.

A kidney can come from a living relative, a living unrelated person or a deceased donor. Because only one kidney is required to survive, living kidney transplants are a great option. Organs from living donors generally function better and longer than those from deceased donors.

About 60 years ago, the first living kidney transplant was performed in Boston between identical twins. Since then, more than 175,000 people have received kidneys from living donors, most of them blood relatives. In 2022, nearly 3 out of 10 kidney transplants were living donor kidneys.

According to the Living Kidney Donor Network, some of the advantages of living donations include: • Living donation drastically reduces time spent on the national waiting list. The average waiting time for a deceased donor kidney is four to six years.

• Short- and long-term survival rates are significantly better for transplants from living donors than transplants from deceased donors. On average, living donor recipients live five years longer than those who received an organ from a deceased donor.
• Living donor kidneys usually start functioning immediately, compared with deceased donor kidneys that in rare cases can take as long as a few weeks to start functioning.
• Health deteriorates the longer someone remains on dialysis, and a living donor recipient may be able to avoid dialysis altogether.
• The surgery can be scheduled at a mutually agreed upon time rather than performed on an emergency basis.

Donors should be between ages 18–65 with two normal kidneys. The donor’s medical expenses typically are covered by the recipient’s insurance.

Steven Hays, MD, medical director of hemodialysis and renal replacement therapy and the living donor kidney program at Baylor University Medical Center at Dallas, said within their program, about 1 out of every 4 transplanted kidneys is from a live donor.

Dialysis

So, what if your care team recommends dialysis? Dialysis takes over a portion of the function of the failing kidneys to remove the fluid and waste products. A healthy kidney can remove fluid and waste 24 hours a day, but dialysis can only do 10-15% of what a normal kidney does.

While kidney transplantation is a more complete solution, dialysis is often a helpful short-term treatment, especially for those awaiting a kidney transplant. Dialysis can also be a good option for people with acute kidney failure who may just need dialysis until their kidney function improves.

If a transplant may be on the horizon for you, according to Dr. Hays, it’s a good idea to start going down the path of getting a transplant before having to go on dialysis. People who have been on dialysis for longer than six months have a higher likelihood of the kidney transplant not lasting as long, not working immediately or having the body reject the new organ. These risks rise with the length of time on dialysis—so by starting the process sooner, you can give yourself a head start.

Your next steps for kidney failure treatment

Whether transplant or dialysis, or a combination of the two, is the right choice for you, know that you’re not alone in your kidney failure journey. Our team is here to support you and your loved ones through each step, from diagnosis to treatment and beyond.

Learn more about living kidney transplants today.