One potential treatment option when a living donor is involved is a preemptive transplant. This is where you get a transplant before going on dialysis or, in some cases, shortly after. Generally, you won’t be a candidate until your kidney disease has at least progressed to stage 3. Then, you and your donor would go through a quickened evaluation process and set a date for surgery before your kidneys completely fail or shortly after. Preemptive transplantation takes place in 17% of all transplants. The surgery is not for everyone, and some potential barriers include:
- Some patients believe that dialysis is necessary before transplant
- Learning about transplant after dialysis has started
- Not knowing that a living donor is an option
- Discomfort in asking a loved one to be a donor
- Medicare coverage as a primary payer for those who are under 65
- Late referral to a nephrologist
- Variability in transplant center selection criteria across the country
Broad access to a preemptive transplant seems to depend heavily upon education, financial resources and access to a living donor. Benefits of preemptive transplant are mixed, however, data seems to be trending towards an overall benefit in organ and patient survival. Studies have shown up to a 52% reduction in the first-year rate of transplant failure and increased survival of the organ with a half-life of 16.9 years compared to 8 years. Opponents of such findings say that these numbers are artificially improved because of advances in transplant survival rates overall and that other factors such as health status of those that are now getting preemptive transplants are making the numbers look better compared to a broader population. No matter if researchers disagree with increases in organ and patient survival, they still agree that avoiding time on dialysis has benefits. To learn more about this as an option, speak with your healthcare team, and they will be able to share additional details.
 Jay, Colleen L., Dean, Patrick G., Helmick, Ryan A. Reassessing Preemptive Kidney Transplantation in the United States: Are We Making progress? The New England Journal of Medicine.
100:1120-1127. 2016. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989865/